Obama remains committed to health reform, White House official tells wonks

Lambrew President Obama remains committed to comprehensive health care reform in 2009 and believes the declining economy emphasizes its urgency, a top White House official told hundreds of health policy experts Monday in Washington D.C.

“The current economic crisis has really highlighted the problems and put them under fluorescent lights," said Jeanne Lambrew, deputy director of the newly created White House Office of Health Reform.

The Academy Health conference is probably the wonkiest of meetings on the increasingly crowded health reform conference circuit. University PhDs and private sector policy analysts are here to discuss and assess the impacts of reform.

Lambrew provided a glimpse of the President's health agenda in the economic stimulus package, SCHIP and long-term reform efforts. She rapidly reviewed the litany of well-known health care problems: costs, access and quality, and then spoke specifically about health care funding in the stimulus bills working their way through the House of Representatives and the Senate.

About one in five dollars of the stimulus package will go toward health care, nearly matching the one in five dollars of GDP spent on health care.

As previously reported, the roughly $150 billion in proposed funding can be broken into three main categories:

  • Immediate expansions to protect people who are losing their jobs from also losing their health insurance by increasing federal Medicaid match, subsidizing COBRA premiums, and allowing the newly unemployed temporarily to buy into state Medicaid coverage.
  • "Downpayments" on longer-term reforms and job creation efforts in information technology, comparative effectiveness research, and health workforce expansion grants.
  • Funding for health prevention services, such as tobacco and obesity prevention programs.

As for long-term reform, Lambrew reiterated Obama's commitment to offering people the option of buying into a public plan. She left it open as to whether this would be a Medicare-like single-payer plan or something more like the options currently offered to federal employees.

This aspect of the reform has already drawn the most criticism and raised alarm among conservatives, who consider it a step toward government-controlled insurance. Lambrew, however said that Obama believes in choice.

"If we really do believe in competition, why not give the public plan a chance?" she said.

Afternoon update:

The business perspective on reform

Peter Lee, the Pacific Business Group on Health's director for national health policy, emphasized employer's desire to move toward a performance-based, high value health care system.

To him, that means greater transparency on costs and quality, comparative effectiveness research, comparative information on clinician performance, payment reform, health system transformation and emphasis on prevention and wellness. That's a tall order, but his bottom line was that health costs are hampering American businesses' ability to compete globally and the value for money spent is far from optimal.

A good starting place, Lee said, is ensuring that everyone has health insurance coverage. Safeway CEO Steve Burd echoed that. Having 47 million uninsured people, he said, is a great inefficiency borne primarily by the employers who provide health coverage.

Moving away from a fee-for-service payment system is a must, as is balancing the board of physicians who advice Medicare on reimbursement, Lee said. Currently, it's dominated by physician specialists whose preference for technical interventions over primary care services is obvious in the current payment system, he said. Lee wants payers to be part of that decision making process.

Comparative effectiveness research on the horizon

The afternoon conversation moved to whether costs should be part of comparative effectiveness research. The payers want costs included. The pharmaceutical and device industries don't.

"To have comparative effectiveness research not used and to not consider costs is irresponsible from a patient’s and an employer’s point of view," Lee said.

Kathy Buto, vice president for health policy and government affairs at Johnson & Johnson, said the idea of having a centralized government agency doing comparative effectiveness research and including costs is scary.

“Cost-effectiveness analysis is used by countries to limit coverage of treatments – and is a poison pill,” she said.

Lambrew spoke briefly this morning about the $1.1 billion in the stimulus bill to fund comparative effectiveness research. She said lawmakers from both sides of the aisle recognize the need for better evidence to guide health decisions and there is strong bipartisan support to fund this research.

The legislation would allow for gathering information on costs but prohibit Medicare from using it to determine coverage. At this point, she said, the goal is to create legislation that allows for the maximum amount of flexibility in design and scope of the research.

Mark Gibson, of the Center for Evidence-based Policy at Oregon Health and Science University, spoke about how states are already using comparative and cost-effective research to make policy decisions.

He got his start in state health policy 20 years ago, during Oregon’s infamous Medicaid experiment to expand care to more people by limiting services based partly on their cost effectiveness. Gibson admitted to feeling a sense of déjà vu, particularly over the rising alarm about the prospect of rationing health care.

“At some point, we’re going to have to realize that we can’t do everything in the health care system for everyone who needs it or wants it,” he said.

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  1. Limo Divers Protest Medicare Mediciad Reform Cuts, It’s rumored this issue could become part of the Tea Party movement. AmeriChoice Health is also rumored to take a position on this reform. Recirculate those tax dollars? Help keep limo drivers working, benefits flowing and overpaid tax dollars remain in abuse.
    Medicare.gov as well as other Federal agency’s encourage you to report any fraudulent activities, yet, the same government agencys were notified the way this company does business yet did nothing. Three years ago they were reported to these Federal agency’s and as of todays date not only were they allowed to continue doing business but were never charged once. Protected vendor status sure, politics sure,limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat existed. Even with the vast changes in the laws and budgets,a hands off policy remains, you tell me what’s wrong with this picture? The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money to pay for bribes and kickbacks, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal government. Should your tax dollars be held to a higher standard? Should the government agencys responsible for there review be held to that same standard?Should the IRS audit their corruption? Why has this company not been charged? How long can the buck be passed here in more ways then one? Hey, it’s your tax dollars don’t complain now.. then don’t complain later on…
    ps… I know times are tough for a lot us, but it would be great to have a free limo to go to the Doctors, Pharmacy, Movies, Grocery shopping, and given free tickets for the movies. Offered soda, pop corn and hotdogs, as well as have them receive free coupons for Grocery items……Kind of makes you wish you also had Medicare and Mediciad right?

  2. Fried Chicken? Mediciad Inducements?
    The 101 Dumbest Moments In Business 2003 EDITION Whiffed pitch No. 6: blatant stereotyping. By Mark Athitakis April 1, 2003 (Business 2.0)– GRAND PRIZE WINNER, DUMBEST MOMENT OF 2002 Which leads to the question, Who is Chicken Man? & Why were whole fried chickens selected?
    In September, insurance company AmeriChoice brings trucks to blighted neighborhoods in New York City and gives away coupons for “free chickens” as an incentive for the underprivileged to switch their Medicare coverage. New York state senator Carl Kruger files a complaint with the state attorney general. The 101 Dumbest Moments In Business 2003 EDITION – April 1, 2003 Apr 1, 2003 … Just don’t tell him about the “Chinese health balls.” ….. In September, insurance company AmeriChoice brings trucks to blighted … New York state senator Carl Kruger files a complaint with the state attorney general….. Falling on his sword, Welch announces he’ll give up most of the perks,…2009 and 2010 $120,000 from your tax dollars.
    Chicken Feed? Chicken Pox?
    Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools. These checks came from AmeriChoice Health and on the surface seems like fine gifts. Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share or induce its share of the market place. This is not allowed as a use of your taxpayers dollars, yet it happens.What does it really cost the City of Philadelphia to receive this money? Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that? PS… Did the Mayor send for Chicken Man or was he approached by Chicken Man? The Mystery Widens! Can Chicken Man save the Liabraries?
    Dirty Birds? Chicken Wings Take Flight?
    CEO of AmeriChoice Health Bolts.. Was that Chicken Man? John J. Kirchner – Director, Operations John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations. Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009.
    Chicken Gate Returns? Bad Eggs?
    Will this mystery man or woman or chicken ever be caught? Will the “secret eggs” given out to housing authority officers Clinics, Doctors and whoever, make it into through that crispy crust prepared by their Home Office Line Chefs?. Will the Doctors who collected all those extra eggs for sharing thier patients recipes with the Home Office Line Chefs ever really be rewarded? Will the Great Head Chef Chicken Man or whomever that directed and approved all to avoid, overlook the rules, laws and regulations Menu, ever be really compensated for their true worth or will Salmonella remain the dish served for Medicare and Mediciad Industry.
    PS Is the Chicken Man a Blues Brothers Wanna B??? HEALTH INSURANCE COMPANY PROFITS IN 2007:A Whole lot Of Chicken UnitedHealth Group —$ 4.654 BILLION. UnitedHealth Group owns, AmeriChoice Health.

  3. National Health Insurance Reform in America
    President Obama’s health care reform bill is to be taken very seriously. Americans can’t sit by and hope things work out for the best. I agree that America needs health reform, currently over 15 percent of our nation is uninsured and far more are under insured. This is the effect of America having the highest health care cost than any other country in the world. The Obama Plan promises that all we will be offered affordable health care regardless of pre-existing conditions, and guarantees insurance renewals. While this sounds great, there is far more in the reform than simply giving us health care at rates we can afford. America needs a change in the health care system, but Obama’s Plan falls short of being in the best interest of our nations people.

  4. I would like to propose a bill to do away with free government employee health care. Why should federal and state employees get free health care included in with their jobs, as a normal part of their package of benefits, when so many of them are saying they are against free health care?
    There is no reason that they should have healthcare benefits, at this time, paid for from the taxes from the rest of the U.S. citizens — many, who after paying taxes, will not get the same benefits.
    If so many in the Senate and the House are against healthcare reform, they should be 100% for giving up their own healthcare packages, as well. Since they want many in the U.S. to buy private health insurance, they should have to buy private health insurance, too.
    They should have to pay, like everyone else, for their insurance. We should not be giving government employees free health care, especially since so many seem to be against this type of benefit.
    Many Republicans in government, now, don’t feel that other U.S. citizens should not have free health care. We have seen many oppose this. They feel that we can’t afford it.
    Well, we can’t afford to pay for their health care either. Can we?
    Therefore, I would like to propose a bill to do away with free government healthcare benefits for federal and state employees, as well, who are non-military government employees.

  5. The Cults, Greedy, Racial Profiler’s and Predjudice will always go along with their Kind! No matter if it right or wrong. They are as THREE MONKEYS SITTING ON A STUMP…. Saying SEE NO EVIL..HEAR NO EVIL..SPEAK NO EVIL..and a blind man, a deaf man and dumb man has more sense then they do! And this is FOOLISH and PROPHECY! And as MARTIN LUTHER KING would sum it all up as them HAVING NO “CHARACTER OR CHARISMA”!
    I am saying support Health Care Reform and Reject Racial and Predjudice Profiling toward’s the Minorities and the Poor! Martin Luther King’s “I HAVE A DREAM” is still yet alive..Even thou he was Murdered and he is resting in his grave. Thank you God for President Barrack Obama!

  6. I was diagnosed with multiple sclerosis THIS YEAR. My injections cost over $2000 MONTHLY. Now that I have a PRE-EXISTING CONDITION, – will you, the PROTESTERS, PAY for the medicine I will NEED for the REST OF MY LIFE if I want to further my career at a different company?!!
    Private insurance penalizes those with chronic health conditions!!! I pay taxes. Why should I not be able to get health insurance?!? If YOU will not help me pay for my lifelong medical condition, then you should keep your insurance as Obama has said SEVERAL TIMES, and I should be able to get help through the reform Obama is pushing.
    YOU PROTESTERS are basically saying that anyone with a chronic condition has to stay at the job they currently are with. I shouldn’t be punished into staying at my current job just because IF I LEAVE IT I WONT BE ABLE TO GET HEALTH INSURANCE BECAUSE NOW I HAVE A PRE-EXISTING CONDTION.

  7. I am a small Business Owner and because of the new Cobra Rule where even if the employer cannot afford to pay the COBRA Health Insurance for a terminated employee he still has to pay for it and wait for a year for the govt to refund so the best thing to do is not hire a new employee.Isn’t that sad that the govt is passing bills that are preventing people from getting jobs. Why can’t our Government wake up.

  8. Please President Obama and all our US Senators stop this health care bill. You are hurting small business that is the back bone of our great nation.

  9. how many people can 12 billion dollars cover every year? That is what the top 7 insurance company’s made in 2007 profit after awarding all their fat bonuses to executives. This is where reform should start then tort reform must follow and then open competition among insurers

  10. Very interesting post and comments. I have written up many of these ideas on my site about health reform and I think anybody interested in this blog will find the information there very salient. Many of these ideas are things I am studying right now at The Wharton School as an MBA, although I combine thoughts as a practitioner in industry as well.
    Please do check it out!
    All ad profits go to fight ulcerative colitis!

  11. What is truly scary is that this blog exists. Anybody that’s ever dealt with TriCare as the military health care insurance program knows that government managed health care, even on a small scale is a disaster. We’ve been waiting since October to get a surgery that we’ve needed in our family. We knew it, and some people around us knew it but by the time we weaved through the minefield of government bureaucrats who enjoy their power the months kept creeping by. Now the problem has developed into a much more dangerous situation due to lack of initiative by paper pushers who just don’t care. Now that big brother is watching, let the protests continue, do the right thing by canning Medicare and Medicaid, limit rewards from lawsuits and let medical care be competitive and out of governments hands. Anything else is foolish, ask the Brits and Canadians who all come here since their systems are broken.

  12. Access Pubmed, then enter “antidepressants” and “cancer.” You will find more than 60 articles showing that antidepressants kill cancer cells, inhibit their proliferation, convert multidrug resistant cells to sensitive, protect nonmalignant cells from damage by ionizing radiation and chemotherapy, and target the mitochondria of cancer cells, while sparing those of healthy ones. This innovation alone could make a vast contribution to health reform, provided the resistance of vested interests is overcome by political intervention.

  13. While I believe a system like universal health care would be great in certain aspects I still believe that it is not government’s responsibility to provide healthcare. It is unfortunate that the American Dream no longer exists and people have this new found sense of entitlement. The great men who laid the ground work for this country and got it flourishing would roll over in their graves if they where able to see the US today.

  14. I hope President Obama will take a close look at the health insurance companies. The health insurance companies have played a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us, workers and employers alike, face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.
    1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
    2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
    3. Aetna Inc. — $ 1.831 BILLION
    4. CIGNA Corp — $ 1.115 BILLION
    5. Humana Inc. — $ 834 million
    6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
    7. Health Net — $ 194 million
    The huge insurance company profits—BILLIONS EACH YEAR—could be used to provide quality healthcare for millions of people. We need to get the insurance companies OUT of healthcare, so patients can receive the care they need and physicians can be paid adequately for their work.
    The only way that we all will have affordable, quality care is to get the insurance companies OUT of healthcare! We can no longer tolerate a healthcare system where those without medical expertise or genuine interest in our patients’ health have absolute control, and where profits are made by denying care.
    FOR MORE INFORMATION, SEE: http://www.insurancecompanyrules.org/learn_more/the_roster/

  15. It will be interesting to see how Obama’s health care reform plays out. Cobra is so expensive what good will it do to extend it?

  16. COBRA is one of those financial items that people don’t understand. For those who do, they forget that even with COBRA, their healthcare costs are going to be quite large. This is why an emergency fund is so important.

  17. “The end result? Simplified billing codes and forms that save time, and thus money.”
    And the Utah Legislature is something like 75% Republican! Go figure.

  18. Nate,
    My apologies for not seeing your question earlier. Let’s see…
    The Utah Legislature — I don’t think they’re the people who created “the mess” but I’m all ears if you have an argument to the contrary — passed a law a while back that created a *process* for simplifying billing codes and forms. As I understand it, insurers, academicians, consumer advocates, and others engaged in the process.
    The end result? Simplified billing codes and forms that save time, and thus money. What works at the state level should minimally be considered at the federal level, no?

    My Rx?- More incentives for-
    -primary care
    -chronic disease mgt
    -home health care
    -public health
    -ethical and compassionate rationing (usually at end of life)
    Dr. Rick Lippin

  20. Both the UBS Healthcare Services conference and the annual BIO CEO meeting will descend on New York on Sunday 8th through mid-week. Under one roof will be the more than 1,500 portfolio managers, analysts, and investors at UBS and over 800 investors and close to 200 companies at BIO CEO.
    UBS features presentations by senior executives from firms representing acute care, alternate site, distribution, healthcare REITs, information technology, laboratory services, long-term care, managed care, pharmaceutical services, staffing, and other sub-sectors. I could not find a list of presenters for this year but individual companies are issuing press releases so you can track attendees using a Google news search
    BIO CEO features issue-oriented plenary sessions, educational sessions focused on hot therapeutic areas and key business issues, company presentations, one-on-one meetings, and networking opportunities. Presenting companies are listed on the BIO CEO website.
    Importantly this year, the BIO folks have also invited 12 patient advocacy and disease research groups to present.
    That’s a lot of movers and shakers in one place at one time – the money, the patients, the delivery technologies, and the medicines of the future!
    Now if only we could get Obama’s healthcare team and new FDA commissioner to work the lobby we could get a lot done in short order!

  21. Steve,
    “And then there’s another form of waste that I hope to see the Obama/Kennedy/Baucus plan tackle, and that’s the complicated insurance billing forms and codes that force docs and staffs to spend too much time doing paperwork.”
    Do you honestly expect the politicians that created the forms and codes to come up with something easier and more efficient? Why do you look to the people that created the mess to clean it up?
    “Besides pushing paperwork, denials, record profits and incredible bonuses for their executives, what exactly do the insurance companies produce? How many lives have their employee physicians saved or how many ground breaking/money saving compounds have their clinical research people discovered?”
    How many lives have been saved by the postal service? Have banks discovered even one ground breaking compound? Have landlords contributed to the bettermeant of the nations health?
    You seem to be confused about the role of insurance. Insurance companies are suppose to financially protect people from a large or unexpected expense related to their health. In actuality they faciliate the financing of healthcare delivery. Just as, I assume and hope, you wouldn’t expect the mailman the picks up and delivers claims or the bank the transfers the money between parties to be perforing research or delivering care why do you have these expectations of insurance companies?
    It’s highly hypocritical of Obama to appoint him, but he is the 17th or 18th lobbyist be any measure but Washington’s. 2 weeks in office he has already gone back on his word more times then most politicians do in an entire career.

  22. How can the administration support the Daschle candidacy when he’s clearly tied to the health Insurance business which should be at the focal point of reform? He’s been lobbied for years by the Health Insurance business and owes them a great deal. This is hypocrisy at its worse. Obama talked about ethics and transparency. Daschle’s tax problems are not nearly as problematic as his relationship with the insurance companies that have sent health care pricing into a tailspin since the 1970’s. Besides pushing paperwork, denials, record profits and incredible bonuses for their executives, what exactly do the insurance companies produce? How many lives have their employee physicians saved or how many ground breaking/money saving compounds have their clinical research people discovered? The US is a leader is Science and Medicine for the world. You would never know this by talking to health insurance representatives or their mouthpieces, like Daschle. Shame on you Obama. Not only have you broken several of your campaign promises, but now you’re pushing a former colleague who will continue to destroy innovation and the future of medicine for this country.

  23. The funding for tobacco and obesity prevention should be getting far more attention (and funding) than the other components mentioned in the plan.

  24. It’s indeed about waste. Much of the overtreatment/overtesting that rbar mentions is fueled by the fact that money was spent up front to invest in the technologies. And then there’s another form of waste that I hope to see the Obama/Kennedy/Baucus plan tackle, and that’s the complicated insurance billing forms and codes that force docs and staffs to spend too much time doing paperwork.

  25. Rick,
    It depends on the definition what you’d consider R and what W.
    Aggressive treatment in terminal illness and/or dementia is, in my opinion, W. Rationing (by my terms) would mean: this procedure/drug is too expensive (or not worth the small benefit), and therefore it is not covered/not available. Too some degree, the terms are interchangeable. So maybe what you’d call rationing, I would just call cutting waste and correction of costly practice variation.
    And yes, Joel, part of this should be tort reform. I still cannot get over the fact that a colleague of mine ordered a neck MRI in a patient who had a fall … not only did this patient have no signs of cervical myelopathy whatsoever, but also was she in her mid eighties and NH bound for significant dementia. I am afraid that the PH academia largely fails to understand the significance of defensive medicine, reason for this probably being that this is a phenomenon that is all but impossible to measure.

  26. The Big Fix in Health Care
    If you’re like me, you’re wondering what the Big Fix for the economy and health care is going to be. David Leonard, an economics columnist and staff writer for the New York Times, thinks he knows. It’s going to be government investment in medicine, education, and healthcare.
    In the case of health care, the big fix will focus on Medicare, the biggest payer that health plans always follow.
    Obama will, have government,
    One, initially invest heavily in EMRs for doctors and hospitals.
    Two, within five years, restrict Medicare payments only to those doctors and hospitals who have EMRs.
    Three, use Medicare-acquired data, to pay doctors and hospitals, at the prevailing rates in the least expensive part of the U.S., e.g. the same in urban New Jersey as in rural Minnesota.
    Four, stop or reduce Medicare payments for expensive treatments that don’t work, as determined by a federal comparative outcome institute using EMR-generated Medicare data.
    There you have it, a conprehensive Medicare EMR data-driven solution. I may be overstating this, but I don’t think so. It’s simple, it’s straightforward, and it cuts the legs out from beneath hospitals and doctors.

  27. rbar
    Have you checked Medicare expenditures in the last months of life?
    Will get much worse as 80 million US boomers hit Medicare.
    That is why we need to face up to “R”= rationing-but it needs to be ethical and always compassionate
    You ARE correct about waste= “W”
    Rick Lippin

  28. To remove waste out of the system, there needs to be Tort Reform. Lets start at the heart of defensive medicine and get systematic change that makes a real difference.

  29. I am not sure how early the R word needs to come up, because we first have to tackle the W word (waste). We (as physicians) are overtesting and overtreating big time,which is related to a conglomerate of defensive medicine and patient preference/medical culture.
    Not a particular popular position with my fellow physicians, but I would advocate cookbook medicine in the many cases where cookbook medicine can be applied. As an example from my specialty, if you have textbook migraines and a normal exam, brain scans are not indicated and therefore should not be paid for (unless the patient wants to foot the bill).
    My best hope for the new administration’s policies is: they will offer a public plan similar to medicare, curb waste within that plan and outlaw private insurance cherrypicking … it may turn out to be all we really need.

    Their tripartite emphasis on access,uneven quality and cost has been consistent and is correct!
    To me the way to really get at the cost issue(the most important one)is through much more emphasis on primary care,prevention,public health and ethical and compassionate rationing.
    (but no politician with any survival instincts uses “the R word”=rationing) But some day we will grow up and face this reality. It is an economic imperative.
    Rick Lippin

  31. “”If we really do believe in competition, why not give the public plan a chance?” she said.”
    Does anyone think the fourth estate even exist anymore? What exactly does Lambrew consider competition and choice?
    In 1973 When Ted Kennedy wrote and passed the HMO Act making it a Federal Law employers with more then 25 employees had to offer HMOs was that Choice? When they further subsidized them so they could under cut existing plans was that Competition?
    When Washington and the States legislate artificially low reimbursement rates forcing providers to bill private insurance higher rates thus transferring billions in liability is that competition?
    When the type of plan, benefits to be offered, and how they are offered are dictated to you by politicians is that choice? Doesn’t the term benefit mandate pretty clearly exclude the presence of choice?
    When States charge increasing premium taxes to private insurance which Medicare and Medicaid are exempt from is that competition?
    Yes we do believe in choice and competition but it has been denied us by Obama, Kennedy, and every other politician since the 60s. For no “journalist” to call Lambrew and the Administration out on this is proof the 4th estate is buried and forgotten.

  32. Immediate expansions to protect people who are losing their jobs from also losing their health insurance by increasing federal Medicaid match, subsidizing COBRA premiums, and allowing the newly unemployed temporarily to buy into state Medicaid coverage.
    What are great way to waste money. In typical politician fashion take a simple problem and find the most inefficient way to partially solve it.
    probably 80%(search 80/20 rule for non actuaries) of those covered by a group policy can buy an individual policy cheaper then their COBRA premium. Why should tax payors pay $300 a month in COBRA premium for a 25 year old male that can buy an equally good policy for $100 a month? Since the vast majority of people are without insurance for only a few months before they find another job the smart thing to do would be to buy a HDHP plan and save the premium.
    This is a terrible idea that never should have seen the light of day

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