“You know, they are saying, ‘Ignore the wishes of the American people. We know more about this than you do. And we’re going to jam it down your throats no matter what,’ ” Senate Minority Leader Mitch McConnell (R-Ky.) said on “Fox News Sunday.” – Washington Post

APTOPIX Obama 2008

Sen. McConnell provides the Republican reality and backdrop for today’s call with the White House on the President’s health care proposal, prior to Thursday’s bipartisan meeting.

One specific that has been leaked is that the President will adopt Sen. Feinstein’s oversight idea for insurers’ rate increases, which was the response to the big rate increases in California.

Linda Douglas convened the call, with Nancy-Ann DeParle, Jason Furman also on the line to coincide with the President’s health care meeting proposal. Pheiffer said the “President would have signed both the House and the Senate bill” if either of them had come to his desk.

There is no public option in the bill, with Dan Pfeiffer, White House Communications Director, however, the President supports it. You figure that one out. This answer came in answer to a question later in the media call, Is a public option in the plan and what about reconciliation?

“There is not a public option in here. As you know the President supports a public option. … … We have made no determination (about reconciliation) … going forward. … The people deserve an up or down vote. … – Dan Pfeiffer

Pfeiffer also said the President is working from the Senate bill.

“Our take on how to bridge those differences… The opening bid for the health meeting. … We took our best shot of bridging the differences. … It is our hope that the Republicans will come together with their plan”  (and post it online, too) … – Dan Pfeiffer

This includes mandates, known as “Improve Individual Responsibility”:

All Americans should have affordable health insurance coverage. This helps everyone, both insured and uninsured, by reducing cost shifting, where people with insurance end up covering the inevitable health care costs of the uninsured, and making possible robust health insurance reforms that will curb insurance company abuses and increase the security and stability of health insurance for all Americans. The House and Senate bills require individuals who have affordable options but who choose to remain uninsured to make a payment to offset the cost of care they will inevitably need. The House bill’s payment is a percentage of income. The Senate sets the payment as a flat dollar amount or percentage of income, whichever is higher (although not higher than the lowest premium in the area). Both the House and Senate bill provide a low-income exemption, for those individuals with incomes below the tax filing threshold (House) or below the poverty threshold (Senate).The Senate also includes a “hardship” exemption for people who cannot afford insurance, included in the President’s Proposal. It protects those who would face premiums of more than 8 percent of their income from having to pay any assessment and they can purchase a low-cost catastrophic plan in the exchange if they choose. …

Employer responsibilities are not mandated, like what’s in the Senate bill. However…

Under the Senate bill, there is no mandate for employers to provide health insurance. But as a matter of fairness, the Senate bill requires large employers (i.e., those with more than 50 workers) to make payments only if taxpayers are supporting the health insurance for their workers. The assessment on the employer is $3,000 per full-time worker obtaining tax credits in the exchange if that employer’s coverage is unaffordable, or $750 per full-time worker if the employer has a worker obtaining tax credits in the exchange but doesn’t offer coverage in the first place. The House bill requires a payroll tax for insurers that do not offer health insurance that meets minimum standards. The tax is 8% generally and phases in for employers with annual payrolls from $500,000 to $750,000; according to the Congressional Budget Office (CBO), the assessment for a firm with average wages of $40,000 would be $3,200 per worker. Under the President’s Proposal, small businesses will receive $40 billion in tax credits to support coverage for their workers beginning this year. Consistent with the Senate bill, small businesses with fewer than 50 workers would be exempt from any employer responsibility policies.

According to the White House spin, which they provided prior to the call this morning, Pres. Obama’s plan will, for one thing, offer “policies to improve affordability and accountability”:

Increase Tax Credits for Health Insurance Premiums.
Close the Medicare Prescription Drug “Donut Hole”.
Invest in Community Health Centers.
Strengthen Oversight of Insurance Premium Increases.
Extend Consumer Protections against Health Insurer Practices.
Improve Individual Responsibility.
Strengthen Employer Responsibility.

There are also policies to “crack down on waste, fraud and abuse,” as well as policies “to contain costs and ensure fiscal sustainability.”

Nancy-Ann DeParle, Obama’s health care czar, we’re talking bout the Senate bill with important provisions, including getting rid of the “Nebraska provision,” with help offered to all states, details offered in the President’s Proposal. Closes the Medicare “donut-hole”:

Close the Medicare Prescription Drug “Donut Hole”. The Medicare drug benefit provides vital help to seniors who take prescription drugs, but under current law, it leaves many beneficiaries without assistance when they need it most. Medicare stops paying for prescriptions after the plan and beneficiary have spent $2,830 on prescription drugs, and only starts paying again after out-of-pocket spending hits $4,550. This “donut hole” leaves seniors paying the full cost of expensive medicines, causing many to skip doses or not fill prescriptions at all — harming their health and raising other types of health costs. The Senate bill provides a 50% discount for certain drugs in the donut hole. The House bill fully phases out the donut hole over 10 years. Both bills raise the dollar amount before the donut hole begins by $500 in 2010. Relative to the Senate bill, the President’s Proposal fills the “donut hole” entirely. It begins by replacing the $500 increase in the initial coverage limit with a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. It also closes the donut hole completely by phasing down the coinsurance so it is the standard 25% by 2020 throughout the coverage gap.

…strengthens the Senate bill for families, invests in community health centers, stronger consumer protections against health insurer practices, increases threshold for excise tax to $23,000 to over $27,500 for a family plan (2018 for all plans), creates a new Health Care Rate Authority that will provide oversight on unfair increases. Obama will adopt the “hardship exemption” from the Senate plan, with premiums more than 8% of your income or at 100% of poverty.

Jason Furman answered the first question on the excise tax, from ABC News, dental and vision wouldn’t count in the calculation. David Corn followed up pointing to the House Dems not liking this provision at all, drawing to the point Obama made that if people liked their health care plan they wouldn’t have to change it. Jason’s response, in part was, “This entire plan is about giving insurance companies more of an incentive to be more efficient… this provision is just part of it.”

Wall Street Journal asked the total cost of the plan. DeParle said the whole plan is “offset,” going into details with the bottom line being that it would be deficit neutral.

Mark Knoller used his question to make the statement that what the White House is offering is much more than what the Republicans are expecting.

Abortion language was another question. Looks like women will be able to buy abortion coverage with a separate check. Once the President’s actual proposal in unveiled we’ll know more, but what I’ve heard so far is that it’s definitely not Stupak.

From the summary,

The President’s Proposal puts American families and small business owners in control of their own health care:

  • It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today — and makes coverage more affordable for many more.
  • It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
  • It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
  • It will end discrimination against Americans with pre-existing conditions.
  • It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years — and about $1 trillion over the second decade — by cutting government overspending and reining in waste, fraud and abuse.

The President’s Proposal bridges the gap between the House and Senate bills and includes new provisions to crack down on waste, fraud and abuse. It includes a targeted set of changes to the Patient Protection and Affordable Care Act, the Senate-passed health insurance reform bill. The President’s Proposal reflects policies from the House-passed bill and the President’s priorities. Key changes include:

  • Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
  • Closing the Medicare prescription drug “donut hole” coverage gap;
  • Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
  • Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
  • Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
  • Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.

The full plan is now available, with another important provision the President is offering below:

Preventing Delays in Access to Generic Drugs. Currently, brand-name pharmaceutical companies can delay generic competition through agreements whereby they pay the generic company to keep its drug off the market for a period of time, called “pay-for-delay.” This hurts consumers by delaying their access to generic drugs, which are usually less expensive than their branded counterparts. The Federal Trade Commission (FTC) recently estimated that this could cost consumers $35 billion over 10 years. The President’s proposal adopts a provision from the bipartisan legislation that gives the FTC enforcement authority to address this problem. Specifically, it makes anti-competitive and unlawful any agreement in which a generic drug manufacturer receives anything of value from a brand-name drug manufacturer that contains a provision in which the generic drug manufacturer agrees to limit or forego research, development, marketing, manufacturing or sales of the generic drug. This presumption can only be overcome if the parties to such an agreement demonstrate by clear and convincing evidence that the pro-competitive benefits of the agreement outweigh the anti-competitive effects of the agreement. The proposal also requires the Chief Executive Officer of the branded pharmaceutical company to certify to the accuracy and completeness of any agreements required to be filed with the FTC. Policies to Contain Costs and Ensure

About 31 million Americans will get coverage, but as far as I can see it’s still a maze and quite expensive. California’s Anthem gave the White House a great target. They shot, they scored.

Democrats are going to get something passed, that much seems clear (or go down trying). It remains to be seen if the Mitch McConnell quote at the top will frame Obama or if there is enough in the Democratic package to sink Republicans if they stiff arm Obama on Thursday.

UPDATE: Greg Sargent has Rep. Eric Cantor’s response, which, as I predicted, puts it exactly where it’s most dangerous for Dems:

The Obama plan costs a trillion dollars, puts government in control of personal health decisions, and allows the government to set prices in the private market. That mirrors the Pelosi/Reid plans that have already been soundly rejected by the bipartisan majority of Americans.