says the New York Times. The lobbying and jockeying should get serious now. The hospital trade groups said their 'deal' with the Obama Administration on reductions in DSH payments hinged on 97% coverage....whereas this is projected to produce 94%. Essentially the deal was for them to hold their fire over the Summer, in return for a proposal that reduced uninsured rates, and therefore changed charity care into paid care. How loud will they squak about this? Not sure. Ways to move the coverage levels up would include:
*increase subsidies, but you have to pay for it [have I mentioned that capping the tax exclusion of employer provided premiums at the national mean would raise about $300 Bill MORE over 10 for such subsidies AND will greatly increase cost saving nature of the bill]
*public option of some sort would nudge cover up a bit
Other key issues and tradeoffs:
*state-options will likely become important in negotiations as members of Congress start to see bill as more and more inevitable and start trying to find a way to vote for (if they are Dems) and against (if they are Repubs) while maintaing best set of choices possible for their particular state. Most think of state options/opt outs as allowing states to try and do less than what a national approach would entail, but you might well have states like Vermont say they want to try a single payer of sorts. Essentially, states will likely end up with ability to get rid of individual mandate if they can achieve the coverage levels that individual mandate would produce.
*is it too late for a Republican to jump up and say, I am open to supporting, but what this really needs is serious tort reform? Probably not too late. What about some Blue Dogs in the House? Would they trade triggered public option for tort reform? State option for public option? Would the President? [yes and yes in his case, I think].