Update on Cantwell Amendments

By Josh Feit September 21, 2009

This morning, we reported on Sen. Maria Cantwell's amendments to the Finance Committee version of the health care reform bill—including her Consumer Reports-style propsal that would put tighter regulations on Pharmaceutical Benefit Management companies (PBMs), middleman between drug companies and insurers.

The amendment explains some of the problems with PBMs:

[S]ome of the major concerns with PBMs is that they force beneficiaries to refill prescriptions via mail-order pharmacies (which are largely owned by the PBMs themselves) and that they switch prescriptions from generic to name-brand to increase the spread price, i.e. profit.  By disclosing this information to a federal agency, analysis would be able to determine if the PBMs are utilizing unfair business practices to steer business to themselves.

But you all don't care about this fineprint consumer rights stuff. You want to know about the public option. And as we said in our earlier post, Cantwell signed onto a public option amendment.

We finally tracked down the amendment (it's on page 105 of the bill). It was offered by Sen. Charles Schumer (D-NY). It's pretty simple. It would sub out Sen. Baucus' co-op option and replace it with the "Public Option as passed by the HELP Committee [the Health, Education, Labor, and Pensions Committee]."

The HELP Committee's public opiton has been roundly criticized by liberals as a watered down version.

Re: the Schumer amendment, Cantwell spokeswoman Ciaran Clayton tells PubliCola, "If accepted, it would implement a strong public option in the Finance Commitee bill," adding— "our bill has to get merged with the HELP committee bill, and the public option has a better chance if there's duplicative language."

Responding to reports that the public option is dead, she namechecked a few senators, like Sen. Olympia Snowe (R-Maine) who supports a last resort public option trigger. "It comes down to the final vote count," Clayton says, "and we're not ready to do that yet."

There are five health care bills in play, three in the House, all of which include versions of a public option, and the two senate versions—the Finance Committee bill and the HELP Committee bill.

The Schumer-Cantwell amendment is in full below the fold.


Schumer-Cantwell Amendment #C2 to Title I, Subtitle E-

Short Title: Public Option as passed by HELP Committee

Description of Amendment:

Strike Title I, Subtitle E, Health Care Cooperatives and replace with public option proposal included in the Senate Health, Education, Labor, and Pensions Committee:

The Secretary will establish a community health insurance option that complies with the health plan requirements established by this title and provides only the essential health benefits established in section 3103, except in States that offer additional benefits. There are no requirements that health care providers participate in the plan or that individuals join the plan. The premiums must be sufficient to cover the plan‘s cost. The Secretary shall negotiate rates for provider reimbursement. Reimbursement rates will be negotiated by the Secretary and shall not be higher than the average of all Gateway reimbursement rates. A ―Health Benefit Plan Start-up Trust Fund‖ will be created to provide loans for the initial operations of the community health insurance plan, which the plan will be required to pay back no later than 10 years after the payment is made. After the first 90 days of operation, the community health plan will be subject to a Federal solvency standard, established by the Secretary, and will be required to have a reserve fund that is at least equal to the dollar value of incurred claims. Each state will establish a State Advisory Council to provide recommendations to the Secretary on the policies and procedures of the community health insurance plan.

The Secretary shall contract with qualified nonprofit entities to administer the community health insurance plan in the same manner as Medicare program contracting. The contractor will receive a fee from the Department of Health and Human Services, which may be increased or reduced depending on the contractor‘s performance in reducing costs and providing high-quality health care and customer service. Contracts will last between 5 and 10 year-terms, at the end of which there will be a competitive bidding process for new and renewed contracts.

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