Gang of Six

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The Gang of Six is group of six U.S. Senators, all members of the Senate Committee on Finance, seen, in the summer and fall of 2009, as the core group that might work out an agreement on health care reform in the U.S. Senate. After House passage of the Democratic-sponsored Affordable Health Care for America Act (H.R. 3962) in November 2009, however, the dominant figure on health care legislation in the Senate became Senate Majority Leader Harry Reid.

While they have been called "moderate", that is more in the sense that they have a demonstrated ability to work across party lines, rather than an evaluation of their ideology. They are all from states with small populations, and represent less than 3 percent of the population.

Washington Post columnist Ezra Klein criticized it, in July 2009, as being made up of three centrist Democrats, two conservative Republicans and one centrist Republican, with no involvement from either liberal Democrats, or Democrats significantly associated with health care, such as Jay Rockefeller, Ron Wyden, Chuck Schumer, John Kerry, Debbie Stabenow or Maria Cantwell. Rockefeller is chair of the Finance Subcommittee on health care. [1]

With apparent support of at least five of the six, it produced a specific piece of legislation, usually called the Baucus bill, preliminary text of which began to be available and reviewed on September 18, 2008.[2] The bill has many legislators upset, but in a manner that could be the sort of thing that indicates a compromise that is least unpleasant to the widest range of groups, or could be fatally flawed legislation. Bill Clinton, having failed in a perhaps less open approach, thinks it has a chance of passage with Republican support. [3]

Of the Republicans, Snowe, who does not face reelection until 2012, may be the likeliest to vote with Democrats. [4] While Enzi is known for bipartisanship and spoke positively at the March 2009 White House Forum on Health Reform, he has said he expects to extract Democratic concessions rather than compromise. He gave the weekly Republican radio response, to which Presidential spokesman Robert Gibbs said
Certainly, I think the radio address over the weekend by Sen. Enzi, repeating many of the generic Republican talking points that Republicans are using that have bragged about being opposed to health care, are tremendously unfortunate, but in some ways illuminating...It appears that, at least in Sen. Enzi’s case, he doesn’t believe there’s a pathway to get bipartisan support...Sen. Enzi’s clearly turned over his cards on bipartisanship and decided that it’s time to walk away from the table.[5]

Draft plan

On September 16, Baucus presented elements of the plan.[6] It would cost $856 billion over 10 years and mandate insurance coverage for every American. The proposal has no health care public option, which President Obama has deemed desirable but those further left consider essential, but includes not-for-profit health care cooperatives.

It would bar dropping policyholders as long as premiums had been paid, add protections for pre-existing conditions, and set up tax credits to help purchase coverage.

Structurally, its major sections are:

  • Title I — Health Care Coverage. This has 8 major sections, discussed below.
  • Title II — Promoting Disease Prevention and Wellness
  • Title III — Improving the Quality and Efficiency of Health Care. 13 major sections, discussed below.
  • Title IV — Transparency and Program Identity
  • Title V — Fraud, Waste and Abuse
  • Title VI — Revenue items

Funding and affordability

Both parties have raid concerns that it will raise costs for some sectors, especially the middle class. Baucus agreed ""They're legitimate concerns, I'm going to try to address them...It's important to realize, compared to what? Today, insurance policies are so expensive, people tend to forget that, hey, this is a big improvement over the status quo." [7]

Exchanges

It includes "exchanges" where people could shop for insurance at rates heavily subsidized by the government. The level of subsidy -- and therefore the amount a person would have to pay -- would vary by income.[7] Non-profit cooperatives, in a broader view of health care funding, are not always subsidized.

"In 2013, for example, people making 133 percent of the federal poverty level would have to pay no more than 3 percent of their income for premiums, while people earning 300 percent to 400 percent of the poverty level would have their premiums limited to 13 percent of earnings. Those caps would rise as the cost of insurance increased, however, climbing rapidly into a range that many lawmakers in both parties consider unaffordable.

In 2016, for example, the range would extend from 3.2 percent to 13.9 percent of income, pushing annual premiums to about $4,100 for an individual earning $32,400 a year, according to a preliminary estimate by the CBO. Add deductibles and co-payments, and that person could be spending $5,600 a year on health care, or 17.3 percent of his or her annual income.

For families buying insurance through the exchanges, the expenses are likely to mount even more rapidly, the CBO said. For example, a family of four making $78,000 would face insurance premiums of 13.9 percent of income, or $10,800, in 2016. Add deductibles and co-payments, the cost could rise to $15,300 -- just under 20 percent of income.

Employer role

The bill does not do away with employer-paid coverage as a major component of U.S. health care funding. One of its provision is to tax the higher-benefit employer-paid plans, which could add costs for now-covered people. [8]

Indeed, the core bill does not widen choices available to people with employer-paid coverage; they would be excluded from the cooperatives, raising complaints including one from Sen. Ron Wyden (D-Oregon). He offers a " Free Choice amendment" that would ould instead require employers to offer their workers "a choice of at least two insurance plans, one of them a low-cost, high-value plan. "'Employers could do this by offering their own insurance options, or providing employees vouchers to purchase plans on the insurance exchange, he proposed. Alternatively, firms could insure all of their workers through the exchange, likely at a discounted rate, he said."[9]

Relation to the industry

Several individuals have received substantial contributions from participants in health care, which has raised questions of the appearance of conflict of interest. Some of the early criticism is that the bill is favorable to certain sections of the health industry, but opinion then splits if the favorable aspects are a sellout, or a less-than-ideal approach that will get acceptance from interest groups totally opposed to other solutions.

One interpretation is that certain sectors will get more customers if they give up some discounts and advantaged positions. Other critics, however, believe, sometimes ideologically and sometimes from initial analysis, that too much is given away.

For example, it does contain a mandate that all Americans have coverage or pay a penalty, which, in an of itself, is anathema to some economic conservatives. A broader range, however, say that mandates are absolutely necessary to achieve economies of scale.

It does not contain a public option, but does contain not-for-profit cooperatives. It appears to contain guarantees about being dropped while coverage is paid, and offers protections but not guarantees of protection against pre-existing condition refusals. There is no public option but there are not-for-profit health cooperatives.

Funding analysis

Baucus, however, trails only Obama and McCain, John Kerry and Arlen Specter D-Pa., have received more health contributions than Baucus, $8.3 million and $4.5 million, respectively.[4]

Senator Contributions Rank in Congress
Baucus $3.9 million 5
Grassley $2.7 million 14
Conrad $1.6 million 35
Bingaman $865,000 102
Enzi $844,000 104
Snowe $756,000 122

References

  1. Ezra Klein (28 July 2009), "The Max Baucus Committee", Washington Post
  2. Chairman’s Mark: America’s Healthy Future Act of 2009, Scheduled for Markup By the Senate Committee on Finance on September 22, 2009
  3. Patrick Cole and Thomas R. Keene (18 September 2009), Bill Clinton Says Obama Will Prevail on Health-Care Overhaul
  4. 4.0 4.1 Alan Fram, "THE INFLUENCE GAME: Health interests fund senators", Associated Press
  5. Susan Davis (31 August 2009), "Gibbs Tells Off Sen. Enzi Over Health Care Remarks", Wall Street Journal
  6. "Baucus Unveils 'Gang Of Six' Plan", CNN, 16 September 2009
  7. 7.0 7.1 Shailagh Murray and Lori Montgomery (18 September 2009), "Affordability Is Major Challenge for Reform: Burden on Middle Class Is a Top Concern", Washington Post
  8. Erica Werner (18 September 2008), "A tax provision in Baucus' bill arouses ire: A charge on so-called Cadillac health plans will hurt middle class, fellow Democrats say.", Associated Press
  9. Tony Romm (17 September 2009), "Wyden to offer free choice amendment to Baucus bill", The Hill