Yesterday the President defended the Affordable Health Care Act – Obamacare to most Missourians – noting that one of the biggest problems with the program’s implementation was the unreasoning, mad-dog bile of the GOP, although he didn’t use those exact words – he’s far more gracious than I. He did, however deplore the ugly GOP political games in terms of what they will cost an American populace less interested in right or left partisanship than in pragmatic solutions to their problems:

… anyone defending the remnants of the old, broken system as if it was working for people, anybody who thinks we shouldn’t finish the job of making the health care system work for everybody — especially when these folks offer no plan for the uninsured or the underinsured, or folks who lose their insurance each year — those folks should have to explain themselves.

Ironically, while the President was calling on the obstructionists to explain themselves, they were putting on a little show in a House Energy and Commerce Committee hearing , trying to pretend that Health and Human Services (HHS) Secretary Kathleen Sebelius had to explain herself to the very folks who had done everything in their power to hinder her Obamacare sign-up efforts.

Mixing it up with the bully-boys was Missouri’s Rep. Billy Long (R-7). As Dave Weigel describes Long’s ham-fisted effort to help his GOP colleagues hammer home what seems – inexplicably given it’s inanity – one of their favorite talking points:

But they did try to bring back the “fairness” attack. Colorado Rep. Cory Gardner started a wave of questions to Sebelius about why she didn’t have the integrity to get on the exchange herself, if she was so great.*

Missouri Rep. Billy Long, a former auctioneer who’s built like a kettlebell, did the same, with less aplomb. “If you can, will you?” he asked. “Yes or no? Yes or no?”

Sebelius, looking bored, explained that she couldn’t get on the exchange as she had insurance already (not quite true, she simply couldn’t get the subsidies that other enrollees would get) and that D.C. had its own exchange, anyway.

That Sebelius found this line of questioning tiresome and time-wasting was indicated by a comment overheard on a “hot” mic” at the end of Billy’s star turn. “Don’t do this to me,” she muttered to an aide, a response that reminded me of my own soto-voce, eye-rolling “save me” pleas to my husband after having been cornered by particularly obtuse bores in the past.

As for the substance of the issues with which Billy tried to skewer Sebilius, Duane Graham has very aptly demonstrated over at The Erstwhile Conservative that Billy’s anti-Obamacare cupboard was all too bare: Contrary to Billy’s assertion that everyone other than Sebelius will have to get healthcare through the exchanges, only those Americans who lack employer-supplied insurance and who are ineligible for Medicare will need to use the exchanges; Sebelius isn’t eligible for healthcare through the exchanges since she not only has employer supplied insurance, she is enrolled in Medicare Part A; nor is she, as Long asserted, the “architect” of Obamacare – that honor goes to the conservative Heritage Foundation via Mitt Romney with a little input from several months of congressional wrangling in 2009.

Facts don’t fly with Billy Long, however. He has, after all, just announced that he has signed on to legislation that he says is intended “to ensure those already hurt by the president’s health care law are given a one year break from the law’s individual mandate.” This in spite of the fact that folks “hurt” by Obamacare are kind of thin on the ground – but then, this rhetoric actually pertains to another GOP fantasy talking point du jour,  and involves what they depict as the “millions” who, in Billy’s words, “are beginning to receive notices from their health insurance carriers that the coverage they currently enjoy will be terminated at the end of their current plan year because of the president’s health care law. These same people will be penalized if they do not find new coverage.”

If Billy had not been too busy badgering Secretary Sebelius to listen to the President’s speech yesterday, he might have learned that the situation is far from dire enough to require his legislative intervention:

So anyone peddling the notion that insurers are cancelling people’s plan without mentioning that almost all the insurers are encouraging people to join better plans with the same carrier, and stronger benefits and stronger protections, while others will be able to get better plans with new carriers through the marketplace, and that many will get new help to pay for these better plans and make them actually cheaper — if you leave that stuff out, you’re being grossly misleading, to say the least.

Of course, if Billy had been trying to do the right thing and act in concert with facts, he might not have gotten his name in the headlines for his little performance yesterday and pulled in all the associated Tea Party points – which I am sure that he hopes will prove potent when he comes up for election and has to compete again against  Democratic hopeful Jim Evans, who makes no bones about his  support for Obamacare.

Secretary of Health and Human Services Kathleen Sebelius held a conference call on health care reform for regional media early this afternoon. Part of the purpose of the conference call was to promote reports released by HHS on the status quo of health care in each of the fifty states. After her opening remarks Secretary Sebelius took questions from media in on the conference call.

Secretary of Health and Human Services Kathleen Sebelius:  Good afternoon everybody. And, um, I appreciate you joining us today. Um, as you know, here in Washington people are working hard to push forward health reform and we know that there’s some urgency about this from citizens across this country.

Um, since two thousand health insurance premiums have doubled and health care premiums are growing three times faster than wages. But unfortunately quality of care is going down as those costs continue to rise. So, even with, for people who have, uh, access to health care, uh, all it takes is a stroke of bad luck to become one of the nearly forty-six million uninsured or the millions who have health care and are having trouble affording it.

Today, uh, at the Department of Health and Human Services we’ve released fifty new reports on the health care status quo in every state around the country. The new reports are available on our web site, http://www.healthreform.gov. And they pretty clearly outline the challenges that we have. Um, the reports include statistics on the percentage of residents in each state without insurance, the increase in the costs of premiums, and the overall quality for health care in each state. And they use some of the most current data available.

Uh, unfortunately the reports are a clear demonstration that there are problems with health care in every state. Whether they’re rural, urban, East coast, West coast, it really doesn’t matter. The health crisis impacts all of America. The additional reports out today are from our Agency for Health Research and Quality. And frankly states get a pretty mixed review for the quality of care they provide.

Uh, these are more than just numbers and facts, more than statistics on a page. They represent real people and families in states across the country who are struggling. Uh, what we know is every day in America families are being crushed by the high cost of health care that threatens their financial stability, leaves them exposed to higher premiums and deductibles, and puts them at risk for possible loss of health insurance as employers struggle to provide adequate health coverage.

So now Americans are demanding reform that protects what works and fixes what’s broken. And in Congress, um, a number of members of the House and Senators from both sides of the aisle are working hard to make reform a reality. We were encouraged that just yesterday a bipartisan group of leading Senators, including  the top Democrat and the top Republican on the Finance Committee, Max Baucus and Chuck Grassley, recommitted to working together on health reform this year.

So I’m confident that we are gonna get a bill passed and to the President’s desk. And the statistics that we’re releasing today should help to inform people about the serious challenges that we face and why we can’t wait for reform to happen.

Um, again the reports are on our web site healthreform.gov.  And they are a state by state look at what’s going on in quality and cost. So with that I’d, I’d be willing to, um, answer some questions. I think we have about…

Media questions:

…Question: Hi  Secretary, uh, thank you very much for taking the call. Um, I am wondering what the chance are of getting a, um, public option through this year?

Secretary Sebelius: Well Jenna, as you know the President has made it pretty clear that, um, he actually believes in market strategies and feels very strongly that having a public option compete with private insurers is the best way to have cost containment. Um, I’m pleased that the House bill which has been drafted, and I testified to earlier this week, um, the outlines of the Senate bill from the Health Committee, both have public options. Uh, we haven’t seen the specific language from the Finance bill yet, but I, I think it’s clear that, um, with the bill coming forward the public option is definitely part of the strategy.

…Question: [garbled] Secretary, um, we’re, in Virginia particularly small businesses make up seventy-one per cent. And I’m wondering how the health care plan that’s being developed is going to help smaller businesses and people who work with them in developing a health care option for their employees?

Secretary Sebelius: [garbled] That’s a great question. Um, as you know, not only in Virginia, but in every state across the country small business owners are the majority of employers. And it’s the, um, kind of backbone of our economy. And frankly, in the current system they are the ones offering, I mean, often bearing the brunt of, um, the cost curve. Uh, they get squeezed out of the marketplace more quickly if one or two employees have some kind of pre-existing condition. They pay higher costs because they don’t have the volume to leverage, uh, big discounts. And, um, often they, they don’t get to keep or attract the best employees because employees follow health care. And while over close to sixty per cent of small business owners as recently as five years ago provided coverage, we’re now down to thirty-eight per cent. Um, so it’s, uh, they’re at a competitive disadvantage. So health reform I think offers a lot to small business owners. First of all it kind of pool, in the new health exchange, will give some, uh, affordable options, uh, for small business owners that they don’t have now, gives them choice. The elimination of pre-existing condition will mean that they can actually come into the marketplace without their costs, uh, skyrocketing. All of the proposals, and the President has made it very clear his proposal, um, includes some tax incentives for small business owners who offer insurance coverage. And I think that even if, um,  the kind of pay or play employer mandate ends up in either the House or Senate bill, it’s part of the House bill, but there is an exemption, uh, for small businesses. So I think there’s a, there’s a good deal of focus, um, of beneficial outcomes for small business owners. And at the end of the day costs have to go down for everybody, but I think it’s a, it’s a workforce issue that will make them more competitive with their, in this global marketplace.

…Question: In your report [garbled] you document, uh, the number of businesses that are dropping health insurance benefits. Uh, if there’s a public option won’t that cause more businesses to, to drop, uh, offer, offering health insurance benefits and just tell their employees to go the public option?

Secretary Sebelius: Well, Eric, the way that the public option is, is being crafted it really is available for, um, those who do not have coverage right now. And, um, I think there, there is concern about the so called dumping, but, uh, frankly the President has made it pretty clear that he really wants to encourage a system that builds on what we have. That if people have coverage that they like, that’s affordable, a relationship with a doctor that, um, is good for you and your family [garbled] want to keep it. So the, the exchange, the new marketplace is really for, uh, those Americans who have no insurance coverage at all or who are, um, un, underinsured at this point, uh, because of the cost prohibitive nature of the coverage.

…Question: Yes Secretary, is there any form of ranking here? How do we know how our states are comparing to other states, for example, in the number of uninsured, um, the costs of premiums etcetera?

Secretary Sebelius:  Um, at this point Mary Joe, there isn’t a, a, you know, comparison. These are
really state by state reports. So, there wasn’t an attempt to, um, either on the quality reports or the, uh, cost in coverage side to rank these, uh, in order of one to fifty. Uh, but really give a snapshot for citizens, business owners, policy makers in that state an idea of, of really what’s happening within the borders. Be a good math project for somebody to go through and, you know, calculate this, but, um, that wasn’t part of the, what we do here at the department.

…Question: Madame Secretary, there’s a lot of talk about bipartisanship. I’m just wondering, if the Democrats have the votes to pass what they want, why don’t you just do it? The Republicans have said that they want to kill this project, a lot of them have. Why don’t the Democrats pass what they think is the best proposal and to hell with bipartisan…, bipartisanship?

Secretary Sebelius: Well, I, I, I think, um, while the, the votes may be there because the majority is, is pretty hefty in the House, um, of Democratic support. The reality in the Senate is basically you need sixty votes, uh, in order to move procedurally to a vote of anything, so there’s more of a, a kind of procedural requirement for bipartisanship. But I think at the end of the day health care is probably the most personal issue to every American. It, it really, uh, affects businesses and governments and families. Um, and I would hope, and I think the President is very hopeful and keeps pushing for this, that this, uh, doesn’t break down along partisan lines, but it, it’s an American issue. It’s the one that we really have to figure out a strategy that’s uniquely American. We have a, uh, an insurance system right now that doesn’t look like any other country in the world. We want to build on what we have and fix what’s broken. But, um, I’m still hopeful that, uh, Republicans will be engaged and involved, as they are right now in the Senate Finance Committee. I mean, I think that sets a great example. I’m hopeful we’ll have some House Republicans who end up, uh, becoming part of this solution in moving forward on health reform. This isn’t really a Democratic issue and it shouldn’t be a Democratic bill. It should be a bill that really finds a solution to this challenge for all Americans.

…Question: Yes, Madame Secretary, you spoke about a number of, uh, countries, how we’re different than those, uh, countries. Yet many of these, uh, industrialized countries around the world do better with their health care plans than the United States. Which countries, uh, systems are you specifically looking at in developing a better system for the United States?

Secretary Sebelius: Um, I did not suggest that we were looking to other nations to develop a better system. I said I thought we needed kind of an American solution because our, our health system is different than most countries around the world. I do think we have a lot to learn from other countries about health outcomes and cost effective, uh, strategies that produce better outcomes. So, um, one of the efforts in health reform is really to help promote, incentivize higher quality care for each and every American. It exists in some pockets of the country. Uh, some systems work enormously well, with doctors and hospitals in a collaborative strategy. Others don’t work very well at all. And though we spend twice as much as any nation on Earth, and yet our health outcomes don’t, um, show it, don’t show those results. So I think we, we will continue to learn from what is cost effective and, more importantly, what’s effective for patients in terms of medical strategies and try to use Medicare and the payment system and the incentives we have here in the Department of Health and Human Services to, uh, improve the quality of care for everyone.

…Question: Yes, thank you Madame Secretary. One alternative to the public option that’s been proposed is regional cooperatives. Uh, isn’t that a little bit like putting all the sheep in separate pens to keep them from ganging up on the wolves?

Secretary Sebelius: [laughter] Um, well, I think the, uh, there was a discussion, I think early on in the Senate about, um, actually multiple cooperatives being one alternative, uh, to look at for competition. Uh, my understanding is that recently the, the CBO, the Congressional Budget Office has suggested that they don’t think that’s, um, either a feasible idea or an effective strategy, so I, I think that the conversation going on right now is, is a national, um, option. As you know the President and the administration very strongly support, um, not a cooperative strategy, but a, a true public option that would be a, um, a benefit program run by the government that can compete side by side with private insurers and help hold down costs and offer some choice to consumers.

…Question: Is making it mandatory for all Americans to purchase health insurance being seriously considered? If so, will there be a waiver for those whose religious beliefs preclude them from going to doctors or hospitals, or for individuals who believe in natural or holistic to health and are taking preventative measures such as healthy diet or regular exercise, making them less likely to need medical assistance than someone with risky behaviors?

Secretary Sebelius: Um, the, I, I think there is discussion in both the House and Senate, um, of some kind of an individual mandate. Um, it was part of the Massachusetts strategy when they passed their proposal. I know that there, um, in the House version of the bill is a specific exemption for, um, economic hardship for, uh, the ability of someone to opt out based on, um, the fact that they, whatever the price, they still can’t afford it. I have not seen the specific language, particularly about the religious issue I assume [garbled] Christian Science, Scientists and others who don’t access the traditional health care system. Um, but that’s a very good point. I, I don’t know if that language is in the bill. I, I can take a look at it, but I think that’s one we can share with the committee members….[end]

Senator John McCain posted on Twitter about his vote against confirming Kathleen Sebelius as Secretary of Health and Human Services:

voted against Sebelius – already moving towards socialized auto companies, we don’t need socialized medicine! about 4 hours ago from web

Socialized medicine? You mean like this? [pdf]:

[September 2007]…Members of Congress and retired Members are entitled to participate in the Federal Employees Health Benefits Program (FEHBP) under the same rules as other federal employees. Members meeting minimum enrollment period requirements who are also eligible for an immediate annuity may continue to participate in the health benefit program when they retire. For an additional fee, incumbent Members can receive health care services from the Office of the Attending Physician in the U.S. Capitol; in addition, Members may purchase care from the military hospitals using their FEHBP benefit. Members must also pay the same payroll taxes as all other workers for Medicare Part A coverage…

…Financing. The federal government and enrollees jointly pay for the cost, or premiums, of the FEHBP plans. The Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) established the current formula for determining the government’s contribution, which became effective January 1999. The government’s share is an amount equal to 72% of the average premium of all participating plans (weighted by the number of plan participants) but no more than 75% of the premium of any individual plan. This formula is applied separately to self only and family plans. Participants pay an average of 28%, but no less than 25% of premiums…

…Private Sector Comparability

For individual coverage, the employer’s contribution in the private sector is generally more generous than the federal government’s FEHBP contribution for its employees. According to the Department of Labor, private sector employers’ share for coverage is 81% for individual coverage and 71% for family coverage (compared to FEHBP’s payment of 72% of the average premium of all participating plans).

FEHBP’s family coverage includes all families of two or more, while private sector plans may have different premiums for family plans depending on the family size. Under FEHBP’s family coverage, a family of two pays the same premium as a family of four.

Approximately three-fourths of all workers in private industry had no choice in medical insurance plan, either because they were not offered a plan (30%) or because they were offered only one plan (44%), while many FEHBP participants have the advantage of a wide choice of plans.

The number and percentage of people covered by employment-based health insurance has been decreasing. In the private sector, coverage dropped from 69% in 2000 to 60% in 2007. In particular, retiree health coverage has been hit the hardest. Sixty-six percent of all large firms (with 200 or more workers) offered retiree health coverage in 1988, compared with 33% in 2007. FEHBP is available to federal retirees at the same cost and with the same benefits offered to active employees.

In terms of premium increases, the Government Accountability Office (GAO) found that starting in 2003, FEHBP premium rate of growth was generally slower than for other purchasers. According to GAO testimony, since 2003, the average growth rate of FEHBP premiums has been 7.3% compared with 10.5% for the employer-ponsored plans surveyed by the Kaiser Family Foundation/Health Research Educational Trust. Premium rate growth for the 10 largest FEHBP plans (based on enrollment), that accounted for about three-quarters of total enrollment, ranged from 0% to 15.5% for 2007…

Nice work and good benefits, if you can get it.