Renewing our Belief in American Government

For all the damage that corrupt politicians have done to our country and our state over the past decades, I fear the worst may be that they have very nearly destroyed the average American's belief in our "system" of government, so much so, that any discussion of politics with the average person must invariably involve at least half an hour convincing them that one even exists.  Somehow a substantial portion of Americans have come to believe that our system of government is American's problem, and not the elected officials participating in its daily functions.  The corrupt few (a few bad apples...) who seem intent upon perpetuating this myth among their constituents, hide behind the furor and silently go about the business of deconstructing our government.

The corrupt few have introduced (again) bills calling for term limits for both Senators and Representatives.  This is ludicrous.  Americans can vote for anything we like.  The Constitution has already placed limits on terms, and if Americans see fit to re-elect a Congressman than so be it.  The fight must remain with us, not the Congress.

We are fighting for the life of our form of government.  The issues like health care, social security and so forth are merely key points illustrating that that one group wants the freedom to choose a solution even if it may not be the best solution, while the other group simply wants to halt any argument and stifle the democratic process.  The tea baggers in effect cry, "shut up and do what you are told" while the progressives cry out, "we need to find a solution." 

Regardless of their positions on states rights versus federal authority, the founding fathers believed in the government they hoped to create and the right of the people to influence its actions.  The sharp words exchanged between citizens of our nation for the past year makes me cringe.  One group of Americans has told another group of Americans that they have no right to ask for change, to protest the status quo, to ask their legislatures to change laws or even to speak out in public to other Americans.  It is this last outrage that galls me the most because this is the key to democracy.  One vote is but one vote, but many votes move mountains.  If a person feels passionate about an issue, and exercises respect when voicing an opinion in an attempt to sway others to that issue,  then that person should have no fear under our Constitution.  The right of free speech is protected.  The right to verbally bludgeon others into submission is not protection, nor is the right to threaten others, but the right to civil discourse is protected.  Our government cannot function without this right.  Americans are the body politic, and our representatives are the politicians who tend to us.  That is the true meaning of politics. 

I want to find a way to help people renew their belief in government.  I want everyone, regardless of their political affiliations to look at the Constitution with fresh eyes, to see that it does hold the rights of the one and the few to be as important as the rights of the many, and to understand that the life of our Constitution depends on broad participation of the citizens of the United States of America.  Without it, African-Americans would not have held out hope for equal rights, immigrants who have traveled to America for hundreds of years would not have held out hope for prosperity in a society as classless as any of its time could be hoped for, and woman in our country would not feel empowered to reach across oceans to teach equality to oppressed women in other countries.

For this reason, I intent to redirect my efforts away from direct conflict and back towards education.  How can we as Americans make informed decisions when we no longer understand the structure of our government, how it works, and the job descriptions of those we vote into office.  I will get back to the roots of this website and devote the site to civics, and hopefully encourage citizens to stay involved, to set aside animosity and distrust and be unafraid to participate.  There are ways to root out corruption, to know when and how our representatives vote on issues, and perhaps even to clarify what issues might be worth of secular involvement and those which should be left to communities and religious establishments.

Strong Regulatory Reform Vs. the Public Option

Remember the baby in the bath water.  The house bill and the senate bill have yet to be melded.  Keep writing your reps, and don't let up the pressure.  Within the house bill are a lot of very important regulatory changes that will grealty hamstring the health insurance companies and thier parent organizations.  The public option is important. Heck a single payer system would be divine, but it is vitally important that legislation close some of the worst loopholes in the health insurance system.  I am gravely concerned that that goal may be lost in the fist fight over a public option.  In fact, I highly suspect, the opposition would very much like to see HR 3962 thrown out entirely and I am positive they themselves are feeding the furer over a public option.  If HR 3962 in all of its vitally verbose glory is thrown out, how long will it be before another bill of it's importance is reintroduced?  Within this bill lies the key to crippling the insurance industry's dominance on the medical industry.  Further regulatory changes need to occur in the financial arena which will help to curb ever expanding profit margin of private, for profit, health insurers, but this is a start.  If we can prevent the insurance companies from reaping profits by cutting back on benefits, increase the percentage of our premiums that actually pay for our treatments, then we begin to loosen thier hold on the medical industry by severing their ties to WAll Street.  If Wall Street and the rabid investors who feed from it cannot reap the profits from the captive audience of those paying health insurance premiums, they will drift off to seek other meat.  Only then can we hope to sculpt out a health care system that will truly benefit all Americans.

The Conflict Between Starr an Selkregg is the Rally Cry for the Next Elections

This article was posted today on the KTUU Channel News Website.  Last night the Anchorage Assembly met to discuss and adopt Mayor Sullivan's six year budget plan, a fifteen page plan drafted by the Mayor and his office outlining Anchorage's financial future. 

The usage of the word socialism has frankly been worn out.  Those who use it seem not to truly grasp its meaning.  I had to comment on the article, and to reply to others who made comment. 

Somebody please, in plain English, outline for me how our society has adopted socialism? As I understand the current usage of the term our churches engage in socialism. Churches regularly collect money from the members of their congregation, and redistribute the money to those it determines to be most in need. This is a basic principle of Christian faith and practice. Those of us who have been blessed with more give to those who have less or none. I have no problem extending this tenant of my faith in God to my state and nation. I render to Caesar what is Caesars as Jesus requested I do. I do so because it betters my society, and goes beyond what I or my congregation could do locally. Most of what I contribute goes to the upkeep of the infrastructure of my state and nation, and I am proud of that fact. If a portion is misused, well then that is but a portion, and those responsible can be brought to bare for their crimes. My faith tells me that their misdeeds will come around to trip them up eventually. I look around and see all that comprises my city, my district, my world, and I am grateful for it, and proud to have paid taxes to nurture it. I am blessed, and I can afford to pay a little extra to see to it that someone less fortunate than I has a better chance at life. My government isn't bad. It is run by humans, and there but for the grace of God go I.

Assemblyman Starr is a businessman.  He was elected to help run our city, to watch over its fiscal health and the physical well being of its occupants.  We pay his salary.  If we want a portion of our taxes to be redistributed to the poorest of our citizens, or to improve the commons (public places of commerce, government or recreation), then so be it.  If not to benefit our small portion of society, its commerce, trade, recreation, public health, etc., then for what do we pay taxes?  

I have no doubt that Sheila Selkregg was acting on behalf of her constituency in District 19 of which I am a member.  She has done so consistently even when it has put her in direct conflict with other Assembly members and Mayor Sullivan.

District 19 has been extremely blessed to have elected three competent and able individuals to watch over our public welfare.   At the city level, we have Sheila Selkregg, who has an amazing head for business, and pragmatic approach to problem solving, yet consistently manages to apply both traits to the humanity of the people she was elected to serve.  Her steadfast defense of human rights during the long months of hearings on AO 64 (the sexual orientation ordinance) showed great character and fortitude.

To represent the needs of Muldoon in the state House, we have Pete Petersen.  Anyone who has taken the time to get on Representative Petersen's email list, will attest to the fact that information floweth freely from his office.  I will attest to the fact that its content is as accurate as I can validate through normal means of fact finding available to the citizen.  Representative Petersen has been  involved in and effective at researching and addressing such issues as Enstar's rate hikes, and the suspiciously high cost of fuel in Alaska.  By involved I mean he has been out gathering information, helping to draft legislation, and finally, to get the information gathered back out to his constituency.

Finally, serving ably in the Senate is Bill Wielechowski.  Senator Wielechowski has done a tremendous job striving to achieve his campaign promises. Senator Wielechowski's feedback to his constituency during the AGIA process was much appreciated.  So little was known about the process, and on several occasions, he or his immediate staff responded directly to my doubts and concerns.  Like Representative Petersen emails, the Senator's newsletters go beyond mere campaign bulletins, and the facts they provide have been invaluable to me in my personal attempt to keep up to date on public issues.  The young Senator has either drafted or help to draft key legislation to combat unfair prices hikes by utility companies, and high fuel price.

All of these individuals will have my vote next election so long as they continue to uphold their oaths of office.  They have met all of my criteria for what makes a solid servant of the public.  They have first done no harm, and secondly helped to safeguard against wrongdoing in both commerce and the public.  But above that they have been accessible to their constituency, to those who elected them to office.  They live in their district, and interact with those they serve.  I have seen no evidence of self seeking, and I have been vigilant.  Those who have read my blogs know that I love research.  They have demonstrated more than adequately, and in many instances outstandingly that they have the experience to do their jobs, and the fortitude to persevere when standing up for the public.  They have done even when it has placed them in opposition to the wishes of the business or the religious community.  They have shown no disdain for these institutions.  To the contrary, I believe their actions will ultimately protect them (though some may not think so).

My purpose for this lengthy atta boy/girl for the public servants of Muldoon is a simple one.  Representative Petersen, and Senator Wielechowski are progressives, and Democrats.  The conservative  Republicans have gathered candidates to run for those offices held by Representative Petersen and Senator Wielechowski.   They have this right.  I cherish their right to do so, but I worry that their reasons for seeking election may not be in the best tradition of public office.  By this I mean, I suspect they wish to run for reasons other than to better the health, welfare and economy of the public who may elect them to office.  If this is not the case, then they have only to prove themselves more worthy than the incumbent candidates.  Fair enough, but a warning to them:  our district has had enough of moral piety and empty campaign promises.  We have at our disposal two able bodied gentlemen who have proved their mettle in office.   What ever the opposition offers it had best meet the highest standards of office for they will be scrutinized, and their past actions carefully weighed for sincerity of merit.  Muldoon has just begun to see a spark of resurrection amidst economic disaster.  We have much to lose should we chose unwisely.  Our progression towards better neighborhoods, less crime, safer roads and better schools has been slow but it has been steady and meaningful.

As the next election draws near, we, the progressive citizens of all districts in Alaska must replay in our hearts and heads the words of our newly elected President one year ago.  We must remember that we the people must do our part to ensure that progress remains vital and alive.  Not simply the progress of commerce and trade of a nation (the big boys and girls will slug it out and eventually the tide will turn), but the progress of our small communities and the people who live and work in and for them.  We must take great pains and make necessary sacrifices of time, money and talent to ensure that those who have faithfully served us as they promised to serve us will be reelected.  We must give support to new faces who demonstrate to us a sincere desire and posses credible skills to serve their communities on behalf of the electorate who place them in office.  We must get out and vote.  We must help our neighbors get out and vote.  We must be willing to discuss the politics of our neighborhoods, and confront those would run for office with our concerns and questions.  If volunteers for the candidates we support call us for assistance, we must be willing to dig as deeply as we are able to answer that call.  If we lack money, we must contribute time.  If we lack time, we must contribute money when possible.  If we lack both resources, then we must lend to them the strength and the power of our voices.  We must explore the six degrees of space that separate us one from another.  If we respect our fellow man, we can find a way to discuss a subject that is important to our mutual welfare.  Yes, we will sometimes face hostility, but what is an instant of inconvenience compared to possibly years of it should someone unqualified to serve be elected?  To what lengths are we willing to go to see our children be welled schooled, our infrastructure in good service and repair, and our elders adequately cared for should they have no resources other than the public good will?  These will be the questions to ask ourselves in the next several months, as we recall the thrill of the last Presidential election, and as we listen attentively to the arguments on the Hill of our Capital as they decide the future of health care reform.  Democracy lives, breaths and we have the privilege of participating in it Day to Day.

HR 3200, Section 209 - 242: The House Version of When, Who and How to Deliver a Public Option

The following excerpt was taken from the current version of HR 3200: Americas Affordable Health Choices Act of 2009, reported to the Committee on Education and Labor, 10/14/2009. This is very long read, but well worth it if you want to gain a better understanding how a health insurance bill might organize, implement and fund a Public Health Insurance Option.

H.R.3200
America's Affordable Health Choices Act of 2009 (Reported in House) SEC. 209. LIMITATION ON PREMIUM INCREASES UNDER EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS. (a) In General- The annual increase in the premiums charged under any Exchange-participating health benefits plan may not exceed 150 percent of the annual percentage increase in medical inflation for the 12-month period ending in June of the prior year, unless the plan receives approval for a higher rate increase in accordance with subsection (b) or (c). (b) Exception for Additional Required Benefits- If the Health Choices Commissioner requires Exchange-participating health benefits plans to provide additional benefits, the annual increase permitted under subsection (a) with respect to the first year to which such benefits are required shall be increased to take into account the costs of such additional benefits. (c) Exception to Where Financial Viability Threatened- Subsection (a) shall not apply to any Exchange-participating health benefits plan for any year if such plan demonstrates to the Commissioner (or, if determined appropriate by the Commissioner, the insurance commissioner for the State in which the plan is offered) that complying with subsection (a) for such year would threaten its financial viability or its ability to provide timely benefits to plan participants. (d) Non-preemption- Nothing in this section shall be construed as preempting existing State prior approval laws. Subtitle B--Public Health Insurance Option SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN. (a) Establishment- For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the `Secretary') shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the `public health insurance option') that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care. (b) Offering as an Exchange-participating Health Benefits Plan- (1) EXCLUSIVE TO THE EXCHANGE- The public health insurance option shall only be made available through the Health Insurance Exchange. (2) ENSURING A LEVEL PLAYING FIELD- Consistent with this subtitle, the public health insurance option shall comply with requirements that are applicable under this title to an Exchange-participating health benefits plan, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing. (3) PROVISION OF BENEFIT LEVELS- The public health insurance option-- (A) shall offer basic, enhanced, and premium plans; and (B) may offer premium-plus plans. (c) Administrative Contracting- The Secretary may enter into contracts for the purpose of performing administrative functions (including functions described in subsection (a)(4) of section 1874A of the Social Security Act) with respect to the public health insurance option in the same manner as the Secretary may enter into contracts under subsection (a)(1) of such section. The Secretary has the same authority with respect to the public health insurance option as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act. Contracts under this subsection shall not involve the transfer of insurance risk to such entity. (d) Ombudsman- The Secretary shall establish an office of the ombudsman for the public health insurance option which shall have duties with respect to the public health insurance option similar to the duties of the Medicare Beneficiary Ombudsman under section 1808(c)(2) of the Social Security Act. (e) Data Collection- The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care. (f) Treatment of Public Health Insurance Option- With respect to the public health insurance option, the Secretary shall be treated as a QHBP offering entity offering an Exchange-participating health benefits plan. (g) Access to Federal Courts- The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries. SEC. 222. PREMIUMS AND FINANCING. (a) Establishment of Premiums- (1) IN GENERAL- The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner-- (A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and (B) at a level sufficient to fully finance the costs of-- (i) health benefits provided by the public health insurance option; and (ii) administrative costs related to operating the public health insurance option. (2) CONTINGENCY MARGIN- In establishing premium rates under paragraph (1), the Secretary shall include an appropriate amount for a contingency margin (which shall be not less than 90 days of estimated claims). Before setting such appropriate amount for years starting with Y3, the Secretary shall solicit a recommendation on such amount from the American Academy of Actuaries. (b) Account- (1) ESTABLISHMENT- There is established in the Treasury of the United States an Account for the receipts and disbursements attributable to the operation of the public health insurance option, including the start-up funding under paragraph (2). Section 1854(g) of the Social Security Act shall apply to receipts described in the previous sentence in the same manner as such section applies to payments or premiums described in such section. (2) START-UP FUNDING- (A) IN GENERAL- In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. In order to provide for initial claims reserves before the collection of premiums, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment. (B) AMORTIZATION OF START-UP FUNDING- The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1. (C) LIMITATION ON FUNDING- Nothing in this section shall be construed as authorizing any additional appropriations to the Account, other than such amounts as are otherwise provided with respect to other Exchange-participating health benefits plans. (3) NO BAILOUTS- In no case shall the public health insurance option receive any Federal funds for purposes of insolvency in any manner similar to the manner in which entities receive Federal funding under the Troubled Assets Relief Program of the Secretary of the Treasury. SEC. 223. NEGOTIATED PAYMENT RATES FOR ITEMS AND SERVICES. (a) Negotiation of Payment Rates- (1) IN GENERAL- The Secretary shall negotiate payment rates for the public health insurance option for services and health care providers consistent with this section and section 224. (2) MANNER OF NEGOTIATION- The Secretary shall negotiate such rates in a manner that results in payment rates that are not lower, in the aggregate, than rates under title XVIII of the Social Security Act, and not higher, in the aggregate, than the average rates paid by other QHBP offering entities for services and health care providers. (3) INNOVATIVE PAYMENT METHODS- Nothing in this subsection shall be construed as preventing the use of innovative payment methods such as those described in section 224 in connection with the negotiation of payment rates under this subsection. (4) PRESCRIPTION DRUGS- Notwithstanding any other provision of law, the Secretary shall establish a particular formulary for prescription drugs under the public health insurance option. (b) Establishment of a Provider Network- (1) IN GENERAL- Health care providers (including physicians and hospitals) participating in Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary consistent with this subsection. (2) REQUIREMENTS FOR OPT-OUT PROCESS- Under the process established under paragraph (1)-- (A) providers described in such subparagraph shall be provided at least a 1-year period prior to the first day of Y1 to opt out of participating in the public health insurance option; (B) no provider shall be subject to a penalty for not participating in the public health insurance option; (C) the Secretary shall include information on how providers participating in Medicare who chose to opt out of participating in the public health insurance option may opt back in; and (D) there shall be an annual enrollment period in which providers may decide whether to participate in the public health insurance option. (3) RULEMAKING- Not later than 18 months before the first day of Y1, the Secretary shall promulgate rules (pursuant to notice and comment) for the process described in paragraph (1). (c) Limitations on Review- There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224. SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM. (a) In General- For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers. (b) Requirements for Innovative Payments- The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that-- (1) seeks to-- (A) improve health outcomes; (B) reduce health disparities (including racial, ethnic, and other disparities); (C) provide efficient and affordable care; (D) address geographic variation in the provision of health services; or (E) prevent or manage chronic illness; and (2) promotes care that is integrated, patient-centered, quality, and efficient. (c) Encouraging the Use of High Value Services- To the extent allowed by the benefit standards applied to all Exchange-participating health benefits plans, the public health insurance option may modify cost sharing and payment rates to encourage the use of services that promote health and value. (d) Promotion of Delivery System Reform- The Secretary shall monitor and evaluate the progress of payment and delivery system reforms under this section and shall seek to implement such reforms subject to the following: (1) To the extent that the Secretary finds a payment and delivery system reform successful in improving quality and reducing costs, the Secretary shall implement such reform on as large a geographic scale as practical and economical. (2) The Secretary may delay the implementation of such a reform in geographic areas in which such implementation would place the public health insurance option at a competitive disadvantage. (3) The Secretary may prioritize implementation of such a reform in high cost geographic areas or otherwise in order to reduce total program costs or to promote high value care. (e) Non-uniformity Permitted- Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas. SEC. 225. PROVIDER PARTICIPATION. (a) In General- The Secretary shall establish conditions of participation for health care providers under the public health insurance option. (b) Licensure or Certification- The Secretary shall not allow a health care provider to participate in the public health insurance option unless such provider is appropriately licensed or certified under State law. (c) Payment Terms for Providers- The Secretary shall establish terms and conditions for the participation (on an annual or other basis specified by the Secretary) of physicians and other health care providers under the public health insurance option, for which payment may be made for services furnished during the year. (d) Exclusion of Certain Providers- The Secretary shall exclude from participation under the public health insurance option a health care provider that is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act). SEC. 226. APPLICATION OF FRAUD AND ABUSE PROVISIONS. Provisions of law (other than criminal law provisions) identified by the Secretary by regulation, in consultation with the Inspector General of the Department of Health and Human Services, that impose sanctions with respect to waste, fraud, and abuse under Medicare, such as the False Claims Act (31 U.S.C. 3729 et seq.), shall also apply to the public health insurance option. SEC. 227. APPLICATION OF HIPAA INSURANCE REQUIREMENTS. The requirements of sections 2701 through 2792 of the Public Health Service Act shall apply to the public health insurance option in the same manner as they apply to health insurance coverage offered by a health insurance issuer in the individual market. SEC. 228. APPLICATION OF HEALTH INFORMATION PRIVACY, SECURITY, AND ELECTRONIC TRANSACTION REQUIREMENTS. Part C of title XI of the Social Security Act, relating to standards for protections against the wrongful disclosure of individually identifiable health information, health information security, and the electronic exchange of health care information, shall apply to the public health insurance option in the same manner as such part applies to other health plans (as defined in section 1171(5) of such Act). SEC. 229. ENROLLMENT IN PUBLIC HEALTH INSURANCE OPTION IS VOLUNTARY. Nothing in this division shall be construed as requiring anyone to enroll in the public health insurance option. Enrollment in such option is voluntary. Subtitle C--Individual Affordability Credits SEC. 241. AVAILABILITY THROUGH HEALTH INSURANCE EXCHANGE. (a) In General- Subject to the succeeding provisions of this subtitle, in the case of an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan-- (1) the individual shall be eligible for, in accordance with this subtitle, affordability credits consisting of-- (A) an affordability premium credit under section 243 to be applied against the premium for the Exchange-participating health benefits plan in which the individual is enrolled; and (B) an affordability cost-sharing credit under section 244 to be applied as a reduction of the cost-sharing otherwise applicable to such plan; and (2) the Commissioner shall pay the QHBP offering entity that offers such plan from the Health Insurance Exchange Trust Fund the aggregate amount of affordability credits for all affordable credit eligible individuals enrolled in such plan. (b) Application- (1) IN GENERAL- An Exchange eligible individual may apply to the Commissioner through the Health Insurance Exchange or through another entity under an arrangement made with the Commissioner, in a form and manner specified by the Commissioner. The Commissioner through the Health Insurance Exchange or through another public entity under an arrangement made with the Commissioner shall make a determination as to eligibility of an individual for affordability credits under this subtitle. The Commissioner shall establish a process whereby, on the basis of information otherwise available, individuals may be deemed to be affordable credit eligible individuals. In carrying this subtitle, the Commissioner shall establish effective methods that ensure that individuals with limited English proficiency are able to apply for affordability credits. (2) USE OF STATE MEDICAID AGENCIES- If the Commissioner determines that a State Medicaid agency has the capacity to make a determination of eligibility for affordability credits under this subtitle and under the same standards as used by the Commissioner, under the Medicaid memorandum of understanding (as defined in section 205(c)(4))-- (A) the State Medicaid agency is authorized to conduct such determinations for any Exchange-eligible individual who requests such a determination; and (B) the Commissioner shall reimburse the State Medicaid agency for the costs of conducting such determinations. (3) MEDICAID SCREEN AND ENROLL OBLIGATION- In the case of an application made under paragraph (1), there shall be a determination of whether the individual is a Medicaid-eligible individual. If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding. In the case of such an enrollment, the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency. (c) Use of Affordability Credits- (1) IN GENERAL- In Y1 and Y2 an affordable credit eligible individual may use an affordability credit only with respect to a basic plan. (2) FLEXIBILITY IN PLAN ENROLLMENT AUTHORIZED- Beginning with Y3, the Commissioner shall establish a process to allow an affordability credit to be used for enrollees in enhanced or premium plans. In the case of an affordable credit eligible individual who enrolls in an enhanced or premium plan, the individual shall be responsible for any difference between the premium for such plan and the affordable credit amount otherwise applicable if the individual had enrolled in a basic plan. (3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE- An affordability credit may not be used for payment for services described in section 122(d)(4)(A). (d) Access to Data- In carrying out this subtitle, the Commissioner shall request from the Secretary of the Treasury consistent with section 6103 of the Internal Revenue Code of 1986 such information as may be required to carry out this subtitle. (e) No Cash Rebates- In no case shall an affordable credit eligible individual receive any cash payment as a result of the application of this subtitle. SEC. 242. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL. (a) Definition- (1) IN GENERAL- For purposes of this division, the term `affordable credit eligible individual' means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)-- (A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312; (B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and (C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii). (2) TREATMENT OF FAMILY- Except as the Commissioner may otherwise provide, members of the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle. (3) EQUAL TREATMENT OF CERTAIN EMPLOYED INDIVIDUALS- (A) IN GENERAL- For purposes of applying this section with respect to an individual who is an employee of an employer that has an annual payroll (for the preceding calendar year) which does not exceed $750,000 and that makes the contribution which would be required under section 313(a) if the table specified in subparagraph (B) were substituted for the table specified in section 313(b)(1) (and if, in applying section 313(b)(2), $750,000 were substituted for $400,000), such individual shall be treated in the same manner as an employee of an employer that makes the contribution described in section 313(a) (without regard to this paragraph).

Senate bills, S1679 (Senator Tom Harkin) and S1796 (Senator Max Baucus) also include provisions for a Public Option. I have provided the following links.

 http://hdl.loc.gov/loc.uscongress/legislation.111s1679 

http://hdl.loc.gov/loc.uscongress/legislation.111s1796

 S1679, Section 141 through Section 185 outlines provisions and language that authorize and regulate how states will implement a public option, who and how much will be paid by individuals and employers, and provision for expanding public health facilities.

 S1796, Section 1101 provides for the ESTABLISHMENT OF QUALIFIED HEALTH BENEFITS PLAN EXCHANGES. Another important read for this bill is SECTION 2226. WAIVER OF HEALTH INSURANCE REFORM REQUIREMENTS.

 These are the three top bills highlighted on www.thomas.gov at this time, and the bills receiving the most scrutiny in Congress. Of the three bills, HR 3200 is both the longest and the most straight forward. Its content is well organized, and the sections easily cross referenced against the current laws it seeks to amend. S1679 comes in second for these reasons. S 1796, the Baucus bill, seems the least well organized and the most confusing of the three, and appears to provide the most wiggle room for states, insurance brokers and insurance companies. In addition, S1796, like the house bill (discussed in an earlier blog) supported and cosponsored by Rep. Don Young, also seems to support the creation of independent "state brokers" responsible for the selection and distribution of the proposed public insurance exchanges.

 It will be very interesting to see how the House responds to and adapts the bills submitted by the Senate. As many might remember, the Senate dealt heavy handedly with the House in September 2008 with the TARP bill. The House has had ample time to formulate a strategy to handle the Senate and I for one am eagerly awaiting the outcome.