Medicaid and Medicare

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The federal Centers for Medicare & Medicaid Services has awarded New Jersey a $4.2 million performance bonus for increasing NJ FamilyCare health insurance enrollment among eligible, uninsured, children in the state, Gov. Jon Corzine announced Thursday.

Only eight other states – Alabama, Alaska, Illinois, Louisiana, Michigan, New Mexico, Oregon and Washington – qualified for the bonus.

“Access to health insurance for children has been a touchstone of my administration,” Corzine said. “This bonus is a much appreciated honor for our state and a testament to the commitment we’ve exercised in insuring more than 100,000 new children over four years.”
“With our governmental and not-for-profit partners, the Department of Human Services has been working incredibly hard to find and insure eligible children using innovative programs, including presumptive eligibility in hospitals and clinics, and school-based outreach facilitators,” Commissioner Jennifer Velez said. “This award proves that, while there are many children still in need of health care coverage, New Jersey is making great headway.”

In order to receive the bonus, the federal CMS rated states on two areas: Implementing at least five of eight specific programs to promote enrollment and retention for children, and increasing enrollment above a formulaic target set by the Children’s Health Insurance Program Reauthorization Act of 2009.

New Jersey exceeded CMS’ minimum requirements by successfully increasing accessibility to children’s enrollment in six program areas: Continuous 12-month eligibility, eliminating the financial asset test, eliminating in-person interview at application and renewal, instituting single, unified, form for application and renewal, instituting automatic verification at renewal, and instituting presumptive eligibility for coverage.

New Jersey also achieved a 4.2 percent enrollment increase above baseline enrollment for federal fiscal year that ended Sept. 30.

Presently, NJ FamilyCare, the state’s program for low-income families, insures more than 614,197 children and provides a free or low-cost health care coverage for income-eligible families. For example, a family of four earning up to $77,175 – or 350 percent of the federal poverty level – can qualify to insure their children for $133 a month in the state- and federally-funded program.

Two moderate Democratic Senators facing re-election battles this year said Tuesday they would oppose using a legislative tool that requires only 51 Senate votes to get health care legislation to President Barack Obama’s desk.

Sen. Evan Bayh, D-Indiana, called the move, known as reconciliation, “ill-advised,” while Sen. Blanche Lincoln, D-Arkansas, issued a news release rejecting the procedure.

“I will not accept any last-minute efforts to force changes to health insurance reform issues through budget reconciliation, and neither will Arkansans,” Lincoln said in the statement.

Both the House and Senate have passed separate health care bills, entirely on support from Democrats.

Democratic leaders were working on merging the two bills, but the nation’s political landscape changed last week when Massachusetts elected Republican Scott Brown to fill the Senate seat held by liberal Democrat Ted Kennedy for almost 47 years until he died in August.

Brown’s victory cost Democrats their 60-seat super-majority in the 100-member Senate necessary to overcome a Republican filibuster. The shift means Republicans can block Democratic initiatives such as health care reform.

Now Democratic leaders are working on a plan for the House to pass the Senate bill, along with a separate package of changes in the Senate plan that reflect compromise between the two chambers.

The package of changes would have to pass both the House and the Senate.

Without the 60-seat super-majority, Senate Democrats now are considering using the reconciliation tool that would require only 51 votes to pass the measure.

However, some Democrats in tough re-election fights worry voters will see that as legislative gimmickry, reinforcing complaints that Democratic control of Washington has been business as usual.

Bayh told CNN that using reconciliation “would destroy the opportunity, if there is one, for any bipartisan cooperation on anything else for the rest of the year.”

Senate Majority Whip Dick Durbin, D-Illinois, dismissed opposition to using reconciliation as a way to get health care legislation to the president.

“I think reconciliation has been used effectively by both parties,” Durbin said. “I wouldn’t walk away from it. It’s an option we should keep on the table.”

Senate Democrats still have 59 votes in their caucus, meaning they could lose eight Democratic votes and still have the 51 needed to pass a health care package through reconciliation.

Still, Democratic sources warn that using reconciliation is complicated and fraught with legislative hurdles, raising questions about whether it could happen even if enough congressional Democrats supported the move.

House Speaker Nancy Pelosi, D-California, emerged from a meeting with Senate Majority Leader Harry Reid, D-Nevada, late Tuesday and said they are making progress on “some kind of package,” but reiterated that at this time “there are not the votes in the House, not anywhere near, to pass the Senate bill.”

Earlier, Reid told reporters there is now “no rush” on health care.

Obama, who made health care his top domestic priority last year, will address the issue in his State of the Union Address on Wednesday, said White House Press Secretary Robert Gibbs.

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The 2009-10 “American’s Best Health Insurance Plans” rankings are published by U.S. News & World Report and the National Committee for Quality Assurance. It’s the highest combined ranking CHP has ever achieved.

“I think these data increasingly suggest that some of the best-performing health plans are really the ones that are more connected to their communities, that are more local in scope,” said John Hogan, CHP’s chief executive. The plan is offered in Leon, Gadsden, Wakulla and Jefferson counties.

In last year’s review, CHP was ranked 23rd nationally and seventh among the top plans in Florida.

Hogan said the criteria for the evaluation include physicians’ opinions on the level of care and how the patients themselves view the CHP plan and the services delivered.

“To the extent that we are getting good results, it’s a reflection of the quality of the medical community and their willingness to work with the health plan to try to make sure patients get the things they should get,” he said, also crediting the work of staff and the support from businesses and other employers who offer the plan to their workers.

The assessment results also provide a basis for CHP’s further efforts at improving patient care, said Dr. Nancy Van Vessem, chief medical officer.

“For instance, on the quality measures, we look and see where we are relative to the other hundreds of health plans that have reported data, and we actually set goals that are related to what we want to be, the best in the nation,” she added.

CHP also earned high marks from the Center for Medicare and Medicaid Services (CMS) for its Medicare Advantage plan. CHP is the only Medicare Advantage plan in Florida and one of only three in the nation to receive five stars for the summary rating of health-plan quality from CMS.

Bill Gunter, chairman of Rogers, Gunter, Vaughn Insurance Inc., was serving as Florida’s insurance regulator when CHP was founded 27 years ago. “We are very fortunate, I think, to have Capital Health Plan in Tallahassee. Of course, they started back when I was insurance commissioner,” Gunter said. “I take great pride in how they have developed and the fact they are the top-ranked HMO in Florida.”

One of the important players of the Minnesota health insurance niche is the MinnesotaCare, a public subsidized program meant to help out the residents of Minnesota. These are the people who do not enjoy access to the diverse health facilities and medical coverage effectively.

There are almost over 100000 people who are covered under the MinnesotaCare Minnesota health insurance policy. The program has played an instrumental role in ensuring the welfare reform strategy of the state. Additionally, the people are to be helped out by the without losing out on health care coverage. Other than the kids, the residents are rendered as ineligible in case their health insurances are offered by their employers or they pay about 50% of their health care expenses.

The eligibility criteria for qualifying for MinnesotaCare is that you are required to pay a fixed amount every month as part of a premium, which is defined by a sliding fee scale on the basis of your income as well as size of the family. This Minnesota health insurance policy also offers certain exceptions for families of military personnel and those who are registered with Transitional MinnesotaCare. A lot of them pay their premium through online procedures.

The health care services are offered according to the various kinds of health based plans. This is the reason as to why the people are able to choose the MinnesotaCare coverage that is applicable in your county. The health insurance policy in Minnesota is funded by a state sponsored tax that is levied on the health care providers and hospitals of Minnesota, as well as enrollee premiums and federal Medicaid funds. For the purpose of applying, you can contact the MinnesotaCare office or even the county offices which administer the program.

What are the Health Care Programs Covered Under MinnesotaCare?

The health care programs that are enveloped by MinnesotaCare include the following:

MA or Medical Assistance
MinnesotaCare
Minnesota Family Planning Program
GAMC or General Assistance Medical Care

The above mentioned health care programs in Minnesota are of help in case you are not able to fund for the health insurance costs solely by virtue of your job. There are also other parameters that might qualify you as eligible in this regard:

You dont have a health insurance as you are unemployed
You are disabled or have a chronic condition and require assistance for paying for health care and related services and need to stay at home
You require assistance at a medical facility like nursing home or hospital
You are covered under Medicare and require help for paying premiums and require additional services that Medicare does not cover
You dont have insurance for various reasons

You need to seek information about a few topics to ensure that you are covered under MinnesotaCare. These are:

The amount of your income
Your assets like savings account or property
Are you eligible for insurance anywhere else?
If you have special needs for health care, like a disability
Other information you will be required to provide

The health insurance reform bill approved by the House on Nov. 7 could add more than 318,000 Oklahomans to the state’s Medicaid program and cost the state $128 million more each year, according to estimates from the state authority that administers the health care program for the poor.

“It will have a cost at a very tough time from a revenue standpoint in being able to afford it,” said Nico Gomez, deputy chief executive officer at the Oklahoma Health Care Authority.

Gomez said the Health Care Authority has been trying to estimate the potential impact of various congressional proposals on health care; state legislative leaders and members of Congress have been seeking the estimates because of the major expansion of Medicaid envisioned in both the House and Senate bills.

Medicaid is a federal-state health care program that, in Oklahoma, covers primarily pregnant women and children.

But the House bill would use the program to greatly reduce the ranks of the uninsured nationwide, making everyone eligible whose income was 150 percent or less of the federal poverty level (about $33,000 per year for a family of four.)

The federal government pays an average of 57 percent for Medicaid care and states pick up the rest. The House bill says the federal government would pay an average of 91 percent for the new people added, at a cost of about $425 billion over 10 years. According to the Congressional Budget Office, states would have to come up with about $34 billion over the 10-year life of the bill.

The biggest set of people who would become newly eligible if the House bill were to become law are adults between the ages of 19 and 65 whose income is below 150 percent of the poverty level. According to the Health Care Authority, there are 219,000 Oklahomans in that category.

There are already about 57,000 children in Oklahoma who qualify for Medicaid under the federal Children’s Health Insurance Program but aren’t currently participating, and there are thousands of other low-income Oklahomans who have private insurance but are counted as eligible because Medicaid would be a payer of last resort.

Oklahoma House Speaker Chris Benge said earlier this month that, given Oklahoma’s current fiscal woes, the $128 million in additional Medicaid spending “would lead to further budget cuts, jeopardizing existing state programs and services developed for Oklahomans by Oklahomans.”

Benge said the state is using market- and consumer-driven reforms to move the state’s uninsured into private insurance.

State is among worst in uninsured
However, according to the latest Census Bureau estimates, more than 18 percent of Oklahomans didn’t have health insurance in 2007. That’s among the top 10 uninsured rates in the country.

U.S. Reps. Mary Fallin, R-Oklahoma City, and Tom Cole, R-Moore, said the House bill would put pressure on states at the worst possible time.

“Increasing access to health care for the uninsured and underinsured is an important undertaking, but we cannot do so at the expense of the fiscal stability of states,” Fallin said.

Because Oklahoma is not a wealthy state, Gomez said, the Medicaid expansion mandated in the House bill will make a lot of people eligible, including young working men and women.

December 17, 2009

It appears that the U.S. Senate will vote to close debate on its version of federal health care reform as early as this weekend. Whether or not you have contacted your senators previously, now is the time for you to consider contacting both of your senators and encourage them to continue debate and to improve the legislation.

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It is difficult to overstate the negative implications of Senate Majority Leader Harry Reid’s (D-NV) proposal. According to the Congressional Budget Office, this legislation – if enacted – will have a significant, negative impact on the cost and nature of coverage for our customers. The administration’s chief actuary for Medicare and Medicaid Services has determined that if the Senate health care bill became law, it would increase national health care spending more than if we did nothing. Our own analysis concurs with these assessments and further indicates that Sen. Reid’s proposal will likely lead to higher premiums for many of our customers without reducing the growth in underlying health care costs.

A new Washington Post-ABC News poll indicates that 53% of Americans understand that their personal costs will increase under this proposal and only 37% believe that their personal health care will improve under this legislation. The Senate needs to set aside this version of health care reform and construct a proposal that has broad and deep public support.

Throughout the health care reform debate, our company has sought to partner with our elected leaders in both parties to pursue responsible, sustainable reform that lowers costs and increases access. The current legislation does not meet these goals and Congress needs to hear from individuals who are concerned about the consequences of well-intended but flawed reforms.

While we continue to support health care reform, we cannot support reform that fails to address the cost and quality issues in our health care delivery system and undermines the bipartisan consensus for responsible and sustainable reform.

The holiday season is a busy time for all. Now is the time to get involved today.

The Senate needs to hear from you and time is short.

Health Care Reform, the Medical Community and You

There is a tremendous effort by the President and the Democratic Party to swiftly replace our current system of health care insurance with a government sponsored insurance program designed to bring health insurance coverage to all Americans. Of course, this sounds like a wonderful idea, however, after understanding the details outlined in the proposed legislation, many may want to reconsider their position.

There are a few facts you just can’t get around. When more than 47 million uninsured Americans are added to a system that currently accommodates 260 million Americans, something is going to have to give. Assuming the same patient load, approximately 10,000 more physicians will need to be available or care for the 47 million. Other Americans will need to be delayed or eliminated. This is not unusual in places like England, France and Canada where National Healthcare has been in place for quite some time. Additionally, facilities, resources and support staff will be effected proportionally. The promoters of this legislation can promise all day long that this won’t happen, but unless they have the same capabilities that Christ had when he fed 500 followers with two loaves of bread and seven fish around 2000 years ago, the numbers say it just can’t work without serious health care rationing.

The next issue that stands out is the promise of reforming health care thereby significantly reducing costs. If we look at Medicare and Medicaid as examples and understand the tremendous deficit that is growing due to poor management and excessive fraud, how could we even imagine we could increase the size and responsibility of a program and then believe it would be operated efficiently enough to reduce costs. These are wonderful dreams, but they are just dreams. TARP is operating with little control or knowledge of recipients use of funds, the American Recovery and Reinvestment Act has been unable to disperse funds or lower unemployment as projected and the Cash for Clunkers program was so grossly miscalculated that it ran out of funds in the first week and hasn’t been

able to issue reimbursement payments to auto dealers effectively. We were told these programs would work great and they had to be in place immediately.

But let’s assume for one moment we can some how accommodate the extra 47 million insured and that through some miracle we are able to control costs without reducing the quality or quantity of care. How do we get past the fact that the majority of Americans do not want or support the health care reform legislation being proposed? It appears our elected representatives don’t really care what we want.

Yes, they were elected to represent us, but they represent themselves and their party’s position first. Once they have accommodated them, then they may consider understanding our preferences. Of course, the exception to this position is at election time when every promise is to represent the people that elect them.

Democrats strike a deal to shore up the final vote they need to pass health care reform in the Senate.

By toughening restriction on abortion coverage, Nebraska Senator Ben Nelson has agreed to support the plan.

The President calls Saturday’s compromise a major step forward in providing health insurance to the millions living without.

But, Senator Tom Coburn calls it a fraud that will lead to taxpayer funded abortions. The Oklahoma republican was one of the first to speak out against the bill.

Senator Coburn says Saturday’s developments put the country on the path for federally funded abortions. But his critics call the Senator’s posturing an empty gesture.

“The negotiations, whoever did them, threw unborn babies under the bus,” said Sen. Tom Coburn, (R) Oklahoma.

An angry Senator Tom Coburn took to the podium shortly after it was learned that Nebraska democrat Ben Nelson agreed to a healthcare reform compromise.

The bill has restrictions on abortion coverage in policies sold inside the government exchanges.

States would be permitted to ban insurance coverage of abortions except in cases of rape, incest or to save the mother’s life. It also creates a way to keep funds that would be used to pay for abortions separated from federal subsidy dollars flowing to health plans.

In states where coverage is permitted, consumers must notify the company they want it and pay for it separately.

But Senator Coburn says there’s no way to keep federal money separated unless abortions are strictly prohibited in a public plan.

“For the first time in the history of this country, under this bill, federal tax dollars will be used to pay for abortions,” said Sen. Coburn.

But Oklahoma democrats say the senator’s anger is misguided.

“Clearly he’s just putting a series of political stunts ahead of doing what’s right for Oklahoma or Oklahoma families,” said Karina Henderson, Oklahoma Democratic Party.

Karina Henderson says Senator Coburn should spend more time at the bargaining table than in front of the microphones.

“I think what Senator Coburn is doing is using a divisive issue as an excuse for his own failures to govern,” said Karina Henderson.

The Congressional Budget Office said the Senate bill would extend coverage to more than 30 million Americans who lack it. But Senator Coburn says it simply goes too far to fund a procedure that pro-life groups say should stay out of the government wallet.

The other health care plans under consideration all ban the use of government money to pay for abortions.

Oklahoma Senator Tom Coburn’s news release:

“This reprehensible and deceptive agreement is a historic and radical shift in policy that will require taxpayers to pay for abortion. The American people will be outraged when they realize this so-called compromise is a farce. I can’t imagine there is a single pro-life taxpayer in Nebraska, or any other state, who would agree to pay to end the lives of the unborn for a never-ending Medicaid earmark or tax breaks for insurance companies. Unfortunately, Senators Reid and Nelson disagree,” Dr. Coburn said.

“The fact that the most ardent pro-choice Senators support this agreement while pro-life groups, such as the National Right to Life Committee, oppose it should send a chilling signal to taxpayers in Nebraska and across America. Majority Leader Reid wants to rush this phony agreement through the Senate precisely because he does not want the American people to have time to understand its implications. Yet, in spite of these efforts to mislead the public, the American people will grasp and understand this decision and they will hold accountable anyone who defends sacrificing the unborn on the altar of political expediency,” Dr. Coburn said.

“Senators Reid, Nelson and others are using Enron-style accounting gimmicks to justify this radical shift in policy. Their claim that federal dollars will be separated from private dollars paid by premiums is a farce and they know it. In reality, the dollars will be fungible and mixed just as Social Security ‘trust fund’ dollars are used to finance other areas of government,” Dr. Coburn said. “The fact is this agreement, which was allegedly reached after weeks of gut-wrenching negotiations, is an elaborate charade. This new language is identical to, or worse than, the underlying abortion language in the Reid bill. Senators Reid, Nelson and others will have great difficulty convincing taxpayers that they were working to accomplish something other than carving out special favors for particular states.”

View full post on Social Security Network

Democrats strike a deal to shore up the final vote they need to pass health care reform in the Senate.

By toughening restriction on abortion coverage, Nebraska Senator Ben Nelson has agreed to support the plan.

The President calls Saturday’s compromise a major step forward in providing health insurance to the millions living without.

But, Senator Tom Coburn calls it a fraud that will lead to taxpayer funded abortions. The Oklahoma republican was one of the first to speak out against the bill.

Senator Coburn says Saturday’s developments put the country on the path for federally funded abortions. But his critics call the Senator’s posturing an empty gesture.

“The negotiations, whoever did them, threw unborn babies under the bus,” said Sen. Tom Coburn, (R) Oklahoma.

An angry Senator Tom Coburn took to the podium shortly after it was learned that Nebraska democrat Ben Nelson agreed to a healthcare reform compromise.

The bill has restrictions on abortion coverage in policies sold inside the government exchanges.

States would be permitted to ban insurance coverage of abortions except in cases of rape, incest or to save the mother’s life. It also creates a way to keep funds that would be used to pay for abortions separated from federal subsidy dollars flowing to health plans.

In states where coverage is permitted, consumers must notify the company they want it and pay for it separately.

But Senator Coburn says there’s no way to keep federal money separated unless abortions are strictly prohibited in a public plan.

“For the first time in the history of this country, under this bill, federal tax dollars will be used to pay for abortions,” said Sen. Coburn.

But Oklahoma democrats say the senator’s anger is misguided.

“Clearly he’s just putting a series of political stunts ahead of doing what’s right for Oklahoma or Oklahoma families,” said Karina Henderson, Oklahoma Democratic Party.

Karina Henderson says Senator Coburn should spend more time at the bargaining table than in front of the microphones.

“I think what Senator Coburn is doing is using a divisive issue as an excuse for his own failures to govern,” said Karina Henderson.

The Congressional Budget Office said the Senate bill would extend coverage to more than 30 million Americans who lack it. But Senator Coburn says it simply goes too far to fund a procedure that pro-life groups say should stay out of the government wallet.

The other health care plans under consideration all ban the use of government money to pay for abortions.

Oklahoma Senator Tom Coburn’s news release:

“This reprehensible and deceptive agreement is a historic and radical shift in policy that will require taxpayers to pay for abortion. The American people will be outraged when they realize this so-called compromise is a farce. I can’t imagine there is a single pro-life taxpayer in Nebraska, or any other state, who would agree to pay to end the lives of the unborn for a never-ending Medicaid earmark or tax breaks for insurance companies. Unfortunately, Senators Reid and Nelson disagree,” Dr. Coburn said.

“The fact that the most ardent pro-choice Senators support this agreement while pro-life groups, such as the National Right to Life Committee, oppose it should send a chilling signal to taxpayers in Nebraska and across America. Majority Leader Reid wants to rush this phony agreement through the Senate precisely because he does not want the American people to have time to understand its implications. Yet, in spite of these efforts to mislead the public, the American people will grasp and understand this decision and they will hold accountable anyone who defends sacrificing the unborn on the altar of political expediency,” Dr. Coburn said.

“Senators Reid, Nelson and others are using Enron-style accounting gimmicks to justify this radical shift in policy. Their claim that federal dollars will be separated from private dollars paid by premiums is a farce and they know it. In reality, the dollars will be fungible and mixed just as Social Security ‘trust fund’ dollars are used to finance other areas of government,” Dr. Coburn said. “The fact is this agreement, which was allegedly reached after weeks of gut-wrenching negotiations, is an elaborate charade. This new language is identical to, or worse than, the underlying abortion language in the Reid bill. Senators Reid, Nelson and others will have great difficulty convincing taxpayers that they were working to accomplish something other than carving out special favors for particular states.”

Barack Obama’s quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America’s long-term interests. Obama has reversed this. He’s championing increasingly unpopular legislation that threatens the country’s long-term interests. “This isn’t about me,” he likes to say, “I have great health insurance.” But of course, it is about him: about the legacy he covets as the president who achieved “universal” health insurance. He’ll be disappointed. Even if Congress passes legislation — a good bet — the finished product will fall far short of Obama’s extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama’s claim that he has “solved” the health-care problem. His reputation will suffer.

It already has. Despite Obama’s eloquence and command of the airwaves, public suspicions are rising. In April, 57 percent of Americans approved of his “handling of health care” and 29 percent disapproved, reports the Post-ABC News poll; in the latest survey, 44 percent approved and 53 percent disapproved. About half worried that their care would deteriorate and that health costs would rise.

These fears are well-grounded. The various health-care proposals represent atrocious legislation. To be sure, they would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear. The uninsured now receive 50 to 70 percent as much care as the insured. The administration argues that today’s system has massive waste. If so, greater participation in the waste by the newly insured may not make them much better off.

The remaining uninsured may also exceed estimates. Under the Senate bill, they would total 24 million in 2019, reckons Richard Foster, chief actuary of the Centers for Medicare & Medicaid Services. But a wild card is immigration. From 1999 to 2008, about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren’t covered by Obama’s proposal. If we don’t curb immigration of the poor and unskilled — people who can’t afford insurance — Obama’s program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants’ impact, because it seems insensitive.

Meanwhile, the health-care proposals would impose substantial costs. Remember: The country already faces huge increases in federal spending and taxes or deficits because an aging population will receive more Social Security and Medicare. Projections the Congressional Budget Office made in 2007 suggested that federal spending might rise almost 50 percent by 2030 as a share of the economy (gross domestic product). Since that estimate, the recession and massive deficits have further bloated the national debt.

Obama’s plan might add almost an additional $1 trillion in spending over a decade — and more later. Even if this is fully covered, as Obama contends, by higher taxes and cuts in Medicare reimbursements, this revenue could have been used to cut the existing deficits. But the odds are that the new spending isn’t fully covered, because Congress might reverse some Medicare reductions before they take effect. Projected savings seem “unrealistic,” says Foster. Similarly, the legislation creates a voluntary long-term care insurance program that’s supposedly paid by private premiums. Foster suspects it’s “unsustainable,” suggesting a need for big federal subsidies.

Obama’s overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates the Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small-group markets, where many workers would end up, might rise an extra 25 to 50 percent over a decade. The administration and the CBO disagree. The dispute underlines the bills’ immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.

So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.