With the AARP’s
official endorsement yesterday, the House health bill is moving more
confidently toward its floor vote, just one day away. Several aspects of this
moment gave us pause. The AARP has never
endorsed this kind of comprehensive health care overhaul, and the House bill is
the most sweeping overhaul of health care policy in
four decades.
"We
started this debate more than two years ago with the twin goals of making
coverage affordable to our younger members and protecting Medicare for
seniors,” said AARP CEO Barry Rand to the Associated
Press. "We've read the Affordable Health Care
for America Act and we can say with confidence that it meets those goals with
improved benefits for people in Medicare and needed health insurance market
reforms to help ensure every American can purchase affordable health coverage.”
House
Speaker Nancy Pelosi and Majority Leader Steny Hoyer are no doubt breathing a
little easier. The AARP’s support (or lack thereof) has proved powerful in the
past, helping to pass the 2003 Prescription Drug Benefit Act and stop the
privatization of Social Security under former President George W. Bush.
But
some major issues still remain. In particular, the coverage of illegal immigrants
and restrictions on federal funds for abortion could both be explosive debates.
The NY Times
does a nice job of parsing out the different factions and deals being
brokered around the latter, which are many and could still unravel the
legislation. Here’s to hoping compromise prevails.
Speaker of the House Nancy Pelosi presented
the Affordable Health Care for America Act today, the House’s health reform
bill. At 1,990 pages and $894 billion,
the measure would extend coverage to 36-million people and reduce future
federal deficits by $30 billion over the next 10 years.
That last fact is a big win for President Obama
and the Democrats who are face daily scrutiny from their Republican
counterparts on adding to the deficit.
It would broadly expand Medicare and provide
subsidies to moderate-income Americans to purchase insurance. And, as promised,
it includes a public health insurance plan.
The
bill has strong similarities with the one emerging from the Senate, but
important distinctions as well. The Senate version would fund reform in part with
a “Cadillac” tax on higher-priced policies (to the vocal dismay
of labor unions). But the House bill would instead tax incomes of
over $500, 000, something Speaker Pelosi calls the “millionaire’s tax.” Pelosi’s
version also prompts almost twice the Medicare cuts on the prescription-drug
industry as the Senate’s $80 billion cuts.
Other points of note are that, as expected, the
House bill bars health
insurance companies from denying coverage based on health history and
requires employers to offer coverage to their workers.
On
a sidenote, we enjoyed the NYTimes’ reporting
on some of the symbolic theatre that accompanied the bill’s unveiling. Apparently,
Representative John Dingell brought out the gavel he used in 1965, while
presiding over the House the year it passed Medicare. “I had the privilege of
sitting in the chair when we offered Medicare,
originally offered by my old dad,” Mr. Dingell said, brandishing the old mallet
at the rally.
“I used this here gavel to preside
over the House, and I’m going to lend it to whoever gets to preside over this
legislation, because a good piece of wood doesn’t wear out with one great
event,” he declared.
Mr. Dingell’s father, John Dingell
Sr. began pushing for national health insurance in 1943.
The big news, to a health insurance blog anyway, was the health reform
bill in the U.S. Senate will include a public health insurance option, reported
CNN.
A senior aide to Senate Majority Leader Harry Reid
told CNN that the public option would be included in the bill and have a clause
allowing individual states to opt-out of the plan if they chose.
The opt-out clause, something we blogged about last
week, is a political answer to for the progressive Democratic base that’s
becoming increasingly agitated at the bill’s current form.
Risky move, Senator. Holding on to votes like conservative
Democrats like Senator Ben Nelson and Senator Blanche Lincoln could make or
break health reform. And we surely can’t forget about Senator Olympia
Snowe, who is the only Republican to show interest in what the Democrats are
pushing.
So say we do get reform. Say it passes in December
and the Democrats, especially President Obama, get a $800 billion Christmas
present. Does that mean we the people get ours too? Actually, no, we don’t.
Most of the bill’s provisions, as it
currently stands, don’t go into effect until 2013. That’s
four years of wondering if the bill to change the health care and health insurance
system will work.
Now, on one hand it makes sense. The health system in the United
States is such a complicated mess there’s no way we can implement
major changes within a few months or even a year. Giving us four years of
prepping will likely do a lot of good to help ensure what does work, will work
very well.
But for Americans who need relief now, this bill is
going to be a big disappointment. And there’s a very good chance
public opinion of the bill will take a dive soon after its potential passage.
According to a recent poll from Kaiser Family Foundation, half of
America believes that health care and health insurance changes will start to
happen in the next year.
A staggering 49 percent think within the next year,
people will get financial help in buying health
insurance plans. What’s more, 51 percent believe health
insurance companies will accept all applications with pre-existing
conditions.
So no relief for four years and the push for a
public option that could doom health reform entirely?
We don’t really have to tell you that cancer and health
insurance don’t really get along all too well.
These days, Americans with serious pre-existing
health conditions, such as breast cancer, definitely have trouble finding
coverage.
In light of Breast Cancer Awareness Month this
October, Secretary Kathleen Sebelius and the Department of Health and Human
Services released a report highlighting the benefits that health reform will
have for women with breast cancer.
The report touts different aspects of the current
health reform bill, including out-of-pocket cost limits, access to health
insurance exchanges for comparison shopping and the eventual elimination of pre-existing
condition exclusions.
In addition to the health insurance
side of things, the HHS says health reform will also help improve care quality
for breast cancer patients.
We thought it was a pretty good (and timely) way to
promote the health reform bill’s passage through Congress.
Unsurprisingly,
the bill to block pay cuts to Medicare
doctors was defeated in the Senate yesterday. This is the bill that would have
intercepted the sustainable growth rate (SGR) formula that is more or less
intended to curb doctors’ rates from climbing too fast.
Both the American
Medical Association and the AARP said they were “deeply disappointed,” reports
the Wall Street Journal’shealth blog.
But, if history
is any indication, the proposed 21% cuts won’t go through anyway. Congress
usually passes a short-term fix to stop that year’s scheduled cuts. Then does
it again the next year and the one after that, but always stops short of scrapping
the system altogether.
The way Senate Majority
Leader Harry Reid put it: “Right now, we’re going to a one-year fix.”
Here’s the thing:
Blocking the cut would add $247 billion in federal spending over the next
decade. And while there is talk that the Republicans will offer amendments to
offset the cost, nothing has yet materialized.
However, the issue
is far from over. More wrangling is going to ensue around this, especially with
the recently introduced House bill that would completely axe the SGR
formula.
Back
on the make with new hair, new shoes and — sing it, Patti —
a new attitude.
What
makes it so politically viable this time? A little opt-out clause that may very
well be the magic bullet the Obama administration has been seeking.
The
newest vision for the public option proposes establishing a national health
care plan that states can opt out of. That means that Republicans and
conservative Democrats could more easily sign off on the overall legislation knowing
that they can defer the actual decision to local governments.
And,
clearly, it would get on board progressive Democrats who insist on a
government-sponsored plan. That it has a good chance of garnering
bipartisanship that runs more than one-deep? Even better.
Now,
it’s true something similar has already been proposed (the Carter plan),
wherein states could choose to opt in for a national plan.
But
it’s been estimated that an opt-in would only produce a government plan in
10-20 states whereas the hurdle of having to affirmatively vote a public plan
out on a referendum could conceivably bring that number up to 47, reports the Huffington
Post.
This
idea is still young, yet to be officially introduced, but out of everything
that’s bubbling up in the current phase of amendments and bill-melding, this is
one we’re keeping an eye on.
Just barely has the Democrats’
oh-happy-day sobered up and already serious trouble is galloping their way.
Some of the nation’s largest Labor Unions have
actually come out against the health bill just approved by the all-powerful
U.S. Senate Finance Committee. And we can see why.
The proposal to tax high-priced health
insurance plans would affect half of the 1.6 million members of
the American Federation of State, County and Municipal Employees (AFSCME) union
alone.
Considering that most of them likely traded pay
raises for plusher insurance plans, it’s clear that a fee would kinda sting.
Unions are also pretty unhappy that the bill has no
government-sponsored option.
The Democrats do not want to mess with the unions.
They are a big reason why they got elected — and will be a big reason why they
get re-elected… or not. Something that the union coalition, which also includes
the AFL-CIO, the Air Line Pilots Association and the UAW, is happy to remind their
Senators.
Just one more way politics works into health
reform.
"We worked for all these people. We worked for
Obama," AFSCME head Gerald McEntee told USA
Today. "What do we get for it? We not only don't
get anything for it, we get a slap in the face."
Unless “slap in the face” is a hilariously cute new
term of endearment, it’s clear Labor Unions are none too pleased with the
Baucus Bill.
Unless the Democrats (and a certain Republican)
want to face television ads and "boots on the ground," they’re going
to have to find a way to placate the unions. Unfortunately, the unions’ demands
are strongly opposed by Moderate Democrats and Republicans — who
aren’t expendable either.
If you thought Senator Olympia Snowe’s vote for the health insurance
and health care reform bill from Senator Max Baucus was a big deal, you’d
be right.
Not only did her committee vote set the bill up for
final approval in the full Senate, but it now gives reformers (including the
White House) a major chance of passing the bill without resorting to
reconciliation.
Now, reconciliation is a procedural loophole that allows
the Senate to pass legislation with a simple majority of 51 votes. Only if a
bill is tied to the federal budget can reconciliation happen.
So obviously, health reform qualifies.
Democrats have long held reconciliation as their
ultimate trump card in case they couldn’t hold on to their
conservative party-mates and if Republicans threatened a filibuster. But now
with Senator Snowe’s likely vote, the chance of reconciliation is much,
much lower.
The White House wants nothing more than to call the
health bill bipartisan even if it’s only one Republican who signs on.
Really, it’s kind of like putting lipstick on a… well you get the
picture.
Finance
Committee Chairman Max Baucus kicked things off today declaring, "It's
time to get the job done…This is our opportunity to make history," before
he dipped into some vintage Ben Franklin to caution, “Well done is better than
well said.”
But clearly,
Senator Olympia Snowe didn’t see it as an either/or situation. Just before
indicating that she would vote yes on the pending health insurance
reform bill, she loftily declared, “When history calls, history calls,”
concluding with her own cautionary quote (by Longfellow): “Great is the art of
the beginning, but greater is the art of the ending.”
Walking
on air, Senator Baucus responded that her words would be “long remembered.” Following
the debate on the NY Times’
excellent live blog today, we saw a lot of
words that will be long remembered — for various reasons. Here are a
few gems:
Democratic
Senator Kent Conrad: “Doing nothing is not an option.”
Democratic Senator
Blanche Lincoln: “There is no doubt in my mind that the cost of doing nothing
is simply too high.”
Republican Senator
Mike Crapo: Well, yeah, I don’t know anyone “who believes we should not do
anything.”
Republican Senator
Orrin Hatch: “We’ve just been ramming this through.”
Republican
Senator Jim Bunning, smacking the bill: “This adds insult to injury.”
Republican
Senator John Ensign: “Medicare
will go bankrupt” in a decade.
And our
favorite, courtesy of Republican Senator Pat Roberts: “We are riding hell for
leather into a health care box canyon.”
But at the end
of the day, nothing speaks as loudly as the applause that arose in the room when
the bill finally passed 14 to 9.
A recent Associated Press-GfK poll hands President Obama a good
new/bad news moment which finds increased public support for his health care
overhaul, but still not a majority.
The poll found 40 percent of the country supports
health care and health
insurance reform, while 40 percent oppose reform. That’s a
nice six-point upswing for support and a nine-point downswing of opposition
since last month, according to Politico.
The change in public opinion in reform is extremely
significant, especially as the U.S. Senate Finance Committee is set to vote for
the bill this Tuesday. Polls like these (and the latest CBO
report) are exactly the ammunition the White House needs to put extra
pressure on on-the-fence lawmakers to pass reform.
What’s even better, President Obama’s
approval numbers are back up to 56 percent AND he just won the Nobel Peace
Prize.
The Congressional
Budget Office stated yesterday that the Baucus bill would extend health insurance
to 94% of all eligible Americans. And reduce federal deficits by $81 billion over
ten years and probably lead to "continued reductions in federal budget
deficits" in the years after that.
You
mean it’s healthy and tastes great?
It’s sporty and gets good gas
mileage? It’s something that the Republicans can finally get behind? Yes, yes
and nope.
After
their own review of the 27-page report, Republicans found issue with the tax
increases, voicing further concern that insurers would pass new fees onto
consumers.
Others
wondered just how the bill got their miracle numbers? We loved this headline in
the New York Times health care blog,
Prescriptions: “Reduce the Deficit by Spending $829 Billion. Huh?” That’s was
sort of our initial reaction, too. That Medicaid savings figured heavily into
this was a given, but where was the rest from?
Here’s
what we found in the CBO’s cost-analysis: "The added revenues and cost
savings [from the bill] are projected to grow more rapidly than the cost of the
coverage expansion… consequently, CBO expects that the proposal, if enacted,
would reduce federal budget deficits (beyond 2019) relative to those projected
under current law" by up to one-half of 1% of the national Gross Domestic Product.
According
to the Washington Post,
those spending reductions could mean hundreds of billions of dollars in
savings. Now that’s impressive.
However,
on the bill’s provision of co-ops instead of the so-called public health insurance
option, the CBO were not so glowing. The report noted co-ops would not establish
"a significant market presence in many areas.”
Hmm,
a bit less impressive. But is it a necessary sacrifice?
Yesterday on
the Fox News show “On the Record with Greta Van Susteren” U.S.
Representative John Shadegg discussed health reform, but in a brand new light.
Congressman Shadegg sees a big problem with the current
health reform legislation, in particular the provision which mandates that
every American carry some form of health
insurance.
According to Shadegg, if you defy the law, then you
might face jail time.
While talking with Van Susteren, Shadegg explained
that those who can afford health insurance but choose not to buy a plan will be
fined. This fine, as the bill defines, is considered a federal tax.
In the case where Americans are “fined“
and don’t pay, they can be charged with a misdemeanor. Then the government,
claims Rep. Shadegg, can fine you an additional $25,000 and then put you in
jail for up to one year.
“People find it bizarre, but it shows
how far we’ve gotten away from what we ought to be focused on. Somebody
said it’ll solve the housing crisis, you know?“ said
the Arizona Congressman.
So this is a pretty strong claim that the health
insurance reform bill is out to fine Americans and put them behind bars.
“Can you imagine the sheriff going out
and running you in, throwing you in jail?“ questioned Van
Susteren.
No, we really can’t. If this is truly how
the bill is written, lawmakers definitely need to reconsider the language of
the bill.
“We ought to be focused on bringing down
the cost of health care for every American so they can afford it, deal with
preexisting conditions, deal with people who can’t buy coverage, help
them buy coverage,“ said Congressman Shadegg.
We couldn’t agree more. But why then make
jail time a focus of your conversation on television? Seems a bit odd.
Here’s the transcript of the “On the
Record…“ segment.
Arnold Schwarzenegger is the latest
Republican to support the developing health
insurance legislation.
In a statement,
he said that his goals as governor aligned with those of the Obama
administration — enhancing quality of care, keeping costs down,
improving people’s lives and securing economic recovery.
He underscored “the
vital importance of this issue, and that it should be addressed through
bipartisan cooperation.”
Already last
Monday, former Wisconsin governor and Bush administration health and human
services secretary Tommy Thompson came out in favor of the pending health care
legislation, calling it, “another important step toward achieving the goal of
health care reform this year,” adding that, “failure to reach an agreement on
health reform this year is not an acceptable option.”
And in his own statement yesterday, Mayor
Bloomberg also praised the bill: “The health reform proposal that Congress will
shortly consider is shaping up to merit broad, bipartisan support,
incorporating Republican ideas and earning deserved support from Republican
leaders such as former Senate Majority Leader Bill Frist.”
Oh yeah —
Bill Frist told Time magazine that if
he were still in Congress, the bill would get his vote.
Wow, that’s a
lot of Republican love from the sidelines. Perhaps some of the “let’s get it
done this year” sentiment is catching on…
“I don’t need
maternity care,” said Republican Jon Kyl last week during the Senate Finance
Committee’s health care discussion.
“Your mom probably did,” replied Democrat Debbie Stabenow. (See video below)
Zing! The two senators were debating an
amendment by Kyl that would have prohibited the federal government from
prescribing a minimum benefits package from all insurers, one that includes
maternity care. (The amendment was defeated by a vote of 14 to 9.)
We
couldn’t help but notice a few other instances where the overhaul of health care
has been taking shape as a women’s issue: most notably in Michelle Obama’s speech from the White House
a couple Fridays ago. Although absent from the debate until now, the first lady
stepped forward to address the impact health insurance reform represents for
women, calling it part of “the next step” in their advancement toward full
opportunity and equality.
“Women aren’t just disproportionately affected by this issue because of the
roles that we play in families,” Mrs. Obama said. “Women are affected because
of the jobs that we do in this economy.”
Some
of her key points included that:
Women are more likely to work
part-time or in small businesses or organizations that don’t provide insurance.
Women can be denied coverage
because of pre-existing conditions such as having had a C-section, an
experience of domestic violence, or being a mother (having had a baby).
For more on this subject, see our previous post
on how 7 in
10 women are underinsured or have no health insurance or
yesterday’s NY
Times article by Nancy Folberg, Economics
Professor at the University
of Massachusetts, Amherst, which deftly breaks down how women are
economically disadvantaged by our current system.
The latest Wall Street Journal/NBC poll conducted
this month offered a few interesting insights to what the people, you, think
about health reform and those making the big decisions.
We looked at the results of a few questions from
the 50-plus question poll so we could offer a what-does-it-all-mean type of
analysis.
Here were a few of the poll questions, plus some of
our own analysis:
Question:
Do you generally approve or disapprove of the job Barack Obama is doing in
handling the issue of health care reform?
These numbers are pretty open-ended as the
respondents on both sides could be potentially for or against a sweeping health
reform. So we should take this as a natural division of how a politician can
never make everyone happy.
Question:
Do you generally approve or disapprove of the way that Republicans in Congress
are handling the issue of health care reform?
These numbers are unfortunately also lackluster.
Both parties in Congress almost always have bad approval numbers, and the
reasons for the 65 percent disapproval could be almost anything.
Question:
How well do you think you understand the health care legislation that is
currently being debated in Congress — do you understand it very well,
pretty well, only some, or not very well?
Responses:
57 percent responded very or pretty well. 43 percent responded some or not very
well.
A 14-point swing was a bit more than we might have
thought, but it’s still a telling sign that a large percentage of
Americans still don’t know very much about this health reform bill.
That only leads to misinformation and, many times, unproductive debates.
Question:
From what you have heard about Barack Obama’s health care plan, do
you think his plan is a good idea or a bad idea?
Responses:
39 percent said it was a good idea, 41 percent said it was a bad idea.
This really highlights the deep divisions this
country actually has about health reform. Let’s face it, making
significant changes to a system that’s so big and complex can be a
scary thing. These numbers also reiterate the fact that it’s almost
impossible to make everyone happy when it comes to reform.
Question:
And from what you have heard about Barack Obama’s health care plan,
do you believe it will result in the quality of your health care getting
better, worse, or staying about the same as now?
If you were to point to one thing that could truly
kill health reform, this is probably it. If more Americans believe health care
is about to get worse for them after reform, there’s no way Congress
and the president can politically pull it off. There has to be solid assurances
and proof that health reform won’t worsen the quality of health care
for it to pass.
Question:
Do you feel [the following] absolutely must be included as part of health care
legislation, you would prefer it be included, you would prefer it NOT be
included, or you feel it absolutely must NOT be included?
Responses:
89 percent say reform absolutely must or would prefer that insurance companies are
required cover those with pre-existing conditions.
This is a huge number. Everyone agrees that we need
to be able to provide health insurance
and health care for those who have health conditions. On a side note, if there’s
going to be a “villain” in this tale, the storytellers are
doing a good job making health
insurance companies the scapegoats.
Responses:
57 percent say at absolutely must not be or would prefer not to have a
requirement that all individuals to carry health insurance in the health reform
plan.
Even though Americans want insurance companies to
cover all pre-existing conditions, they’re not willing to match it
with an individual mandate. But because insurance companies will only go for
eliminating pre-existing conditions if there is a mandate, this one might
happen despite of Americans’ worry. We think this number more
reflects our general distaste for rights restrictions and the thought of the
government making us spend money on something.