Archive for March, 2010

Health Reform Insider Goes to the Toast and Polls

Tuesday, March 30th, 2010

President Obama signed the final piece of the health reform package today. So before we do anything else and get caught up in the next round of debate, here’s a toast to all those who have worked so hard over the past year to get us this far.

And what goes better with toast than a bill summary?

(We couldn’t think of anything, either.)

So now what?
Congress’s work on health reform is complete (at least for now) but with barely a pause for breath, the hissy fit against reform has continued, merely shifting venue to the states and the upcoming fall elections. Public outreach is still needed, both because a number of provisions take effect very quickly (here they are), and the ongoing smear campaign against reform.

Thirty something
As we mentioned last week, legislators in over 30 states have filed legislative proposals or constitutional amendments regarding health reform. Although there are a few variations on the theme, the main claim is that Congress does not have the authority to impose a tax penalty on people who do not have qualifying health insurance.

And a dozen or so Attorneys General have filed suit against the federal government, claiming, among other things, that it does not have the authority to condition federal Medicaid matching funds on states meeting federal eligibility criteria, because to do so would impose costs on the states. (This is a strange argument, since the federal government has been doing exactly that since the beginning of the Medicaid program.)

Analysts have concluded that the proposed challenges lack legal merit. See:

But merits shmerits. Remember, the goal here isn’t to build sound legal cases but to gin up fervor to elect anti-reform members to Congress (or in the case of the AGs often to get themselves elected to higher office) and create a screen of apparent public opposition to reform for state officials intent on foot-dragging to hide behind.

They may also be trying to force the administration to make a potentially damaging public admission that the individual mandate constitutes a tax—thus violating an Obama campaign pledge.

A dead end strategy?
Given some truly awful recent Supreme Court decisions, no one can afford to laugh at the prospects of litigation, even though most nonpartisan analysts have concluded that they are without merit.

Still, challenges aside, there is reason to be optimistic about the future of reform.

First, the status quo is unsustainable—and more and more civic leaders are recognizing that. Reform opponents have no meaningful alternative that will address the rising costs and rising numbers of uninsured that are undermining the system.

Second, reform does a number of popular things (insurance reforms and subsidies, say) that will be not only be difficult to undo, but also difficult to separate from some of the less-popular aspects.

Third, reform creates more winners than losers among interest groups. There are not that many stakeholders who have a vested interest in repealing (not to be mistaken for amending) key parts of reform. Hospitals, doctors and drug companies can all find provisions they do not like but on balance, the extension of coverage to more than 30 million people will be good for the health care industry. States have concerns about the cost of the Medicaid expansion, but the expansion is 100 percent federally-financed in the short run, and provisions like increasing the Medicaid drug rebate rate will reduce state costs.

What about businesses? Although some may have concerns about the “free rider” provisions, only a very small percentage of employers will actually be subject to any penalties (The Congressional Research Service estimates only about 5 percent).

So too with the individual mandate. Most people already have private or public insurance or would voluntarily purchase coverage once a subsidy is available. The mandate is a tool to ensure the broadest possible risk pool and to prevent people from churning off and on health insurance on an as-I-need-it basis.

But if Massachusetts is any guide, the mandate will (notwithstanding the political furor of the moment) be, in practice, fairly acceptable to the general public.

Even the insurance industry, which spent millions to defeat reform, may think twice before getting behind a repeal effort. Especially since if the effort is only partly successful, it could be left with new requirements to cover high-risk and high-cost individuals without the guarantee of a bigger and on average healthier subscriber base.

And it looks, early on anyways, that public opinion is swinging toward reform.

This may be the case in part because broadstroke polling has always overstated the opposition—polls and stories before reform passed often failed to break out the anti-reformers from those who were unhappy with the current bills because they wanted reform to go further.

But new post-reform polls (check out this Five-Thirty-Eight post) that have gone deeper show an upward trend of support for reform.

Those, for instance, who say the law is a step in the right direction are unlikely to see repeal as anything but two steps back.

The question becomes: How much of the public can be made to believe things that are not true about health care reform—and for how long—now that it is law?

And here, there’s some cause for concern that goes beyond the persistent misunderstandings of what is in the law. A recent Harris poll shows 23 percent of adults in the US (41 percent of Republicans) think that President Obama wants to use an economic collapse or terrorist attack to assume dictatorial powers, and 24 percent of Republicans think President Obama may be the anti-Christ. We may surmise that these folks are unlikely to be persuaded on health care no matter what advocates (or anyone else) says or does.

On the other hand, as Nate Silver noted in the above link, public support seems to be going toward reform, though it is too soon to say whether this is a long-term trend.

The best thing advocates can do is go out and explain what reform really does (and what it doesn’t do). The more public understands reform, the less support there will be for a rejectionist agenda. Reaching out to constituencies that will benefit from early improvements (again, check out our Quick Win fact sheet)—including seniors, small businesses and children and adults with pre-existing conditions—are a good place to begin.

Seniors have generally been more opposed to reform than most age groups, and opponents have consistently claimed that reform is bad for Medicare. The first changes that seniors will see is the beginning of a phase out of the doughnut hole and new preventive care benefits in Medicare.

Many small businesses are probably unaware that they are exempt from “free rider penalties” or that the new law includes an immediate tax credit for small, low-wage businesses that offer health insurance.

For children and adults with major or chronic conditions, the bill has provisions to, immediately eliminate pre-existing conditions for children (pending HHS regulation), allow young adults to remain on their parents’ plan, eliminate lifetime benefit caps and create (or enhance) a high risk pool, and will provide immediate benefits for children and young adults with special health care needs.

Implementation: a three-piece puzzle

Going forward the keys to successful implementation include:

-An aggressive effort to build public support for reform

-Engagement at the state and federal level around the state laws and state and federal regulations that will govern the details of implementation

-Maintaining and strengthening the Medicaid program during the interim period when the states’ fiscal crisis is still squeezing the program and new federal coverage rules have not yet kicked in.

We’ll look at the way these three interlocking pieces fit together and developments in the weeks ahead.

–Michael Miller, director of strategic policy

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A big f#*@*!* deal

Wednesday, March 24th, 2010

4458527284_21d7409410_mPresident Obama’s signing of the national health reform bill yesterday marks an historic achievement in American history on par with the passage of Social Security and Medicare.  The Patient Protection and Affordable Care Act (summary here) establishes a framework to provide health security for all, and takes immediate steps in that direction.  Of course, there are flaws and omissions in the law as there were (and still are) with those earlier milestones, but PPACA gives us a strong foundation on which to build. How strong? Our fact sheet tells you.

This victory could not have happened without the commitment of the President and legislative leaders, the tireless dedication of staff, and the amazing work of advocates for the health and economic security of all Americans.

Ugly and Ducking

While we can and should celebrate this victory, it has certainly been sad and sobering to witness the opposition’s extremist acts.  Members of the Congressional Black and Hispanic caucuses, as well as openly gay Congressman Barney Frank, were verbally assaulted and spat on.

Someone threw a brick through the window of Rules Committee Chairwoman Louise Slaughter’s office, and Republican Congressman Neugebauer shouted an epithet at Rep. Bart Stupak from the House floor (Rep. Neugebauer later apologized, saying he was talking about the bill).

Many of the protests have called up the worst mob-like vitriol we saw on the 2008 Presidential campaign. House Republicans have generally declined to distance themselves from these events and instead offered embarrassingly weak rationales.

Apocalypse Now?  No?  Well how about now?

Those watching the House floor debate wouldn’t be blamed for feeling like they’d heard the GOP’s world-ending predictions somewhere before.

It seems through a warp in the space-time continuum (perhaps brought about by health reform’s passage) Congressional Republicans are using the same speechwriters as Alf Landon, the 1936 Republican candidate for president, and as the Medicare opponents who wrote this for then pitchman-for-hire Ronald Reagan.

In one sense, however, those who claim this health reform law marks the end of America as we know it are right.  In America as we know it, thousands of people die every year because they don’t have health insurance, and thousands more face bankruptcy from health care bills they can’t afford.

As of yesterday, that America is on its way to being history—the kind of history we learn from, and move beyond. As REM sang, “It’s the end of the world as we know it and I feel fine.”

The Senate Process—the end of the beginning

Democrats scored a key victory late Monday when the Senate parliamentarian ruled against an effort by Republicans to strike on technical grounds an amendment to the excise tax on high-cost health plans.  Yesterday the Senate voted to take up the amendments and started the clock on the 20 hours of debate allowed under the rules of reconciliation.

During the debate we are seeing Republicans do everything they can to delay passage, but their chance of derailing the bill is minimal. This is political theater, but it’s not responsible governing.

The bill now on the floor of the Senate makes mainly popular fixes to the now-law  reform by closing the Medicare prescription drug “doughnut hole,” increasing Medicaid funding for states, striking special deals, and reducing the excise tax on high-cost health plans.

Everything right is wrong again

With the law signed, opponents’ goal is no longer to stop these things from becoming law on the Senate floor (an almost certainly vain effort), but to offer amendments that will make good fodder and embarrassing ads for the November election.

Amendments are being offered on all kinds of subjects, many of them unrelated to the bill, for the express purpose of forcing Democrats to take hard votes. Although it’s possible that some changes will be made in the Senate, which would necessitate a conference committee or one more vote in the House, there is little doubt as to the final outcome.

While passage of the amendments to PPACA will mark a welcome end to a lengthy and often acrimonious debate, there is little time to pause to enjoy the achievement.

With the ink barely dry, the action is already moving in new directions. State and federal officials must begin the task of implementing the bill, some provisions that take effect almost immediately, while opponents are already launching legal and political challenges.

Not in My Backyard

Seven minutes after President Obama signed health reform into law yesterday, 13 state AGs filed a lawsuit claiming the individual mandate in unconstitutional. More than 30 states have threatened to bring bills and ballot questions to repeal health care reform, or elements of it.

Most legal scholars say such challenges are legally specious and will have little purchase on implementing reform. But rolling back reform isn’t the primary aim of such repeal threats anyway–it’s to drive reform opponents (plus the angry and misinformed) to the polls in November.

But already doubts are growing about this strategy. Some Republican leaders are suggesting that they’d like to repeal some parts of the law, but leave others alone (no one wants to be the guy who re-allows insurers to deny coverage to kids with pre-existing conditions).

And a Gallup poll yesterday suggests public support for health reform has already jumped. As more and more people understand what reform is (and what it’s not) those numbers are likely to improve even more.

And that’s the key to making this thing go—the more real people understand the real help that comes from this bill, the harder it will be for state politicos with dreams of the Governor’s mansion to make the case for taking it away.

So the work goes on. Advocates and others who helped this bill become a law now must step up to the challenge of keeping it strong.

–Michael Miller, director of strategic policy

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How sweet it is

Monday, March 22nd, 2010

The U.S. House of Representatives passed the most comprehensive health care bill since Medicare last night–a bill that provides health care coverage to 32 million more Americans, ends decades of unjust health insurance practices that discriminate against those who get sick, and curbs runaway health care costs.

The President is expected to sign the bill tomorrow, and the Senate will begin debate then on a series of fixes to the bill. There is–as always–more work to be done.

But today we thank the Representatives who crafted the bill, who stood in support of reform and took the votes, all their “punk staffers” who have worked without weekends and sleep for the better part of a year (and some for much longer), and all of the reform advocates for their tremendous, sometimes Atlas-like work in helping to pass this bill.

(Here is Community Catalyst’s official statement, and what you need to know about reform right now. And if you don’t follow the Hub on Twitter yet, get on board before the Senate debate begins.)

When it comes to reflecting on What This Means — in history, yes, but also in plain English — there are few who said it better than Michigan Rep. John Dingell, who’s father, John Dingell Sr., gaveled in Medicare in 1965 (and who lent that historic gavel to Speaker Pelosi for the vote last night.) Here’s what he said after the vote last night:

I gotta tell you, the air has been redolent with falsehoods and deceit. And Madame Speaker persisted clear through this, and my colleagues stuck. And nobody ran when the heat got high.

And I want you to know I am very proud of this leadership and of my colleagues, and of a lot of new members who made some very hard and difficult votes,  for which they can be proud, and for which they will be rewarded with re-election, because they showed courage and wisdom. And they did something that was very important.

But dear friends, there’s something else. Now when Americans lose their jobs, now when Americans go to bed, they won’t have to worry when they get up the next morning: Are they going to have health insurance?

We have established a basic principle now–finally–in a bill that is going to the President to be signed–that says  health, and good health, and health insurance, and health care, are not a matter of privilege for the privileged few, but rather they should  be for everyone.

And the government has finally decided we’re going to take care of that.

–Kate Petersen, Health Policy Hub

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48

Friday, March 19th, 2010

I don’t watch the show 24, but here at the Hub, I’m getting the idea. Health care reform in real time. The clock running down on the House vote. And for this blogger, not a whole lot of commercial breaks.

Here is a summary of the bill, with a little discussion on each section about what changed, what hasn’t, and what it means.

As you know, it has been a long road and a few hairpin turns to get here. The next 48 hours can change the course of health care in this country for millions of families.

Despite the political heat, passing this bill won’t be remembered as a political win. If we pass it, it will be a win for people. It’s a step toward taking better care of each other. It is about changing a system that works for companies, not human beings.

You know your networks. You know the numbers. And you know that pro-reform voices are vital to passing this historic legislation.

Let’s get this done. See you Sunday.

–Kate Petersen, Health Policy Hub

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Land Ho!

Monday, March 15th, 2010

After a stormy voyage of more than a year, this Monday morning finds the good ship health reform within sight of a final vote. The tentative timetable has a CBO score out today or tomorrow, Rules Committee action on Wednesday and a vote before the end of the week.

Our understanding is that House leaders are leaning toward a single vote on the Obama fixes that will contain a clause passing the Senate bill passed upon passage of the amendments. That way, House members who are unhappy with the Senate bill will never actually have to vote on it. We do not expect House leadership to wait for all the votes to be locked down before going to the floor, but instead think they will schedule the vote once they are close and try to round up the last few yeses as the debate and vote are happening.

Deconstructing the Opposition Strategy: Be Very Afraid

The Republicans’ strategy at this point boils down to trying to scare the House Democrats into voting no. Their two main lines of attack are:

  1. The Senate won’t pass the fix-it bill, leaving the House stuck with the Senate bill.
  2. It will mean electoral trouble for Democrats in the fall.

Let’s break down each argument:

The first argument has shifted in recent weeks. Originally, the Republicans tried to play on the institutional distrust between House and Senate, suggesting that if House members “took the plunge,” Senate Democrats would leave them high and dry. But as more and more Senate Democrats committed to voting yes on a package of amendments (at least the necessary 50 have done so) the power of this scare tactic has waned, and so Republicans now threaten instead to gum up the works, making passage as hard as possible.

As we observed before, the bill that comes to the Senate will be small and will contain things that are easy to support—e.g. closing the Medicare doughnut hole, increasing federal funding for Medicaid, taking out special deals. Though Republicans certainly might play obstruction games, such parliamentary delay tactics may not play out the way they hope—think of the way Gingrich shutting down government in the 90s backfired with the public.

The second line of attack is that if Congressional Democrats vote yes, it will cost them their jobs. Republicans recently put out a poll from districts of swing members purporting to show that vote for reform would hurt their electoral chances. Whether a coordinated part of the strategy or on their own initiative, two former Democratic pollsters made the same argument in a Washington Post op-ed.

What makes the piece fishy is that a) the only polling they cite is from Rassmussen, a polling company with a well-known “house effect” in favor of conservatives and Republicans  and b) they conclude that what the Democrats should do is essentially pass the House Republican health care proposal (you can compare the GOP proposal to Obama’s plan here).

A more fair reading of the polling:

  • People want major change
  • The main elements of the reform bill are popular, and some are very popular.
  • People don’t know what’s in the bill. As Jon Stewart pointed out (watch at 4:05), there have been not a few misinformation campaigns to take the credit there. But once they learn what’s actually in the bill, they like it a whole lot better.

As the President has become more active in the debate and pushed out a clearer message about what reform does—eliminate insurance company abuses, provide people with security of never losing their coverage, provide tax credits to small business to help them afford insurance—public support has trended up.

Not to say that there aren’t some fundamental glitches in public opinion. Voters think a bipartisan bill is important, and that Democrats should keep working with Republicans until they get it. What the media have failed to convey is that

  1. the bill is supported by Republicans, including governors, former Senate leaders and former administration officials and
  2. the bill is essentially what Republican Senators proposed as an alternative to the Clinton plan in the 90s.

Finally, what should be clear after the Blair House summit is that there is no hope of getting any kind of bipartisan agreement, short of giving up and passing the Republican plan. It would be much more meaningful if pollsters confined their questions to the real choices that are available instead of setting up straw men.

Polls aside, there’s no doubt Democrats are sailing into a stiff headwind right now. The President’s party usually loses seats in the midterm, and this year the persistently high unemployment is fueling voter discontent. Discontent is aimed at incumbents generally, but with a large number of House seats to defend in historically Republican-voting districts, and with incumbent Senate Democrats from conservative states like North Dakota and Indiana retiring, the GOP could see substantial pick-ups. Add in the expected flood of corporate cash into the elections courtesy of the Supreme Court and it is shaping up to be a tough year for Democrats, indeed.

But the fundamental political question persists: are Democrats helped or hurt by failure to pass health reform? They are already on the hook for voting yes and attack ads are already being produced. Flip-flopping is famously unpopular in politics and is unlikely to win a pass from reform opponents in the election. Passing reform gives House Democrats a concrete historic accomplishment with which to fight back.

It don’t come easy: Math in the House
In November, the House health care reform bill passed with  220 votes. Currently with vacancies, 216 are needed to win.  If everyone who voted yes last time votes yes again, reform passes. But House leaders can’t count on every yes vote remaining in place, so every yes-to-no vote must be offset by finding a no-to-yes.

Here are three places where votes are at risk:

Abortion
The number of Democrats willing to ‘vote off’ because of abortion seems to be declining.  A recent letter from pro-life clerics and theologians looked at the abortion provisions in the Senate bill, chapter and verse, and concludes that the bill does not provide federal funding for abortion.  Several members who voted for the Stupak amendment have publicly reached the same conclusion. And although Stupak claimed that he has about 12 members who will stick with him in voting off, his camp seems to be shrinking as the reality that the Senate bill does not allow federal funds for abortion has begun to sink in. Most analysts put the total number of no votes on account of abortion at five or six.

Immigration
The Senate bill bars undocumented immigrants from purchasing health insurance through the new insurance Exchanges even if they use their own money. It also fails to provide equal coverage to legal immigrants, continuing a ban on federal matching funds for state Medicaid coverage and offering instead less comprehensive and more costly coverage in the Exchange. As a result, a number of lawmakers in the Congressional Hispanic Caucus have said that they were leaning toward a no vote.  The issue is further complicated by the fact that the provision relating to undocumented individuals cannot be addressed via budget reconciliation.

But a Medicaid provision that gives states at least the option to cover legal immigrants could be addressed in reconciliation.  While most states would probably not take up the option, the measure could at least provide fiscal relief and perhaps better coverage in those states who now cover legal immigrants with 100 percent of state dollars.

How possible is this? Remember that in the initial House vote in November, there was an 11th hour change on abortion. It’s still possible that House leaders and the President will see the light on Medicaid for immigrants, especially if it is the only remaining obstacle to passage. However, even if this last-minute adjustment is made, the legislation does not go far enough in providing equal access to coverage for immigrants, which only underscores the importance of comprehensive immigration reform (check out this weekend’s march here).

The Scott Brown effect
In the wake of the election of Republican Senator Scott Brown, the Massachusetts delegation has become visibly uneasy about reform. Despite compelling evidence that the Brown election did not turn on the candidates’ positions on health care,  some members of the normally solidly liberal Massachusetts delegation have indicated concern about moving forward, though not all have given the same reasons.  It’s hard to imagine that Massachusetts Democrats would actually sink national health care reform. But as the Brown election proved, nothing can be taken for granted—even in Massachusetts.

Coming soon

Stay tuned for updates this week as the CBO score becomes available and we get more clarity about the vote schedule.

-Michael Miller, director of strategic policy

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And now, the moment you’ve all been waiting for

Tuesday, March 9th, 2010

For months, various parties have been calling on the President to clarify exactly what he was for and, following the loss of a 60-vote majority in the Senate, how he thought that could be accomplished. Starting with the run-up to the Feb. 25 summit, President Obama did just that, laying out a package of amendments to the Patient Protection and Affordable Care Act passed by the Senate and calling last Wednesday for an up-or-down vote on health care within the next few weeks.

The President’s proposal would improve on the Senate bill by toughening oversight of the insurance industry, improving benefits and affordability provisions and closing the Medicare part D doughnut hole. He also added several Republican ideas from the summit such as new proposals to reduce payment errors in Medicare and Medicaid.

In a surprise to many, the RNC called on Groucho Marx to deliver their response.

OK, just kidding. What was striking about the real response from Congressional Republicans was the way they resorted to invective. Away from the Blair House setting—where they could be directly challenged for “having their own facts”—they reverted to much harsher language than they used in the largely civil exchange during the summit. “Job-killing“(Independent analysts say health reform will promote job growth), “budget-busting” (the CBO says that reform will reduce the budget deficit by about $100 billion over 10 years and by $1 trillion over 20 years) “government takeover” (people get a choice of private insurance plans) were some of the greatest hits from the last week in sound bytes. Oh, and of course the ubiquitous “jam” that Jon Stewart spoofed last week (video at 2:20).

Despite the fact that the Senate bill that is remarkably similar to the one that Republican moderates were advancing in the 1990s, today’s Republicans have made it clear (through this RNC fundraising presentation, among other things ) that polarization and fear-mongering are central to their campaign strategy. No wonder no bipartisan health care compromise has been possible.

This fact-resistant extremism could be a factor that helps clear the way for final passage. Another other is a series of highly visible double-digit premium increases that are being proposed across the country, especially in the non-group market. The lack of any insurer accountability has been a stark and timely reminder of the need for change.

Here to there: the New new timetable
Deadlines have come and gone more than once while the health reform debate has dragged on. We now have another schedule for action, albeit a tentative one. The administration is hoping to have a reform vote in the House by March 18, just 11 days from now, and hopes that Senate action will begin prior to the spring Congressional recess, which starts March 29.

The first vote is the hardest
Although the challenges of using budget reconciliation have drawn the most attention from commentators, the hardest step in the process from here on out is the first vote in the House. Although subsequent action will address many of the problems House members have with the Senate bill, the path forward requires the House to vote first for the Senate bill as-is and then vote to fix it—something that many House members have expressed reluctance to do.

Abortion contortion
Probably the House leadership’s biggest stumbling block to assembling a majority is dealing with the abortion issue. In the initial debate in the House, Democrats who opposed choice were joined by Republicans to put in very restrictive language, authored by Congressman Bart Stupak, that many feel will eliminate abortion coverage within the Exchange and may undermine private coverage for abortions in employer-based plans.

According to an analysis by Faith in Public Life,  the language in the Senate already precludes federal funding of abortion.

However, Congressman Stupak has argued that the Senate language is not strong enough, and has declared his intention to vote against the Senate bill, claiming that about 10 other Democrats will join him. Given the very narrow margin of victory in the House, every Democrat beyond Stupak who switches from yes to no because they don’t like the Senate abortion language (or for any other reason) must be offset by switching the vote of someone who voted no the first time to yes the second time.

Facts not worth a hill of beans?
Although it seems his vote is pretty fact-resistant, it appears that Congressman Stupak is misreading the Senate language.2352670827_dc9563c0c3_m

The Senate bill, as best as I can tell, does not allow federal funding of abortions—despite Rep. Stupak’s insistence that it does. And we don’t have to take either Speaker Pelosi’s or the pro-choice community’s word for it. If the Senate allowed federal funding of abortion, then presumably the matter could be addressed in an amendment that would pass through budget reconciliation—an amendment Rep. Stupak would undoubtedly bring.

But there is no such amendment on the table. Why? Because amendments through budget reconciliation must impact the budget, and there is no budgetary implication in the difference between the Nelson and Stupak abortion language. Although there is no public document available, this appears to be the view of CBO.

Remember: the CBO is neither pro nor anti-choice in this debate. They are simply the bean counters. And if they say there are no beans on the table to count that should count for something–if not to Congressman Stupak, then at least to other Congress members who oppose abortion rights as a matter of conscience or religious conviction.

Smooth sailing?
Once a bill does clear the House, the road to reform becomes smoother (not quite seat-belt sign off, but smoother). Although Republicans have threatened to delay the vote in the Senate by filing endless amendments and launching parliamentary challenges, this is as much a psychological game as anything else.

Senate Republicans are trying convince some members on the House side not to take that first vote, playing on the fears of House members who worry that the improvements they’ve agreed to won’t happen and the House will be stuck with the unamended Senate bill. But once the House does vote, the dynamics change. Then the choice is no longer health reform, yes or no, it is health reform as passed by the Senate or health reform with the proposed amendments.

By opposing the amendments to improve the Senate bill, Senate Republicans risk exposing themselves as flip-floppers, voting for policies they previously opposed (such as the special Medicaid funding for Nebraska, and the special excise tax provisions that apply to union-negotiated health benefits) in an attempt to score political points. [I talked about this here last week.]

–Michael Miller, director of strategic policy

photo credit: base10 on flickr

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One year on

Friday, March 5th, 2010

A year ago today, President Obama gathered Congressional leaders, providers, advocates and industry leaders at the White House to start the conversation about health care reform. “The status quo is the one option that is not on the table,” he said then.

And a year later, it’s still not. Millions can’t afford coverage and millions more can’t afford to get sick on the coverage they have. An industry that has profited by exploiting health circumstances that are often beyond people’s control is flaunting 40 percent rate hikes, reminding us that the only people it answers to today are shareholders.  So the status quo is—well—the same.

But we aren’t where we started. In a year of extensive committee hearings, votes and record hours spent working and reworking bills, Congress has crafted a reform that offers coverage to more than 30 million uninsured, allows more people to buy into the private insurance market, and provides help to those who can’t afford it, a reform that prevents companies from denying coverage or sending families into debt spirals after costly procedures, a reform that improves the way we deliver and pay for care in this country – and that pays for itself completely and sustainably. Both chambers have passed such a bill. We are this close.

There are other things that are different a year on. Since the first convening last March and the summer’s glimmer of bipartisan negotiation, Republicans have made a political calculation that though the bills pay for themselves and would offer much-needed help to many people in their districts, they plan to vote against any and all efforts to pass comprehensive health reform.

And after deliberately standing aside to allow Congress to drive and shape reform – (“I just want to make sure that I don’t get in the way of all of you moving aggressively and rapidly,” President Obama said last March) – the President made it clear Wednesday he’s not standing aside anymore.

“Both during and after last week’s summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I do not see how another year of negotiations would help. Moreover, the insurance companies aren’t starting over. They are continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade or even more. The American people, and the U.S. economy, just can’t wait that long.

“So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform….and from now until then, I will do everything in my power to make the case for reform.”

Transcript’s end, he stepped away from the mic and said into the applause:  “Let’s get this done.”

–Kate Petersen, Health Policy Hub

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The Point: The Incredible, Uncoverable Leg

Wednesday, March 3rd, 2010

In this installment of The Point, Hub blogger Kate Petersen’s mother tells about her attempts to get both legs covered by a single health plan. Easy, you say…

I am a speech and language pathologist in a public school system in Arizona. My husband is a retired Public Health Service officer with excellent federal health insurance, and additionally he works full-time as an epidemiologist at a nonprofit organization.  In addition to his federal health benefits, he has  also subscribed to the insurance program offered by his employer so as to cover our daughters as dependents, and to provide primary insurance for me.

My story begins in May 2005 when I was going to an awards dinner. Late on the afternoon of the dinner, after my two-mile exercise walk, I decided that I certainly needed a new frock for the dinner and slipped on sandals to take a brief walk-through of our local outdoor mall.  I succeeded in finding a new dress, but was running very late in getting ready, so I was running across a street in the mall area to get to my car, when the side of my sandal hit a pot hole in the street between brick pavers and I fell.  I continued on my way and went to the dinner, but I had trouble walking and so afterward my husband took me to the emergency room.

I had a non-dislocated fracture of my right ankle.  With a standard course of treatment of casting and non-weight-bearing for six weeks, followed by a walking boot, I gradually returned to full function.  There are no residuals from the fracture.

In 2007, my husband’s business changed insurance companies, and the monthly premium substantially increased.  We considered buying our own policy in order to maintain my coverage and that of my remaining dependent daughter, who was still in college.  My husband got several quotes through an insurance broker who came to the house to ask the ‘few questions’ before collecting the fee and signing us up.

After a lengthy discussion, he told me I would be covered with the exception of my right leg…Not ankle—leg!   I told the agent that there was no follow-up care to my simple fracture, my right leg was uninvolved, and that I was back to hiking and exercising and had been for two years. But he was unswayed in his pronouncement that my right LEG would never be covered.

Needless to say, my husband and I signed up for his company’s group insurance with a higher premium after all, to avoid my leg exclusion.  If the broker agent had only asked the right questions, he would have found out that I had also had a minor surgical procedure on my right index finger earlier that year to remove a cyst – again, without any further treatment. Perhaps then he could have offered me insurance with an entire right SIDE exclusion!

With health care reform,  companies would be barred for denying people with pre-existing conditions coverage – pre-existing conditions that I found out can be specious and exaggerated at the expense of consumers.

Our current system of health insurance coverage is sad and unfair, and I am so grateful to the President, Congress, and all the advocates who are devoting their time and energy to seeking change and justice in the health insurance system so that people get health care benefits they so badly need.


Do you care about changing the health care system? Send your support of health care reform to Congress by signing the petition now (the link works today!)  then sending it on to your family, friends and coworkers.


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UPDATE: You put the right bill in, you get the right vote out

Tuesday, March 2nd, 2010

(Please see corrected link below)

It’s not about the process
With the summit behind us, the press has returned to obsessing about (and misconstruing) the process by which health reform might move forward. So a few important clarifications are in order.

First, health reform will not pass via reconciliation.  Comprehensive health reform will pass as part of the normal Congressional order via a majority vote in the House of Representatives (more on that vote in a minute); having passed the Senate with a super-majority of 60 votes.  House Republicans will have one last chance to vote on this package and nearly everyone assumes that they will unanimously vote no.

What will also pass–by majority in both the House and Senate–are amendments to that bill.  Those amendments, as outlined by President Obama, would do a number of important things: They would increase and equalize federal Medicaid payments across states, provide low- and moderate-income families with better benefits and/or premium subsidies, close that Part D “doughnut hole,” make the excise tax on high-cost plans fairer, and provide tougher oversight of health insurance premiums.

The question that will come before Congress will be on these amendments.  And here’s what the media should be spending more time on: If Republicans vote no in a block, they will be voting for the “Cornhusker kickback” and against more Medicaid dollars for their states.  They will be voting against improving coverage for seniors with multiple chronic conditions  They will also have to cast a vote that makes it clear whether they stand with regular people or insurers on the issue of premium rate hikes. If we focus on substance over process, then voting for a package of fixes to the Senate bill should be a great vote for supporters of reform, and a tough vote for opponents.

About that vote
The President is expected to offer more specifics on the path forward later this week (probably Wednesday, so check in then for our update). But by now, it seems clear that the Republicans have no interest in tighter regulation of the insurance industry or a major effort to cover the uninsured—and Democrats have no interest in scrapping these elements of reform and starting over.  So we can expect a party-line vote going forward.

There has been a lot of media speculation about whether the votes are there for reform in the Democratic caucus in this scenario. Although it’s impossible to do a real vote count before a package of amendments is agreed on, both branches seem close to having the majorities they need.

Much of the recent speculation has centered on the House, where the challenge will be to find a sweet spot that will satisfy both Blue Dogs and Progressives, avoid too many defections on the abortion issue, and also attract 50 votes in the Senate.

Does that sweet spot exist?  Speaker Pelosi and Majority Leader Hoyer believe the answer is yes, and have reiterated their commitment to passing reform. And the House leadership team has so far shown an uncanny ability to move difficult legislation through the House, so betting against them would be unwise.

The final votes in both chambers may be close, and certainly an all-out effort from the grassroots will be needed, (so sign this petition to send a message in support of comprehensive reform and forward this link to your friends and networks too.)  But as we enter the homestretch of the health care reform debate this year, there is good reason for optimism.

About that status quo
Instead of focusing on the intricacies of Congressional procedure and speculating about the vote count, we need to focus on why reform is necessary.  To that end, the Urban Institute is out with a new issue brief that shows just who loses if health reform doesn’t pass.  The biggest losers (out) are older adults, people with pre-existing conditions (and many of you know firsthand just how big a group insurance companies have made that), small businesses and their employees, low-income households  and young adults. These are the groups for whom the current dysfunctional system works least well, and who will be most at risk of being priced out of coverage if reform doesn’t pass.  But ultimately, the Urban brief points out, improvements in security and stability of coverage, and in the quality of care people get, will benefit everyone.

And that’s what it’s all about.

–Michael Miller, director of strategic policy

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