by Julie Rovner
March 9, 2010
Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.
So here’s a short refresher.
According to the Congressional Budget Office, the Senate-passed bill would expand coverage to roughly 30 million of the 46 million people in the U.S. who lack health insurance. Most of the remaining uninsured would be undocumented immigrants, who would be ineligible for benefits under the bill.
One of the most popular things the bill would do is ban insurance companies from excluding people or raising their rates, because they have what’s known as a pre-existing medical condition.
What’s that? Here’s how California Democratic Rep. George Miller described his: “I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I’m dead in that insurance market if I have to switch policies or switch companies.”
But in exchange for getting insurance companies to agree to accept everyone, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that’s a lot more controversial: It requires everyone to have insurance.
That’s something many Republicans used to support, but don’t now. “Never has the federal government said any American had to buy anything. Now, [you] have to buy insurance. If you don’t buy insurance, pay the IRS more money,” said Sen. Charles Grassley (R-IA) during the Senate’s floor debate in November.
Grassley is correct in that the mandate would be enforced at tax time. If you can’t prove you’re covered, you’ll pay a penalty.
But help will be available. If you’re poor, you’ll get health insurance for free through the Medicaid program. For the first time, able-bodied adults who are simply low-income would become eligible for Medicaid.
Middle-class people who have to buy their own policies would get government subsidies. And small businesses would get tax credits to encourage them to help pay for insurance for their workers.
Those who have to buy their own health insurance get another leg up — a new marketplace called an exchange. There they could pool their buying power and compare their options.
At the same time, said Senate Finance Committee Chairman Max Baucus (D-MT), “exchanges will make it easier for consumers to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans.”
Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health care professionals.
“We … believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed,” House Majority Leader Steny Hoyer (D-MD) said at the White House health meeting last month. In other words, the new payment system would be based on how health care professionals do their jobs, rather than just how many tests they order or exams they perform.
But politics has had a lot to do with getting the bill this far. Now House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they’ll have to approve that Senate bill with no changes.
That means, as Sen. Lamar Alexander (R-TN) reminded everyone at last month’s meeting, “It still has the sweetheart deals in it. … I mean, what’s fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what’s fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming?”
Alexander was referring to several deals cut by Senate Majority Leader Harry Reid to win the 60 Democratic votes needed to get the bill passed by the Senate.
Of course, here’s where this process gets even more complicated. Those so-called sweetheart deals are expected to be cancelled in a second bill. That so-called fix bill will carry the compromises now being made between the Senate and the House. That bill is also likely to alter the way the health care program is paid for.
But that second bill is still being drafted, and House Democrats are skittish about its ultimate prospects. Don’t expect a House vote on the Senate bill until they get some assurances about what that second bill will do — and that the Senate can actually pass it.
Last Thursday’s first-of-its-kind summit capped off a debate that has lasted nearly a year. Every idea has now been put on the table. Every argument has been made. Both parties agree that the status quo is unacceptable and gets more dire each day. Today, I want to state as clearly and forcefully as I know how: Now is the time to make a decision about the future of health care in America.
The final proposal I’ve put forward draws on the best ideas from all sides, including several put forward by Republicans at last week’s summit. It will put Americans in charge of their own health care, ensuring that neither government nor insurance company bureaucrats can ration, deny, or put out of financial reach the care our families need and deserve.
I strongly believe that Congress now owes the American people a final vote on health care reform. Reform has already passed the House with bipartisan support and the Senate with a super-majority of sixty votes. Now it deserves the same kind of up-or-down vote that has been routinely used and has passed such landmark measures as welfare reform and both Bush tax cuts.
Earlier today, I asked leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And now, I’m asking you, the members of the Organizing for America community, to raise your voice and do the same.
The final march for reform has begun, and your participation is crucial. Please commit to join with me to take reform across the finish line.
Essentially, my proposal would change three things about the current health care system:
First, it would protect all Americans from the worst practices of insurance companies. Never again will the mother with breast cancer have her coverage revoked, see her premiums arbitrarily raised, or be forced to live in fear that a pre-existing condition will bar her from future coverage.
Second, my proposal would give individuals and small businesses the same choice of private health insurance that members of Congress get for themselves. And my proposal says that if you still can’t afford the insurance in this new marketplace, we will offer you tax credits based on your income — tax credits that add up to the largest middle class tax cut for health care in history.
Finally, my proposal would bring down the cost of health care for everyone — families, businesses, and the federal government — and bring down our deficit by as much as $1 trillion over the next two decades. These savings mean businesses small and large will finally be freed up to create jobs and increase wages. With costs currently skyrocketing, reform is vital to remaining economically strong in the years and decades to come.
In the few crucial weeks ahead, you can help make sure this proposal becomes law. Please sign up to join the Organizing for America campaign in the final march for reform:
When I talked about change on the campaign, this is what I was talking about: coming together to solve a huge problem that has been troubling America for 100 years and standing up to the special interests to deliver a brighter, smarter future for generations to come.
I look forward to signing this historic reform into law. And when I do, it will be because your organizing played an essential role in making change possible.
President Barack Obama
U.S. Secretary of the State Hillary Clinton, visited Chile yesterday bringing aid and promising U.S assistance. Her trip was confined to the Santiago airport and then to a visit with President Michelle Bachelet and President-elect Sebastian Pinera. At Chile’s request, Clinton brought with her 25 satellite phones and a technician to set them up. Satellite phones are needed to help authorities communicate with areas where telephone lines have been destroyed by the quake.
“America is ready to respond to requests from the Chilean Government, not only in solidarity, but with the specific provisions they need for reconstruction work,” Clinton said.
Chilean President Michelle Bachelet thanked Clinton and President Barack Obama for the “support, friendship and cooperation” of the United States.
Further U.S. aid may include eight water purification systems, power generators and medical and dialysis equipment, and supplies. Other donations could include mobile kitchens, temporary bridges and helicopters
Her trip to Chile was part of a five-day tour to visit Latin American countries, including Uruguay, Argentina, Brazil Costa Rica, and Guatemala to gain support for U.S. sanctions against Iran amongst other reasons.
Photo Source: www.thepulse.cl
The government of Chile officially asked for help from the United Nations today. In response, the UN stated that it is “ready to take action”. The 8.8 magnitude earthquake that struck 200 miles south of the capital, Santiago has left the death toll currently at 708 with 2 million people displaced. Since the earthquake two days ago, the Chilean government has been assessing the damage and international aid groups have sent experts and funding but have held back on providing large amounts of aid. U.N. humanitarian spokeswoman Elisabeth Byrs said Chile formally made its request for temporary bridges, field hospitals, satellite phones, electric generators, damage assessment teams, water purification systems, field kitchens and dialysis centers.
The International Red Cross has also stepped in to help by providing $280,000 of its own funds and dispatching aid experts and volunteers to areas hardest hit by the quake. The International Red Cross states that they will have to wait on local officials and the Chilean Red Cross to find out what is needed.
Doctors Without Borders said it sent an exploratory team of health workers to help the Chilean government. They will travel today to the Maule region and will focus on areas close to the epicenter of the earthquake, prioritizing rural villages where aid often takes far longer to reach than in cities.
Tomas Munita for The New York Times
All week President Obama and members of his administration repeatedly denounced pundit claims that the healthcare summit was an act of political theatre. Neither side of the aisle wanted to imply that the summit had any real chance at producing a significant breakthrough in the healthcare debate. In fact, Congressional Democrats came into the meeting having already threatened to expedite the bill through the legislative process, ironically, called ‘reconciliation’. Congressional Republicans, prior to the assembly, planted their feet firmly into poll tested talking points and took every chance they could to mock the Presidents sincerity and willingness to act bipartisan.
As for the meeting itself?
Well, it was too boring to be called political theatre and too theatrical to bring about any reconciliation. There are two issues that immediately come to mind when attempting to define the reasoning behind this summits failure. The first, is that it was simply too late in coming. Had President Obama come out immediately announced the meeting in early 2009 and challenged the two parties to discuss their differences face to face and in front of television cameras, then maybe he could have silenced much of the resistance and maintained control of the debate. This actually brings to view the inexperience of President Obama, who deserves to take full responsibility for this disappointment. President Obama promised to make his administration the most transparent in history only to turn around and hold closed-door meetings on healthcare reform with members of his own party long before meeting the brick wall known as the Republican Party. This gave both instant legitimacy to Republican talking points and easy fodder to establish lasting distrust of President Obama’s agenda. This, along with the lack of unity within the Democratic Party itself on this issue, allowed the republicans to keep the focus on bashing Obama’s proposal’s and fanning the flames of distrust that President Obama himself ignited. Therefore, long before the summit was even announced, pundits were able to pump their rhetoric into the cynical minds of conservatives, loyal Republican Party constituents, and disillusioned moderate Democrats. In other words, after a year of debate, minds were simply already made up and no amount of nationally televised discussion, even if it had been substantial, would have changed them.
…and that brings me to my second point.
President Obama challenged the Republicans to present their alternatives in front of the cameras because he viewed much of their rhetoric to be melodramatic and thought he could prove the Republicans were indeed just the party of ‘NO!’. The Republican point of view was that this meeting of minds was just another slip up by the President and considered the offer to meet publically as a win-win scenario for their party. If they showed up and engaged the President and Democratic Party than they could squash the partisan label that the Democrats had been trying to place on them. Or they could walk away, regardless of how the debate went, declaring that it was the Democrats who continued to play partisan games because they refused to take the presented Republican concerns into account.
Although both parties utilized the media’s presence with emotionally charged tales of constituent despair, it was the Republicans who maximized the attention and at times appeared to treat the event as a kind of massive campaign event. The healthcare debate is so hot right now that Republicans knew it was not in their interest to present any in-depth, unified alternative to the Democrats plan, but instead cite polls showing the unpopularity of “Obamacare” and use the media stage to continue to present themselves as the voice of the American people.
For the American people, the healthcare summit was really a bittersweet moment.
I praise President Obama for orchestrating, and the representatives of both parties for participating, in a delightfully transparent view of the legislative process. But I can’t help but feel that the conduct of our elected officials in this conference was bad for Republicans, worse for Democrats, and demoralizing for the American people.
Image Source: Reuters