A Public Service Announcement

Speaker Pelosi and President Obama, take a bow
I didn't think I would blog tonight, despite many interesting developments in the political world since Sunday night (did you know that 24% of Republicans think our President could be the Antichrist?)  I strive for substance over filler on this blog, and I didn't feel I could summon the mental energy to write a quality post, but something caught my attention which was just too good not to share.  Following up on Sunday's posting about the health insurance reform bill, I was directed to this fantastic, clearly-defined blog posting from Speaker Pelosi's website detailing further what Americans can immediately expect from the health care bill; there's something for everyone:

(And before you check the posting below, just another note that the health care bill has now jumped in popularity since even last weekend, "By 49%-40%, those polled say it was 'a good thing' rather than a bad one that Congress passed the bill."  Compare that to approximately 45% for/48% against on March 9th, not too shabby.  Now that Americans can stop hearing about the sausage-making that went on for 14 months and can start focusing on what the legislation will actually do for them, these reform measures will only rise in popularity.  Also, Sen. Harry Reid is aiming to have the Senate pass the reconciliation bill on Saturday, which will put the final fixes to the reform bill in place, so we will be officially free and clear of this debate.  Onwards to financial reform!)

Lastly lastly: this photo is just beyond words.

What’s In The Health Reform Bill For You Right Away?

March 23rd, 2010 by Karina

Under the legislative package the House passed on Sunday (the Senate-passed health bill as amended by the reconciliation bill) many key provisions take effect this year - here are some of them:

IF YOU ARE A SMALL BUSINESSES OWNER:

SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available. Effective beginning for calendar year 2010. (Beginning in 2014, small business tax credits will cover 50 percent of premiums.)

IF YOU ARE A SENIOR:

BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)

FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.

HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Effective 90 days after enactment.

IF YOU HAVE PRIVATE HEALTH INSURANCE:

NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to adults as well.)

NO RESCISSIONS—Bans health plans from dropping people from coverage when they get sick. Effective 6 months after enactment.

NO LIFETIME LIMITS ON COVERAGE—Prohibits health plans from placing lifetime caps on coverage. Effective 6 months after enactment.

NO RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts new plans’ use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.)

FREE PREVENTIVE CARE UNDER NEW PLANS—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.

NEW, INDEPENDENT APPEALS PROCESS FOR NEW PLANS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions. Effective 6 months after enactment.

MORE FOR YOUR PREMIUM DOLLAR—Requires plans to put more of your premiums into your care, and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual and small group market to spend 80 percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers that don’t meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.

NO DISCRIMINATION BASED ON SALARY—Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.

IF YOU DON’T HAVE HEALTH INSURANCE:

IMMEDIATE HELP FOR THE UNINSURED WITH PRE-EXISTING CONDITIONS (INTERIM HIGH-RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition - through a temporary high-risk pool – until the Exchanges up and running in 2014. Effective 90 days after enactment. (Beginning in 2014, health plans are banned from discriminating against all people with pre-existing conditions, so high-risk pools would phase out).

EXTENDING COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE – Requires health plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.

GENERAL REFORMS:

COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years. Effective beginning in fiscal year 2010.

MORE PRIMARY CARE DOCTORS—Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.

HEALTH INSURANCE CONSUMER ASSISTANCE—Provides aid to states to establish offices of health insurance consumer assistance to help consumers file complaints and appeals. Effective beginning in FY 2010.

A NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.

And in 2014, once the exchanges have formed, more insurance reforms go into effect, including:

NO DISCRIMINATION AGAINST ADULTS WITH PRE-EXISTING CONDITIONS
BAN ON HIGHER PREMIUMS FOR WOMEN
PREMIUMS BASED ON AGE CAN ONLY VARY BY A MAXIMUM OF 3-TO-1 RATIO
CAP ON OUT-OF-POCKET EXPENSES for private health plans

Why I Support The Health Insurance Reform Bill

Speaker of the House Nancy Pelosi

The interminable march towards health care reform (HCR) is continuing in earnest today, with an end finally (FINALLY) in sight.  So what is actually happening right now?  And what's this "reconciliation" business all about?  There's no good way to sum up parliamentary procedures into a bite-size format, so bear with me, as this email will be long.  

Procedural Issues

In brief, the House of Representatives voted today on the HCR bill passed by the Senate in December.  The Senate bill, as you may have heard, includes some rather unsavory deals that were cut in order to win 60 votes and to pass the bill; deals such as the "Cornhusker Kickback" that was negotiated by Sen. Ben Nelson (D-NB) that would provide indefinite federal funding to cover the expected increase in Nebraska's Medicaid costs due to expanding coverage to more people (Medicaid is paid for in part by federal funds and in part by state funds, so any increase in Medicaid costs will cost the states directly).  The Kickback and other deals that were made for specific Senators in specific states to win their votes are obviously not terribly popular with rank-and-file Democrats, and so by the House voting for the Senate bill as it is, they made those Senate deals into law.

However, over the last few weeks President Obama, Nancy Pelosi, Harry Reid, and other key Democrats in both chambers of Congress have worked out a deal to pass a reconciliation bill that "fixes" all of the deals that were passed in the Senate bill and that will work to further reduce the deficit (the Congressional Budget Office, the main non-partisan arbiter of all things budgetary, has stated that the bill will reduce the federal deficit by $140 billion over the first 10 years it is in place and by $1.2 trillion over the second 10 years it's in place, although those numbers are subject to a large amount of skepticism on both sides).  This reconciliation bill will be voted on tonight by the House once the Senate bill is passed by the House, and then that reconciliation bill is supposed to be passed by the Senate, hopefully later this week, although the timing is debatable.  Members of the House are afraid that the Senate will seek to alter the reconciliation bill, upsetting the delicate balance that has been struck between leadership and the members, although Senate leadership has worked to reassure nervous House Democrats that the Senate will pass the bill as-is.  Any changes that are made in the Senate will have to be voted upon again by the House before President Obama can sign the bill, delaying the legislation further, an outcome Democrats are working to avoid.  

So is the use of reconciliation by the Democratic majority "unconstitutional" or a "nuclear" procedure, as Republicans have sought to portray it?  Well, considering that the majority of the uses of reconciliation have come when Republicans were the majority in Congress (16 out of 22 reconciliation bills) it seems a bit rich for Republicans to call it an extraordinary procedure now.

Finally, abortion.  A lot of hay has been made in the last few weeks about whether there is any federal funding of abortion in this HCR bill, and the fact is, there never was any federal money for funding abortions.  There is a provision in the House called the Hyde Amendment, that bans spending federal money on abortions, and the HCR bills that have been debated have always upheld that provision.  It has now been reported that President Obama has issued an Executive Order banning the use of federal money on abortions, as an extra safeguard, so thankfully, this argument is now moot.

Why I Support The Bill

The primary reason that I am in favor of passing this bill, despite the fact that it does not include the most effective cost-saving measures of either a public option or single-payer system, is that the bill enshrines in US law the fundamental concept that health care is a right, not a privilege.  For too long in this country, we have consigned our fellow Americans to suffer from treatable, often preventable illnesses and conditions by claiming that people have the "choice" to buy health insurance if they want it.  Sadly, the reality has never been quite so simple.  Two of the more significant reforms in this bill are those ending the denial of health insurance for those people with pre-existing conditions, and making illegal the use of rescission (where the insurer cancels your health insurance just when you need it most due to a usually dubious claim of "fraud" on your insurance application).  These two revisions alone will help keep far fewer people from going bankrupt due to medical care (click for shocking statistics).  

Consider the fact that if you receive your health insurance through your employer, as the vast majority of Americans do, what will you do if you lose your job?  You will have COBRA coverage for a few months, but generally COBRA is quite expensive, and moreover, it's temporary.  How many of you who are lucky enough to have jobs still are unwilling to leave a job that is no longer satisfying because you are afraid of losing your health insurance?  Is that lack of mobility not an impediment to your freedom?  Does not the health insurance system we have now foreclose upon choices that we would otherwise have if we were assured of health insurance?  Far from reducing our freedom as many opponents of the bill have claimed, this bill will greatly enhance freedom and will enhance job mobility.

For small business owners and entrepreneurs who would like to start out on their own, but are not able to afford exorbitant health insurance costs, this bill provides subsidies for health insurance for their employees.  Whereas the current system has skewed the benefits towards existing companies, and especially towards companies with large employee bases that can be insured under group plans, this bill begins to level the playing field between newer and more-established businesses, and between larger and smaller businesses.  

As a young person, I will be paying for this bill for the rest of my days, and despite that (in fact, because of that) I still support it.  I have faith that the bill will be improved, refined, expanded, and remade in time.  Young people are the linchpins upon which reform depends.  The reason we have coverage mandates in the bill is so that younger, healthier people (who tend not to buy health insurance) will be forced to buy insurance.  Younger people tend to have better health than the not-as-young, and because of that, it is unlikely that a young person will spend as much on health care as they pay in annual premiums.  The idea is that the insurance companies will shift those excess premium dollars (after shaving off a nice profit) to pay for more expensive people's health care, who may have spent more on care than they paid in premiums.  So they need us, which is a reason why the HCR bill has a provision that allows dependent children to be covered under their parents' health insurance plan until they're age 26.  As long as somebody's paying the premiums for their insurance and not costing insurance that much money on care, the insurance companies are happy.

Finally, I support this bill because even if you have insurance and you're happy with it, you already are paying for the uninsured.  In fact, you're paying quite a lot for the uninsured, and it'll only get worse unless something is done.  When a person does not have health insurance and gets sick, they'll probably wait until they're really sick and then go to the emergency room for treatment.  As everyone is surely well aware, emergency room treatment is the most expensive kind, and when patients can't pay the hospitals back for the care they've received, the hospitals then charge insurers more for patients with insurance, which leads to higher premiums for insurance, which more people can't pay, and so they become uninsured...the cycle goes on.  This bill is an attempt to stop that cycle.

It's not perfect by any stretch of the imagination, but this bill is far, far better than the status quo.  For more information, see the two links below, both by the non-partisan Kaiser Family Foundation's Health News:

The Immediate Effects of The Health Reform Bill

A Consumers' Guide to Health Reform

More Highlight Videos from the Health Care Summit

I had said yesterday that President Obama came off well at the summit, and that the health insurance reform bill is actually quite moderate, and here's some video proof of that:



Yes, I'm a policy wonk, but this is a fascinating exchange, and well worth the 7.5 minutes to watch.  Obama explains just how difficult it is to craft reasonable health care regulations, since the government has to be responsive to industry concerns as well as those of individual consumers on what is an extremely personal topic.

Lastly, Speaker Nancy Pelosi courageously and valiantly stood up for the public option and called out Republican lies in regards to whether the reform bills allow for public funding of abortions and Medicare benefit cuts for seniors (neither are in either of the reform bills from the House or Senate.)  There have been egregiously misleading statements made about these bills by the GOP, statements that any person with an internet connection or access to a newspaper could very quickly refute, yet they continue to try to scare the public into opposition.  Bravo to Speaker Pelosi - see her in action below:

The Upside of Scott Brown's Election...

Image via Wikipedia

...the Democrats in the Senate have finally been freed of having to seek the ever-elusive "60th vote" to pass health care reform.  I had discussed the reconciliation process a few months ago, but it finally seems that Harry Reid is prepared to use a majority vote to pass health care reform, regardless of what the "moderate" Democrats say.  By losing the 60th seat in the Senate, Democrats have been forced to seek other methods to pass legislation than negotiating with their own corporate-owned members (see Ben Nelson, Mary Landrieu, Joe Lieberman, etc.) and this has led directly to using the reconciliation rule.  So this week a major push has been made by a range of Senate Democrats to include a public option in the reconciliation bill, with Senators from Dianne Feinstein (pretty moderate) to Chuck Schumer (former head of the Democratic Senatorial Campaign Committee during the 2006 and 2008 elections, who is widely regarded for his political acumen) signing on to the letter to Majority Leader Reid.  But hold on a minute, isn't the public option a HUGE LOSER among the public?  Don't Americans want less government intervention?  Well, not really, it turns out.  A poll of Nevada voters released yesterday contains some stunning revelations - 56% of Nevada voters favor "the national government offering everyone the choice of buying into a government administered health insurance plan" versus 38% opposed.  Nevada, if you'll remember, was a major battleground state in the 2008 election; after being solidly Republican for many years (with a strong Libertarian, anti-government streak to boot) President Obama prevailed there in the general election, so Nevada's a pretty good bellwether state through which to gauge the national mood.  The poll also has implications for Harry Reid's reelection prospects, as he is not doing too well in polling in his home state, so a strong move to pass Democratic legislation could in fact help his prospects in Nevada.


We will see what happens, and I'll try to be a bit better about posting timely information, as health care reform continues to provide lots of twists and turns to keep track of.

The Bipartisanship Myth

I have noted before that Cenk Uygur of The Young Turks is one of my favorite bloggers out there.  But tonight, reading his latest posting on the Huffington Post, he hit the nail on the head when discussing the Democrats' love for "bipartisanship" in all things, but especially in the health care and financial reform debates:

And the Democrats are perfectly happy to [compromise] because they take the same, if not more, amount of money from those same corporate lobbyists [as the Republicans]. Except they have the meddlesome problem of pretending to be for the people. Republicans are not burdened with this; everyone expects them to help the rich and the powerful. But the Democrats need cover, and they have the perfect excuse in the mantle of bipartisanship. What could they do, the Republicans made them do it! And aren't they so reasonable for compromising?

I highly recommend reading the entire article, as it neatly lays out just how it is the Democrats have managed to accomplish very little of substance despite having the largest margins in decades in the Senate and the House, not to mention the Presidency.  There is a perpetual balancing act among American politicians of between being a good member of one's political party and engaging in electoral self-preservation (often at the expense of one's party).  At the same time, the campaign finance system that is currently in place makes it highly profitable for politicians to kowtow to corporate interests for their own personal gains (in the form of campaign contributions and favorable "issue ads" being run in their districts).  Similarly, the national committees of the two parties also have incentives to keep their corporate sponsors happy, as the corporations will then provide more donations to the parties who will then cultivate and fund the campaigns of more mini-corporatist candidates in elections around the country.  So in this context, the corporate line is the party line is the individual legislator's line - the corporation wins every time, since the corporation's interests are everywhere reflected in our political system.

This truth of government by corporation is nowhere more evident than in the recent Supreme Court decision Citizens United v. Federal Election Commission.  One does not have to look far to find strong reactions to the 5-4 majority ruling and opinion in that case, but the overwhelming consensus is that the Supreme Court has effectively granted US citizenship to corporations, with every faculty intact but the right to cast a vote for a political candidate.  I am rather tired tonight, and not in the best position to discuss the implications of this case fully, but let me say this: corporations exist for no other reason than to make a profit.  That is their sole motivation.  While corporate interests have been donating to politicians (and hence altering their political calculations) for years, Citizens United gives those interests expanded rights to pursue their ends through political channels, rather than through competition in the open marketplace.  This ruling creates incentives for corporations to find the politicians who will do their bidding most effectively, rather than spend more money on R&D to improve their product or service.  The ruling also creates incentives for politicians to be the most effective advocates for their corporate sponsors that they can be, regardless of the effects on the public at large.  The money is, in effect, divorcing us from our elected representatives.  This is nothing particularly new, mind you.  But these activities have never in our country's history been given such explicit sanction by our highest court, and the effects have the potential to be disastrous.

Elections have consequences, and those consequences are often most apparent in the makeup of the Supreme Court, where justices have lifetime appointments.  We need a lot more Sonia Sotomayors to make up for this ruling.

Another reason to pass the healthcare bill...

Senate Minority Leader Mitch McConnell.  Image via Wikipedia

Is so that the Republicans in the Senate won't block funding for the troops anymore???  Yes, this is truly crazy, but the GOP attempted last Thursday to delay the healthcare bill through filibustering the defense appropriations bill; by holding up the defense bill, that could throw off the carefully crafted schedule Harry Reid put together to pass healthcare before the Christmas recess.  The Senate's parliamentary maneuvers and roadblocks have been on full display during the healthcare debate of late, however, Congressional historians agree that filibustering one non-controversial bill to block a controversial one is rather unprecedented.  Mitch McConnell, Senate Minority Leader, proving once again that principles can always take a backseat to political expediency.

UPDATE: Let's pass healthcare reform

Image via Wikipedia

UPDATE BELOW: I had started a post earlier bemoaning the state of the healthcare reform bill, but over the last few hours I've been reading many persuasive arguments for both killing the Senate bill as it now stands (quick recap: no public option of any sort, mandates for 30 million currently uninsured people to buy coverage, premiums capped at 8% of income...more here courtesy of Sen. Paul Kirk, Ted Kennedy's replacement and former Chief of Staff) and for voting in favor of it.  I'm torn, and here are the two most persuasive arguments pro and con:

In favor of the bill (with great graphics): Igor Volsky.

Against the bill (with a strong and principled argument): Cenk Uygur.

Cenk argues that the public option was the focal point of so much progressive advocacy because it fundamentally alters the rules of the health insurance game, in the sense that health insurers only make a profit through taking your premium payments and finding ways to pay out less in benefits than you pay to them in premiums.  The incentive for insurers, therefore, is to deny care when possible, which is morally repugnant on its face.  The public option would provide an oppositional counterweight to the reigning insurance industry model in the form of health insurance that is not concerned with profit so much as providing the most effective care the most efficient way possible.

It's heartbreaking to have to give up the public option at this point, however the fact is, there will be time to tinker with the bill, and key Democrats are now saying that the public option will be "revisited" legislatively as early as 2010.  After looking at Volsky's graphics and reading about how much money average families and individuals are projected to save on their health insurance, I have to support the bill.  The subsidies to help people pay for the insurance they will now be required to purchase are generous as they currently stand, and if our ultimate goal is to insure more people, then despite the compromises involved, this bill needs to pass.

UPDATE: Here is the most complete and understandable breakdown of how heath care reform will affect the premiums various families of four will pay as of 2016 (once the program if fully phased-in).  Be sure to zoom in on the table embedded in the text - it's quite impressive.  My hope is being restored, little by little...

Obama, Health Care Reform, and Corporate Chicanery: Capitulating the Battle and Losing the War

Image via Wikipedia

So health care reform is virtually over, the chance for progressives to win out and to really cut costs and inject competition into the health insurance market has passed, and the corporations won out again. As noted below, I was despairing earlier today, but after reading Bob Cesca's latest piece at Huffington Post, I feel slightly better. His main point is that, despite being truly, utterly pissed off about how things have transpired in the health care debate, there is too much still at stake to actually "kill the bill." To wit:

Yet I can't help but to believe that killing reform will only heap an even larger failure on top of losing the public option, the Medicare buy-in and so forth. Only this time, it won't be a failure limited to an ideological or political routing. The failure of health care reform will invariably mean at least another decade (if not two decades) of a desperate health care system in crisis. Another decade or two of medical bankruptcies and deaths due to a lack of insurance -- exponential premium hikes and rescissions. You know the list.

If I stop being pissed off long enough to take a good look at what remains in both the Senate and House bills, there aren't necessarily fool-proof solutions to these problems, but there are regulations, subsidies and reforms that will ameliorate a significant chunk of the present crisis. For example, the Senate bill will reduce the cost of insurance for a family of four earning $54,000 from around $19,000 per year to around $9,000 per year.

[snip]

Do progressives really want to tell working-and-middle class families of that they're not allowed to get a $10,000 annual break on their insurance payments? If you're okay with that, I admire and respect your integrity, but I just can't be a part of it. Objective reality dictates that there's no other path at this point but to support the bill and to subsequently endeavor to fix it.

So incremental reforms it is, but at least 30+ million additional Americans will have insurance coverage, despite having to pony up the cash to buy that insurance themselves. Let's hope those subsidies come through, and that they're generous...

But the larger issue here is a sense that our President is selling us out. He could have drawn a line in the sand and fought harder for the public option, rather than pay lip service to it to appease the liberal base. He could have fought for pharmaceutical reimportation from Canada to help save the US taxpayer over $100 billion over the next 10 years, as he had when he was a Senator, however he brought his considerable political weight down on the side of killing that reform effort in order to preserve his backroom deal with the pharmaceutical companies to preserve their profits as long as they did not work to destroy reform. Beyond health care reform, the sense that Barack Obama is not living up to be the President we voted for is also apparent in the "financial reform" efforts I wrote about earlier today, and Cenk Uygur writes passionately about that sense, laying out a concise summary of all that is disappointing about our President thus far. In brief:

But I don't put the civil liberties and the wars in the same equation as the other issues I mentioned. Why? Because it's one thing if I disagree with your policies and principles, if they are genuinely held. Ok, that's a sad day for me but doesn't necessarily indicate that you're wrong or unprincipled (no matter how much I might disagree with you). What I mind is the give-aways to corporate lobbyists that have nothing to do with your principles and have everything to do with politics and money. What I mind is when you sell out the American people to protect corporate America. I hate it when the Republicans do it and pretend to be for the little guy. And I hate it when this administration does it and pretends to be for change.

There was always going to be buyer's remorse when a huge portion of the voting public places their hopes and dreams in one man who must work within the system that is presented to him, however I don't think anyone expected the remorse to be quite this sharp, on so many issues of such great importance to our country. I hold out hope for a change from Obama, but hope is fading fast these days.