Alex Blaze

Health care reform passes

Filed By Alex Blaze | March 22, 2010 2:30 PM | comments

Filed in: Living, Marriage Equality
Tags: Alan Grayson, government, health care reform, Ken Cuccinelli, lawsuit, reform, single-payer medicare expansion, Virginia

In case you haven't heard, health care reform finally passed, 219-212. Now Congress moves onto a much easier big ticket item: immigration reform! Unlike with health care reform, I'm sure racists and big business won't be able to find angles to work there....

Anyway, there's a lot of good in this bill, even though it doesn't change the fundamentals of America's health care system: most adults will still get coverage through marriage or their employer, most insurers will still operate effectively as monopolies, and Americans will still be vastly overpaying for health care because the looting of people's money won't stop. But more people will be covered as they're forced to buy insurance and fewer people will be denied coverage as insurers will no longer be allowed to rescind policies for pre-existing conditions that they only find once people get an expensive disease. Premiums will be capped, insurers won't be allowed to discriminate, and large employers will be forced to provide insurance.

But, unfortunately, using the reconciliation process did not get the public option passed. It passed with a majority in the House before and one would think that with 57 Democrats plus Sanders in the Senate it could have garnered at least 50 votes plus Biden. As I said right when Scott Brown won his Senate seat and everyone thought that the Senate would finally be forced to use reconciliation and could then pass the public option Democratic leadership said had between 50 and 60 votes, that plan depended on Democratic leadership actually wanting a public option. And they don't. And so it didn't pass.

The system will still be unfair to LGBT people as most LGBT provisions put forward by Tammy Baldwin got taken out. The Advocate is counting as the "only LGBT-specific provision" a part that will lower prescription drug costs to some low income folks with HIV/AIDS. But data collection got knocked out, as well as removing the unfair taxation of same-sex domestic partnership benefits, allowing low income HIV positive folks onto Medicaid, and creating a health care system that completely bypasses employment and the institution of marriage, since LGBT people have diminished access to both.

Even though there probably won't be another vote on health care for a few years, the fight for that last one stays alive. Alan Grayson is trying to get a vote on Medicare buy-in, a great idea if ever there was one. If everyone's being forced to buy insurance, there's no reason they should be forced to buy private insurance.

The right's riled up by this; they consider the passage of this bill illegitimate and I'm guessing we haven't seen anything yet. They still think there is single-payer and death panels embedded in the bill, mainly because they're predisposed to opposing this bill for various reasons and because they're being lied to constantly through various conservative media networks. But they do know that it passed with no Republican votes, that the bill is going to take their money and kill them, and that the government simply doesn't have the right to go and do something they don't approve of. That's a volatile mix.

Our new friend, the LGBT anti-discrimination policy-eliminating Attorney General of Virginia Ken Cuccinelli, promises to sue the federal government to overturn part of the bill:

Cuccinelli, the Virginia attorney general, said today he also planned to sue the federal government, calling the health bill an "unconstitutional overreach of its authority.

"With this law, the federal government will force citizens to buy health insurance, claiming it has the authority to do so because of its power to regulate interstate commerce," he said in a press release. "We contend that if a person decides not to buy health insurance, that person -- by definition -- is not engaging in commerce, and therefore, is not subject to a federal mandate."

The states that say they will sue are Alabama, Florida, Michigan, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Virginia and Washington.

I have no idea if his argument has legal merit, but I do know that if there's something to it there's a sympathetic Supreme Court right now.

Although Cooch is very close to the part of this bill that's wrong: the fact that people everywhere are being forced to buy a private industry's product without even the option to buy it from the government. The solution isn't to just let people off the hook, though. The cost of health care decreases significantly if everyone, including people who don't think they're going to get sick, is insured. The solution is single-payer, although something tells me Cooch wouldn't be happy with that either.


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Reality check: health care reform was never introduced or debated. What we got was a massive transfer of wealth from working people to insurance companies.

Worse than nothing at all

Helen Redmond examines the health care proposals that Barack Obama and the Democratic Party want to push through Congress in the name of "reform."

March 19, 2010

THE DEMOCRATS' mad rush to pass health care legislation--any health care legislation, no matter how awful--is center stage in Washington politics.

And they got a step closer to their goal this week with the capitulation of Rep. Dennis Kucinich, the last of two House Democrats who previously voted against health care "reform" legislation because it doesn't do enough to actually reform the system.

Now, Kucinich--who still claims to support a single-payer system that would cover everyone under a government-run program and cut out private insurers--is championing a proposal that not only isn't single payer, but doesn't even include the "public option" half-measure that liberals once insisted was non-negotiable.

Kucinich had continued to criticize the measure backed by the Obama White House and congressional Democratic leaders--until last Monday, when he was invited to fly with the president on Air Force One. By Tuesday, he had called a press conference to announce his support for Barack Obama's version of health care reform, and by Wednesday, he was marching around the House floor, trying to convince fellow Democrats to get on board.

Former Democratic National Committee Chair Howard Dean was another vociferous critic of the Senate bill last year. In an op-ed article, he presaged how the health care endgame would play out.

In Washington, when major bills near final passage, an inside-the-beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health care reform is done. The result is legislation that has been crafted to get votes, not reform health care.

That's exactly what's happened--but Dean is now a supporter of the Senate bill.

These surrenders are only the latest steps backward--away from the promises during the 2008 campaign of a reformed health care system, where the abuses of the insurance industry would be stopped, and toward the dismal reality of legislation that will do the opposite.

- - - - - - - - - - - - - - - -

IN SPITE of the hysterical complaints of Republicans, the truth is that the health care measure House Democratic leaders hope to ram through this weekend is a disaster in the making for working people and a massive giveaway to the medical-pharmaceutical-insurance complex.

It will "mandate" people to buy policies from private insurers, without any guarantees of affordable premiums or adequate coverage. It won't have a "public option." It will slash spending and benefits for the federal government's Medicare program by $500 billion. It will impose a tax in some form on employer-provided insurance--supposedly aimed at expensive "Cadillac" plans, but in reality affecting any insurance that has decent benefits.

The list goes on and on. But the conventional wisdom is that the fate of the Obama presidency hangs on passing this legislation, so the White House and Democratic leaders like House Speaker Nancy Pelosi are bullying and bribing the holdouts in their party--mostly conservative "Blue Dog" Democrats who want even more concessions to the right.

A lot of the media's attention has been focused not on the content of the legislation but the bizarre maneuvering of the Democrats now that a united Republican Party has 41 votes in the Senate--enough to block a final version of the legislation negotiated between the House and Senate from coming to a vote.

Instead, House Democrats plan to approve the health care bill passed by the Senate late last year, but with a number of revisions that would be included in a separate measure called a budget reconciliation bill. The reconciliation measure could bypass a Republican filibuster in the Senate.

The possibility remains, however, that the Senate could ignore the House Democrats' revisions--there's no guarantee that it would take up the budget reconciliation bill.

In any case, the convoluted parliamentary maneuvers were an excuse for still more retreats. For example, in compiling the revisions that the House wants in the Senate bill, Democratic leaders dropped a measure supported by Obama that would give the federal government the authority to regulate health insurance premiums.

- - - - - - - - - - - - - - - -

THE ADMINISTRATION'S push for health care legislation has been in trouble since January, when Republican Scott Brown won the special Senate election in Massachusetts. The Democrats still have the biggest majority in both houses of Congress than either party has had for years--but the fact that they don't have the super-majority necessary to overcome Republican filibusters under the undemocratic rules of the Senate has become the all-purpose excuse for Democrats to act like a panicked minority.

Nevertheless, the administration got a new boost of momentum--ironically, from something that shows the need for much more radical measures to fix the health care crisis.

In February, Anthem Blue Cross, a division of WellPoint, raised premiums by a whopping 39 percent on 700,000 individual plans in California. The increase caused an uproar that the Obama White House exploited to renew pressure on Congress to take up health care legislation.

Summoned to a congressional hearing, a well-coached Angela Braly, CEO of WellPoint--which netted $4.7 billion in profits last year--was unapologetic. "Raising our premiums was not something we wanted to do," Braly declared, "but we believe this was the most prudent choice given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times."

Braly went on to criticize the Democrats' health care proposals for having a weak "personal coverage requirement"--read: mandate. In fact, the legislation will force tens of millions of people into the arms of private insurers, but that's not good enough for Braly and Co.--they want no one exempted from the mandate and higher financial penalties for anyone who doesn't get coverage.

The next stop for Braly--along with Stephen Hemsley, CEO of UnitedHealth, the country's largest health insurer--was a private meeting at the White House with Obama and Health and Human Services Secretary Kathleen Sebelius. The meeting was described in the New York Times as "surprisingly cordial," but there were no concessions from the insurers on the premium increases.

The farce continued when Sebelius was dispatched to a meeting of America's Health Insurance Plans (AHIP), the insurance industry's association--not to demand anything, but to politely ask insurers to disclose requests for increases in premiums, along with data showing costs and other factors that justify the hikes. Insurance companies in 27 states have to do this already.

"It's not too late to work on this issue together--for insurance companies to come to the table and work with us," Sebelius told the meeting. But the truth is that the insurance bosses have been at the table from day one, shaping the Obama administration's proposals to be more in their favor.

The health care industry has used a two-pronged strategy with Washington. Its representatives participated as "stakeholders" in discussions with the Obama administration--and even more centrally with members of Congress, like Sen. Max Baucus, who actually wrote the legislation.

But the health care bosses have also kept up a steady stream of criticism of the Democrats' proposals, and provided financial and political support for the Republicans' opposition to all reform. This is meant to box in the Democrats from considering more radical proposals. For the health care giants, it's a win-win situation.

- - - - - - - - - - - - - - - -

MEANWHILE, THE administration's push to get health care legislation passed at all costs is being aided and abetted by liberal commentators and some progressive Democratic-aligned organizations.

Economist and New York Times columnist Paul Krugman claims that the Senate version of "reform" is "a seriously flawed bill we'll spend years, if not decades, fixing." Nevertheless, he writes, "For a real piece of passable legislation, however, it looks very good. This is a reasonable, responsible plan. Don't let anyone tell you otherwise."

Wendell Potter--the former director of corporate communications for insurance giant Cigna-turned-whistleblower and trenchant critic of the insurance industry--now supports the Senate bill. In an interview with PBS's Bill Moyers, Potter declared, "Yes, it'll be a win for the insurance companies, but I don't think we're going to wind up with the insurance companies walking away and winning the whole ball game. If we don't do anything right now, that's what will happen."

Krugman, Potter and other liberal voices--some of them previously passionate defenders of single payer--who claim that "something is better than nothing" are wrong. The health care legislation that the White House and Congressional leaders want to pass is worse than nothing at all.

As Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine and a sharp critic of the Democrats' proposals, explained:

What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the linchpin of health care reform...Not only does it keep them in place, it pours about $500 billion of public money into these companies over 10 years...and it mandates that people buy these companies' products for whatever they charge.

One argument in favor of the Senate version of health care legislation made by Democrats and groups like Health Care for America Now, the labor-backed organization that has been for the Democrats' highly restricted "reform" proposals all along, is the claim that 30 million people without insurance today would gain coverage under the bill.

What they don't say is that it will take 10 years for that number to gain coverage. Fully half will be covered by Medicaid, a program that is in fiscal crisis in every state, where officials have made drastic cuts to balance budgets. More and more doctors are refusing to take Medicaid patients because reimbursements rates have been slashed.

And on top of that, more than one-third of the uninsured today, or around 20 million people, will still be uninsured 10 years into the reform--among them, millions of undocumented immigrants who won't be eligible for federal subsidies.

The other measures that can be painted as reform--like forbidding insurers from denying coverage to patients with pre-existing conditions--are long overdue, but are offset by concessions to insurers, like provisions allowing them to charge older patients more than younger ones.

On one point, according to liberals, the Senate bill is superior to the health care bill passed by the House last year: women's reproductive rights. The House version contained an amendment proposed by Democrat Bart Stupak that would have barred any insurer participating in the government insurance exchange for the uninsured from covering abortion as a medical procedure.

The Senate language on abortion, written by anti-choice Democrat Ben Nelson, isn't as all-encompassing--but it still represents an outrageous attack on women's rights. Women could buy a policy through the government insurance exchange that covers abortion, but they would have to write two checks each month, and insurers will have to keep the income in separate accounts. The incentive will be for insurers to drop abortion coverage.

Republicans and some Democrats still claim this isn't tough enough--but it was good enough for the organization that represents 90 percent of the 59,000 Catholic nuns in the U.S. to put its support behind the Democrats' health care measure.

If Obama and Pelosi get their way and the Senate bill is rammed through the House this weekend, we'll hear that the vote was historic. And it will be--a historic failure to mobilize the massive popular sentiment to get profit out of health care and truly reform a broken system.

Alan Maass contributed to this article.

a few thoughts about all of this:

--right off the bat, i would suggest that the tone of some of the articles cited was a bit more frenzied than the facts actually warrant.

here's just one example: kucinich is portrayed in the first article as having been persuaded to "champion" a bill he does not support thanks to a ride on air force one. there is also an implication that kucinich is no longer a supporter of single-payer.

i would suggest that obama made arguments that persuaded kucinich on that airplane ride, which is considerably different than being persuaded by the ride itself.

i would also suggest that agreeing to vote for a bill is not necessarily the same thing as "championing" a bill. (i would also put howard dean in this category of "acquieser", rather than "supporter".)

kucinich, additionally, still seems to support single-payer--a lot, as does dean.

should kucinich have been persuaded by obama?

the argument that seems to have persuaded kucinich is that this is a time to pass what could be passed now, and to try to make a thing that is indeed less than optimal better over time.

the counterargument to that, of course, is that you should never pass a bill that isn't the best solution possible.

which way should a legislator go?

how about this: civil rights legislation is the classic example of making a bad bill better over decades.

the voting rights act and the civil rights act did not contain the protections of the ada--or the protection we now seek in enda legislation.

would we have been better served waiting for the entire package, or moving incrementally?

environmental law has followed the same path--with decidedly mixed results; the endangered species, clean air, and clean water acts all required separate legislative processes...and chipping away at them has also been an incremental, and all too effective, process.

--is this bill really without merit?

look: i wanted single-payer...and i still do...and i also think obama made some of the best arguments for a public option being necessary for his vision of reform during the '08 campaign.

i do not, however, think single-payer had any chance of passing--and i knew it when kucinich and edwards, combined, weren't pulling better than 25% of democratic primary voters after february of '08...and the trend was moving quickly downhill.

(full disclosure: i supported edwards and posted to his site, but i was never, in any official capacity, "on the team".)

i recently wrote an article suggesting that it should not have been tough to get republicans on the defensive during and after august of '09, and i do think that, if only from a political point of view, it was a tactical and strategic failure not to get a public option in this bill right now.

that said, the possibility of coming back and adding a public option to "the exchange" by simply changing the eligibility rules for medicare is a real possibility, and probably an easier "legislative lift" than what we saw this time.

could "medicare for all" be converted to single-payer?

not easily, and not soon, but it's not impossible.

--is there really no way to control premium costs?

i did see the quote you offered, but after tonight's broadcast of rachel maddow's show i was of the impression that insurers would be selling insurance into a price-regulated exchange. msnbc is reporting that premium regulation did survive.

to be frank, i was also of the impression that the price regulation could be politically manipulated, but that said, i had the impression a price-regulation mechanism is to be established.

in any event, i have an email out to try and sort out if the controls survived or not; i'll let you know if i find out more about this.

--are the democrats a panicked majority?

usually.

the alternatives are tougher, as they either involve "top-down command and control", as the republicans do, or arguments so powerful, so persuasive...so uniform in their application...that every member of a wildly diverse democratic party, from barney frank and alan grayson to joe lieberman and arlen spector, will voluntarily--and fearlessly--go along with the program.

good luck with that.

--wanna punish stupak for the abortion language?

keep pressing him for the facts behind who was subsidizing his rent at the c street house for all those years. keep writing about it.

that is a big weak point for him, and it's a button worth pushing, over and over.

--what about those medicare cuts?

first and foremost, cutting medicare spending is not only not inherently bad...it's mandatory for national economic survival.

it's one of the two most important reasons why we're trying to do this reform in the first place.

cutting the growth of medicare spending over time is the whole "it's going to drive us bankrupt" part of reform.

obama reported at the health care summit (which i sat and watched over the course of two days) that one reason the medicare cuts were coming because he was proposing to end the "medicare advantage" program.

he says that the reason he wants to do this is because the insurance companies gained, under current rules, a big 'ol fat windfall from the way that program is set up, with no provable improvements in heath care outcomes for the extra expense.

he also reports that the 80% or so of non-medicare advantage medicare enrollees are subsidizing the advantage program through their own elevated premiums, to the tune of about $8 a month per enrollee.

there are also medicare savings to be had by being more efficient (this is the reason behind the big push to get providers off of paper and on to databases for patient records), and by doing things like emphasizing preventative care.

when we save money by doing things better, it means we have to ability to cut spending and maintain current levels of service, and that's what the administration hopes will happen here.

--finally: there is no way, no way, no way no way no way that the current congress would approve care for those residing here illegally, and i have to respectfully tell you that i don't believe there is any argument, moral or ethical, no mater how profound, that would get you a majority in either house on this issue.

i'll take it further: if jesus christ himself appeared in a puff of smoke in a house hearing room to announce the support of the father, the son, and the holy spirit for this type of reform, someone like louie gohmert or michelle bachmann would still find a way to turn it ugly, and about 30% of america would be out in the streets behind them...and i'll bet they would be looking to do a bit of crucifying.

this was an imperfect victory, and it was a poorly executed political process...but we are probably better off than we were if we did nothing...but i say that with my suspicious nature not yet fully satisfied that all will, indeed, work out well.

i did get a response back, regarding price controls, from a contact i have at a congressional committee, and here's what he said:

Ok, here’s what I got from our 1-pager on Health Insurance Exchanges.

http://docs.house.gov/energycommerce/EXCHANGE.pdf

? For states that choose not to operate their own Exchange, there will be a multi‐state Exchange run by the Department of Health and Human Services.

? State insurance commissioners will continue to provide oversight regarding consumer protections, rate review, and solvency.

? Protects the financial integrity of the Exchanges through annual audits and financial reporting overseen by the Secretary of Health and Human Services, and establishes procedures and protections to guard against fraud and abuse.

So it appears the commenter is both right and wrong. State insurance commissioners will oversee state-run exchanges, but there will be Federal oversight."


Actualy Triple pay would be what would work for the US.Work provided insurance Government (Medicare for all) and you paying the difference.Now Id love to see work insurance include any one who works for a company for at least 5 days a week no matter what there hours would be.That would cover most socalled part time workers.For now however that aint happening but I suspect the lawsuits will get tossed as the seem to be to broad in scope.True states are the ones who rgulate insurance but they dont regulate mandated insurance like auto insurance.

Caty
Politics is a contact sport with no rules.

Correction they can regulate how much you need to cover in each state and set the rates .But the Feds were the ones who said we all have to have it or lose those highway dollars like the over 21 to drink law that was Federaly mandated.

to add to the oddness of the "ag threatening to sue" part of the story, here in washington (the same washington that we may all remember from the r-71 fight in 2008) the governor may be suing our ag to get him to not join the effort to sue to stop health care...which is very twisty for the mind, and the subject of a story i'm starting to get together.

on another point: if the rs feel that forcing people to buy insurance violates the constitution...well, that sounds to me like the republicans now prefer single-payer, which uses the authority of government to levy taxes as the mechanism to pay for national health care, instead of a system that forces people to buy private insurance, and i'm glad to see that the republicans and i finally agree on something.

SarasNavel | March 23, 2010 2:32 AM

"At any cost" indeed. Looks like President Obama has betrayed yet another group of radical liberals (i.e., pro choice women) that trusted his campaign promises (to get rid of the Hyde Amendment) and worked to get him elected. In effect, he traded getting the bill passed for ensuring (via executive order) that no federal funding be used for non-emergency abortions.

From http://www.now.org/press/03-10/03-21a.html:

March 21, 2010

The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women's access to abortion. Through this order, the president has announced he will lend the weight of his office and the entire executive branch to the anti-abortion measures included in the Senate bill, which the House is now prepared to pass.

President Obama campaigned as a pro-choice president, but his actions today suggest that his commitment to reproductive health care is shaky at best. Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law -- it is an illegitimate tack-on to an annual must-pass appropriations bill. NOW has a longstanding objection to Hyde and, in fact, was looking forward to working with this president and Congress to bring an end to these restrictions. We see now that we have our work cut out for us far beyond what we ever anticipated. The message we have received today is that it is acceptable to negotiate health care on the backs of women, and we couldn't disagree more.

There's also the 40% tax on "Cadillac" policies.

Those which cover SRS.

The cost of those will soon mean they're only for the very wealthy - and even if it means they don't get a perfect score from the HRC any more, few if any firms will be able to justify the additional costs. A smaller pool of the insured means cost will increase in addition to the tax - probably threefold.

Why not just give the insurance companies all the money and be done with it. Between the bail outs and now Health Care, they will have to use dump trucks to haul the money to them. I have long thought we need universal health care, that covered everyone but this Bill is not it from what I can see. It is just a law to force everyone to buy whatever coverage the insurance companies offer us at whatever fees they decide to charge. Without the much feared Public Option, I do not see how this is anything more than a give away to the Insurance industry.

Hi Zoe,

The executives that the tax was aimed at can negotiate a lower premium, higher copay/deductible plan that stays under the limit & then get compensated in salary. If that increase in salary is then used for health care *or* if a secondary policy is utilized, there is not tax imposed.

The real shame about the Cadillac tax is not that it will likely be applied to policies that cover SRS, but in many parts of the country, non-executive health coverage is set to reach those cost levels about the time the tax goes into effect or within a few years afterward. Although billed as a 'Cadillac' tax, it will actually be more of a Corolla tax.

The solution to the SRS problem is to publicly push for insurance companies to cover, to some degree, SRS. All too often it's done quietly, on an individual basis to reduce cost and I suspect, 'protect' their image. Then again I'm still waiting for the day when Estrogen and Testosterone are actually approved for use on transsexuals as I'm tired of being an "off label" application. Makes me feel like any day some religious congressperson could put a stop to it simply by adding a rider to a logging and land use bill.