EDITORIAL

Reform We Can Build On

Now that the health insurance reform bill is signed into law, perhaps the mainstream media can get to work calling down the Republicans and teabaggers for the lies they have been telling about the reform efforts over the past year.

In fact, there are no “death panels,” and there never were. Seniors will keep their Medicare benefits. In fact, those seniors who hit the “donut hole” for prescription drug expenses will get a $250 rebate this year, thanks to the Democrats. The reform bill is paid with taxes on wealthy individuals and the health care industry and it actually reduces the federal deficit. The new law also gives small businesses a 35% tax credit to help pay for health insurance for their employees. Community health centers will get federal funds to double the number of health center sites to 15,000 and double the number of patients they can see to 40 million over the next five years. The National Health Service gets $1.5 billion to train more than 17,000 primary-care doctors, nurses and other public health professionals to serve in medically underserved areas.

Aside from the hysteria about a government takeover, the reforms are conservative, preserving the role of private insurance, but they provide a foundation on which progressives can build. Within 90 days, the law creates a re-insurance program to offset costs of expensive health claims for employers that provide health benefits for retirees aged 55-64; it provides a high-risk pool for Americans who are uninsured because of a pre-existing condition.

Within six months, the law bans health plans from dropping people from coverage when they get sick; it bans discrimination against children (under 19 years) with pre-existing conditions; it bans lifetime limits on coverage; it restricts annual limits on coverage; it requires free preventive care under new private plans, it ensures consumers in new plans have a process to appeal denials of coverage by their health insurance plan; and it allows parents to keep their children on their insurance policy until their 26th birthday.

Effective Jan. 1, 2011, the law eliminates co-payments for preventive services under the Medicare program; it requires that plans in the individual and small group market spend 80% of premium dollars on medical services, and large group plans must spend 85% on medical services, and insurers must provide rebates to policyholders if they spend less. It also creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

Enacting those aforementioned provisions would be a good day’s work, but in 2014, federal regulations will prohibit insurance companies from discriminating against all customers due to health status, gender or pre-existing conditions. Health plans will no longer be able to impose annual limits of individual coverage.

Then health insurance exchanges will be set up in each state to enable individuals and small employers to compare standardized health packages. Yes, people will be required to have some sort of insurance, but tax credits will help individuals with incomes up to 400% of the poverty level buy insurance through the state exchange. That is, individuals making up to $43,320 or a family of four making $88,200 would get assistance or face a tax that increases from $95 in 2014 to $695 in 2016.

Businesses with 50 or more employees that do not offer coverage to their employees will have to pay $2,000 annually for each full-time employee over the first 30 as long as one of their employees receive a tax credit.

Medicaid eligibility will increase to 133% of poverty for all non-elderly individuals, or $29,327 for a family of four. That is a huge improvement. Ron Pollak of Families USA noted to the Washington Post’s Ezra Klein that in 43 states, childless adults are excluded from Medicaid. For parents, the median income eligibility is 69% of poverty and it runs as low as 25% of poverty.

The federal government will pick up all the cost of new Medicaid enrollees through 2018. In Texas, where an estimated 6.1 million people — one quarter of the state’s population — now go without health coverage, expansion of Medicaid and Children’s Health Insurance is expected to cover 2 million of those Texans in 2014 but state officials are complaining that it will increase the state’s workload. State workers already are struggling to enroll low-income Texans in the food stamp program as quickly as the federal government requires (there was a backlog of 42,000 applicants last fall). Instead of making plans to step up to the task, Gov. Rick Perry denounced the expansion and Attorney Gen. Greg Abbott announced he would join other Republican state attorneys general in challenging the health insurance mandate as unconstitutional.

Now, I don’t like being told that I have to buy private insurance either, but that doesn’t mean we should let people go without insurance. The answer is to cover everybody under Medicare — or at least give us the opportunity to buy into that popular government insurance program. But you don’t see Republicans taking that tack. Instead, they are signing onto a frivolous lawsuit that only proves that those attorneys general are ignorant of Art. 1, Sec. 8 of the Constitution.

The reforms will be paid for, in part, with taxes on insurance companies, drug companies, medical device manufacturers and people making more than $200,000 a year, along with phaseout of the inefficient Medicare Advantage program. In 2018, an excise tax on high-cost employer-provided health plans becomes effective. The tax, paid by insurance companies, will hit plans worth more than $10,200 per year for individuals or $27,500 for families, with higher thresholds in high-risk professions, and the thresholds will be indexed with inflation.

The nonpartisan Congressional Budget Office has refuted the Republican lie that health reform will increase the federal deficit. In fact, according to the best estimates, the reforms will reduce the deficit by $143 billion over the first 10 years and more than $1 trillion over 20 years.

Again, we think a more sensible and efficient solution would be to expand Medicare to cover all Americans. Failing that, Congress should allow Americans to buy into Medicare instead of being forced to buy private insurance. But we have three years to see how private insurance handles the push for universal health coverage before anybody is forced to buy anything. In the meantime, as Republicans push for repeal of the health insurance reforms, voters may wonder why they would want to return to the days when insurance companies can deny coverage to children with pre-existing health problems or rescind coverage to customers who had paid their premiums once they turn up with a medical condition or women can be charged higher rates simply because they’re women.

Republicans want to repeal all that to keep the status quo. In the past year they have resisted efforts to draft a health reform bill. Then the GOP resisted attempts to bring the bill to a vote. Then, after the Senate passed the bill with some controversial pork barrel provisions demanded by conservative Democrats, Republicans even resisted efforts in the reconciliation process to fix the complaints that those same Republicans had.

The Democrats — without a single Republican vote — managed to pass the health insurance overhaul fair and square. It is expected to add more than 30 million Americans to the ranks of the insured. That coverage perhaps will save the lives of 30,000 people annually who will be able to afford timely medical attention that previously they might have been put off until it was too late. And a person with a medical condition will be able to change jobs or even start his or her own business without fearing being left without insurance coverage.

Republicans think they can win in November by urging voters to reject those reforms.

I think Democrats can win that debate. — JMC

From The Progressive Populist, April 15, 2010