Health Reform Update: Falling Into Place, or Falling Apart?
December 9, 2009
Washington, D.C
The unfolding U.S. Senate debate over its version of a health care reform bill continues. Each day brings "news" and reports of this or that addition or subtraction from the legislation. The wrangling and deal making has now hit a fever pitch, owing to the fact that Senate Democrats are determined to finish their side of the process before adjourning for the Christmas Holiday. It's possible that this self-imposed deadline will be met, but it's also quite possible that this could stretch into January -- or later. One has to wonder if this is a good way to conduct business, but on the other hand it is the only thing that forces Senators to buckle down and get the job done. It's hard to tell some times if things are falling into place, or just falling apart.
To help provide some clarity on what is no doubt a very confusing Congressional process, here are some facts and figures about where we are at;
* Remember that the House of Representatives version is a different version from the Senate bill we are hearing about right now. The House bill passed several weeks ago.
There will be no final health care reform bill until the House and Senate versions are combined, and then voted on again by each body. That won't happen until sometime early in 2010 at best.
* All of the Senate changes being made and discussed are taking the Senate version farther away from the House version. The House version was bare-minimum in it's positive aspects; the Senate bill was even less positive from the start. Combining the final versions of each is going to be a very difficult task.
* In the Senate debate now it appears that they have abandoned the idea of a "public option" for insurance buyers. The gist of both House and Senate bills is to force individuals to buy health insurance -- if insurance is not provided by your employer, and if you are not poor enough to qualify for a government subsidy -- so not even having at least one option to buy which is a public-run plan is a key concession to the insurance companies. With no "public option" all the choices will then be private insurance companies. Beware schemes that promise a "non-profit" plan, but set up and run by an insurance company. This move by the Senate will set up a possible impasse with progressive members of the House who are demanding the "public option" inclusion in any final bill.
* In a trade for dropping the "public option", the Senate bill may allow people to buy into the Medicare plan as early as age 55, rather than having to wait until you become Social Security eligible. But, and a big but, we don't know how much they will charge someone who wants to buy-in. Affordable premiums for enrollees in this age group might be a major advance; but if monthly premiums are sky high it might only be available to a few who can afford it. What is an "affordable" premium? We don't know, but since every single Senator -- and many of their staff members -- earn fabulous salaries with very full health and pension benefits, we should be concerned.
* In the evolving Senate plan it has been advertised by some that the current federal employees health plan would somehow be incorporated into the new "Exchange" process. This would presumably allow people to buy in to one or another federal employee group insurance plan. That's nice, but again it won't make much difference if it's not affordable.
* All of the watering down and re-arranging of the Senate plan is caused by the 8-10 Senate Democrats who object to some part of the plan. They are all pro-business Democrats who have no problem threatening to oppose the final bill if they do not get their way. Since Senate Democrats refuse to discipline these members -- and since the Democrats will not restore majority rule ( 50+1, instead of the current 60 votes needed for passage of a bill) to the process, this small number of Senators is being catered-to.
* The Republican Senate minority continues to oppose each and every aspect of health care reform, stalling, complaining, and tossing every kind of roadblock in the way that they can think of. Many of their arguments against reform are being closely coordinated with the right wing media machine. Never mind that many of their so-called "arguments" are a mixture of half truths, lies, fabrications, and sheer lunacy. This is intended to stoke-up anti-reform voices. The disastrous handling of the reform campaign by the Democrats and the White House -- where pro-reform momentum was deliberately deflated as the process spun out-of-control this summer and fall -- now leaves the movement for positive reform at a vulnerable moment. At the very time that massive pressure on Senate Democrats is needed, there is no question that many pro-reform activists are spent, frustrated, discouraged, or even angry about the way the process was bungled. No other outcome was possible given the enormous amount of accommodating and compromising which Democrats offered to Republicans and the insurance and medical lobbies earlier in the process.
* The powerful and influential insurance companies are tending towards being more and more critical of the reform process, but they are not -- yet -- opposing the Senate bill. In the end if they are given a chance to sell more over-priced health insurance they will likely support the legislation. They will look out for themselves, and nobody else.
* Overall, UE will measure the Senate bill by the same yardstick used on the House bill. Is the plan affordable to working people? Will employers be barred from dropping the coverages they currently provide, or will they pay a small penalty and then be set free? Does the plan really control the zooming insurance cost increases, or just claim to do so? Will horrible insurance company abuses be stopped? Will the various insurance choices include some kind of public, affordable, and accountable selection?
Stay tuned for updates. Please see previous updates in this section for details on related issues.