Congress Passes Historic Health Care Reform

For the first time in generations, the US Congress has passed a bill reforming our nations health care system.

Historical Attempts

This lofty goal has eluded reformers ever since Teddy Roosevelt attempted it during his 1912 run for president. A national health insurance program was proposed by FDR as part of Social Security, and the effort was continued by his successor Harry Truman in the 1940s, but stiff opposition by conservatives derailed the effort. Lyndon Johnson managed to get limited reforms enacted with the passage of Medicare in 1965, although this national health insurance program is only available to those over 65 years old (and a few others in certain circumstances). Despite nearly universal support today, conservatives vehemently opposed Medicare at the time, claiming it would be the start of government takeover of the health care system. In fact, Sarah Palin almost quoted verbatim the fear mongering speech by Ronald Reagan to the AMA in 1961 that opposed the creation of Medicare.

Richard Nixon proposed the Comprehensive Health Insurance Act in 1974, and this effort continued under Jimmy Carter, although it ultimately failed to materialize due to opposition by liberal Congressman like Ted Kennedy because it did not go far enough. Bill Clinton unsuccessfully attempted a modest overhaul of the system after in 1993 which was viciously attacked by right wing politicians and talk radio.

HCR Today
Along with the Great Recession and Iraq War, health care reform was one of the central issues that helped in the landslide victory of Barack Obama and progressive Democrats in 2008. Starting in May 2009, the push began for comprehensive reform.

That the country needs to reform its health care system is painfully obvious. At least 47 million Americans have no medical coverage, 75 million are underinsured with skeleton plans, and 86.7 million Americans have been uninsured for at least 6 months over last two years. There has been a dramatic rise increase in the uninsured rate in every state. Lack of health care coverage caused 45,000 deaths per year. Health care premiums shot up more than 90% between 2000 and 2007, while the profits of the 10 largest insurers increased 428 percent over the same period. Without real reform, there will be a 94% increase in health insurance premiums by 2020. Harvard researchers say 62% of all personal bankruptcies in the US were caused by health problems—and 78% of those filers had insurance. Finally, and perhaps most importantly, despite having the most expensive per capital health care in the world, the US in only ranked 37^th in the quality of care.

To the dismay of many reform advocates, a fully socialized medical system, like the highly successful ones used in Scandinavian countries was not even considered despite their cost effectiveness and long life spans. A Single-Payer system (sometimes called Medicare-For-All) is still pushed for by strong reformers, although the Democratic congressional leadership abandoned serious consideration of this early on due to the same cries of ‘socialism’ that plagued Medicare during it’s creation.

The fall back position of real reform advocates has always been a strong, robust public health insurance option that would give a bit of competition to highly consolidated markets (for instance, large regions of some states only have one or two insurers). However, the public option was scaled back many times, until it was a public option in name only, that would have prices set by the very health insurance giants whose costs it was supposed to keep in check and even then only cover 6 million by 2018. In the end, even this was abandoned in the bill.

The Final Health Care Bill

HR 3590, the Patient Protection and Affordable Care Act is the same as the US Senate bill passed months ago.  HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010 is essentially the same as the bill passed by the US Senate, and was posted online on Tuesday as part of a new ritual of making bills freely available to the public 3 days before a vote. A breakdown of the bill with by section can also be found in pdf format.

The nonpartisan CBO (Congressional Budget Office) estimated it would expand coverage at a cost of $940 billion over 10 years (~$94 billion per year on average) and cut the deficit by $143 billion in the first decade, and by cut it by roughly $1.2 trillion over the second decade. It brings coverage for 35 million more Americans, which should mean over 95% of the public will be covered when it takes effect in 2014.

Rep. John B. Larson (D-CT), the Chairman of the Democratic Caucus in the U.S. House of Representatives writes that the top 10 immediate benefits of the bill will be:

Prohibit pre-existing condition exclusions for children in all new plans;
Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
Prohibit dropping people from coverage when they get sick in all individual plans;
Lower seniors prescription drug prices by beginning to close the donut hole;
Offer tax credits to small businesses to purchase coverage;
Eliminate lifetime limits and restrictive annual limits on benefits in all plans;
Require plans to cover an enrollee’s dependent children until age 26;
Require new plans to cover preventive services and immunizations without cost-sharing;
Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;
Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.

The health care reform expert Karoli adds:

1.Adult children may remain as dependents on their parents’ policy until age 26
2.Children under age 19 may not be excluded for pre-existing conditions
3.No more lifetime or annual caps on coverage
4.Free preventative care for all
5.Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
6.Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
7.The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
8.Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
9.Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment)

This massive effort passed despite an unprecedented effort at obstruction from the Republican Party, conservative media propaganda, the Tea Party demonstrations (including a last minute temper tantrum filled with racist and homophobic slurs), and upwards of a billion dollars spent mainly by health insurance giants, who flooded Washington D.C. with 6 lobbyist for every member of Congress.  Rush Limbaugh even promised to leave the country if is passes, ironically promising to relocate to Costa Rica, a country that has aspects of socialized medicine.  Various non partisan groups like Politifact.org had to submit various fact sheets debunking strong undercurrents of disinformation deliberately spread about health care reform.

The first vote today had the House pass the Senate bill. A second vote was for the reconciliation bill with some changes, which will now head to the US Senate for a simple up or down vote, then go to the desk of President Obama, who is highly likely to sign it and make it into law.

Update 8:33 pm PST: HR 4872 (the reconciliation bill) has just passed as well by a vote of 220-211.

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