The Senate is ready to vote on its version of the health care reform bill on the morning of Christmas Eve. The Republicans decided not to demand the full 30 hours of debate after the last cloture vote after they realized that would mean a final vote at 7:00 PM, and not being able to spend Christmas Eve with their families. They did, however, have to filibuster three times, twice followed by the full 30 hours. I would imagine there is little left to debate.
President Obama called this a historical moment – the first time since Harry Truman first tried that a bill has ever passed in both houses. After the new year, leaders from both houses will meet for conference to iron out the differences between the bills. Obama said that the bills agree on 95% of their content, so it is only the last 5% that needs work.
Of course, that 5% includes the public option that is in the House bill and not in the Senate’s. It includes language further restricting abortion coverage in both, but more stringent in the House version. It includes stronger regulation of insurance companies in the Senate bill. The Senate bill also has a mandate to purchase insurance with higher penalties, and it pays for the subsidies and other costs with a tax on better insurance plans usually provided under union contracts while the House bill raises taxes on the highest levels of income. The House bill changes the structure of the health insurance industry, while the Senate bill does not. Both leave millions uninsured.
To understand what this means, it is important to consider a change the White House made several months ago, from calling the bill health care reform to health insurance reform. What is the difference?
While campaigning, all the Democratic candidates for president called for access for all Americans to affordable, quality health care. Access is important. There are parts of the country, especially in rural and inner city areas, where people cannot get to medical providers, even for emergency care. Ambulances in some places are miles and miles away, taking valuable time in an emergency. It is not surprising that a Harvard study found a strong racial divide in the quality of care, and in the number of fatalities in emergency rooms.
In addition, besides the 47 millions of uninsured Americans, there were millions more who had insurance but could not afford to use it. Low cost policies offered by insurance companies generally had high deductibles, co-pays and other out of pocket costs. That means that besides paying a monthly premium, holders of these policies have to pay thousands of dollars for medical costs before the insurance pays anything. It also means that people do not go to the doctor when they need to when they cannot afford to pay, so, like those with no insurance, they present when they are sicker.
In order to fix these two problems with access to affordable and quality care, many choices were debated. Should there be a public option, and how strong should it be? Should we open Medicare to everyone? To some people other than the elderly and disabled? How should we raise the money for all this?
The Senate bill does nothing for the second group of people, those with “junk insurance.” In fact, it requires people to buy insurance and offers subsidies that in some cases will still require people to pay up to 20% of income for the total of insurance and out-of-pocket costs. If they do not buy insurance, they may have to pay 2% of their income in penalties.
It will also, by taxing the better insurance policies, encourage employers to switch to poorer coverage, and to shift more of the costs to the workers. It will also encourage them to use fewer full-time, full-benefitted workers in favor of parttime workers. This will add to the numbers of both uninsured and underinsured workers.
I know a woman who had passed her annual insurance payment limit before a brain tumor was diagnosed. She has been holding fundraisers with friends and family, and trying to continue working two jobs. She just found out that Israel has a grant program, and will send a neurosurgeon to perform her surgery at no cost. The tiny country of Israel is providing this to someone in the richest country in the world – and this is someone with insurance! We are receiving international aid.
On the other hand, the Senate Bill includes funding for hundreds of new Community Health Centers, which will improve access to care in underserved areas, thanks to an amendment offered by Senator Bernie Sanders of Vermont. These health centers treat those receiving public and private insurance, and to use a sliding fee scale for those without insurance.
As things progress after the Christmas recess, it will be important whether Congress decides to provide access to medical care, or only to health insurance.
I get my news from the New York Times, C-Span for following the congressional debates, several political blogs. I also receive frequent updates from several organizations that have been working for health care reform.