Hi little girl, it’s me – don’t you know who I am?
I met you last summer when I came up to stay with my Gram
I’m the guy-uy-uy who left you with tears in his eyes
You didn’t answer my letters, so I figured it was just a li-i-i-i-ie
“Girl Don’t Tell Me” – The Beach Boys
The health care debate has so many moving parts that it’s hard for anybody to keep them straight. So we decided to put together an overview of where we’re at—both good and bad—and what we’re all going to need to keep fighting for.
Neither of these bills is close to perfect. But we’re entering the home stretch where we risk losing a lot of what’s good in these bills and where we have a huge opportunity to strengthen the parts that need work.
Here’s where we are:
The House of Representatives passed their bill last month. The Senate is aiming to pass its version before Christmas.
Overall, both pieces of legislation would do four major things:
* Create a “Health Insurance Exchange.” The bills create a one-stop marketplace where people can choose from various insurance plans, including the public option. The details aren’t set yet, but initially the Exchange would likely be open to the self-employed, people without insurance at work, and small businesses.1 The key with the Exchange is that it brings “the bargaining power and scale that’s generally accessible only to large employers” to individuals—and with that, lower costs and better options.2
* Provide insurance to over 30 million more people. The House bill would expand coverage to 36 million people by 2019. The Senate bill extends coverage to 31 million.3
* Outlaw discrimination based on pre-existing conditions and gender. Insurance companies will have to stop denying coverage to people with “pre-existing conditions.” And they won’t be allowed to charge women more than men for the same coverage.4
* Eliminate coverage limits and price-gouging. The bills differ on some details, but in general would place limits on how much people have to pay for health care beyond their premiums. They both cap out-of-pocket costs and ban insurance companies from setting limits on how much health care they’ll cover for a person each year.5
Of course, the devil is in the details, and much in these bills still needs work.
Here’s what still needs to be fixed:
* Both bills leave millions uninsured. The House bill leaves 18 million without insurance in 2019; the Senate bill, 24 million. Neither comes close to the vision for universal coverage so many of us fought for for years. We’ll all need to fight to continue to expand coverage in the bills this year, and in the years to come.6
* The Senate public option is weak, and conservatives are pushing to make it weaker. The public option is a core piece of reform that will create real accountability and competition for private insurance—and that’s why it’s at the center of such a huge fight. While the House bill creates a national public option, the Senate lets states opt out, denying their residents access to it. Plus, conservatives are working to weaken it even more. We’re all going to have to fight hard for the strongest version possible.7
* Many reforms don’t start quickly enough. While some pieces of reform go into effect right away, the larger structural changes are not scheduled to go into effect until 2013 (House bill) or 2014 (Senate bill). This includes the Exchange, the public option, and subsidies—the major ways coverage will be expanded.8
* Required insurance could still be too expensive for many. Both bills require virtually all Americans to have insurance. But the caps on how much we’re expected to pay are way too high, and the subsidies are way too low. Many progressives are working to fix this, but it’s going to be a significant fight.9
* Reproductive rights are severely restricted in the House bill. An egregious anti-choice amendment in the bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. We need to make sure the final bill doesn’t include this rollback of reproductive rights.10
* The Senate bill could discriminate against lower income workers. The current Senate legislation retains a version of what’s called the “free rider” provision, which essentially penalizes employers for hiring lower income workers. This provision needs to be fixed before the bill is finalized.11
There’s a lot going on in these bills, and we’re all going to need to be vigilant to ensure the good pieces end up in the final bill, and the bad ones are fixed. It’s going to be a rocky ride. But if we fight together, we’ll come out stronger in the end.
Sources:
1. “A Health Insurance Exchange: The Fine Print,” The New York Times, August 20, 2009
http://www.moveon.org/r?r=85241&id=18172-11381997-6Gfo9tx&t=3
“Health Reform at a Glance: The Health Insurance Exchange,” House Committees on Ways and Means, Energy and Commerce, and Education and Labor, July 14, 2009
http://www.moveon.org/r?r=85665&id=18172-11381997-6Gfo9tx&t=4
2. “Health Insurance Exchanges: The Most Important, Undernoticed Part of Health Reform,” The Washington Post, June 16, 2009
http://www.moveon.org/r?r=85664&id=18172-11381997-6Gfo9tx&t=5
3. “H.R. 3962, Affordable Health Care for America Act,” Congressional Budget Office, November 20, 2009
http://cbo.gov/doc.cfm?index=10741
“Patient Protection and Affordable Care Act,” Congressional Budget Office, November 18, 2009
http://cbo.gov/doc.cfm?index=10731
4. “Top 10 Ways Health Insurance Reform Works for You,” The Speaker of the House, October 29, 2009
http://www.moveon.org/r?r=85669&id=18172-11381997-6Gfo9tx&t=6
“How Health Insurance Reform Will Help Your Family,” Senate Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-responsiblereform.cfm
“Meeting Women’s Health Care Needs,” The Speaker of the House
http://www.speaker.gov/newsroom/legislation?id=0327
“Reports on Health Insurance Reform—Women,” Senate Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-responsiblereform.cfm
5. “Top 10 Ways Health Insurance Reform Works for You,” The Speaker of the House, October 29, 2009
http://www.moveon.org/r?r=85669&id=18172-11381997-6Gfo9tx&t=7
“How Health Insurance Reform Will Help Your Family,” Senate Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-responsiblereform.cfm
6. “H.R. 3962, Affordable Health Care for America Act,” Congressional Budget Office, November 20, 2009
http://cbo.gov/doc.cfm?index=10741
“Patient Protection and Affordable Care Act,” Congressional Budget Office, November 18, 2009
http://cbo.gov/doc.cfm?index=10731
“REPORT: How the Senate Bill Compares to Other Reform Legislation,” Think Progress, November 19, 2009
http://www.moveon.org/r?r=85670&id=18172-11381997-6Gfo9tx&t=8
7. “Sen. Reid Announces ‘Opt Out’ Public Plan,” The New York Times, October 26, 2009
http://www.moveon.org/r?r=85673&id=18172-11381997-6Gfo9tx&t=9
“Carper: Conservative Democrats Not Likely To Support Senate Public Option,” Talking Points Memo, November 17, 2009
http://www.moveon.org/r?r=85675&id=18172-11381997-6Gfo9tx&t=10
8. “Top 14 Provisions That Take Effect Immediately,” The Speaker of the House
http://www.moveon.org/r?r=85676&id=18172-11381997-6Gfo9tx&t=11
“What happens before 2014?” The Washington Post, November 19, 2009
http://www.moveon.org/r?r=85677&id=18172-11381997-6Gfo9tx&t=12
“Senate, House Democratic health bills compared,” The Associated Press, November 18, 2009
http://www.moveon.org/r?r=85667&id=18172-11381997-6Gfo9tx&t=13
9. “The Details of The New Merged Senate Bill,” Think Progress, November 18, 2009
http://www.moveon.org/r?r=85668&id=18172-11381997-6Gfo9tx&t=14
“REPORT: How the Senate Bill Compares to Other Reform Legislation,” Think Progress, November 19, 2009
http://www.moveon.org/r?r=85670&id=18172-11381997-6Gfo9tx&t=15
“Analysis: How the Senate health care bill stacks up with the House health care bill,” Think Progress, November 19, 2009
http://thinkprogress.org/2009/11/19/senate-house-comparison/
10. “The Ban on Abortion Coverage,” The New York Times, November 9, 2009
11. “The noxious ‘free rider’ provision,” The Washington Post, November 25, 2009
http://www.moveon.org/r?r=85671&id=18172-11381997-6Gfo9tx&t=16
“Senate Health Bill Improves Employer Responsibility Provision,” Center on Budget and Policy Priorities, November 19, 2009
http://www.cbpp.org/cms/index.cfm?fa=view&id=3003
“The Baucus Bill: The Worst Policy in the Bill, and Possibly in the World,” The Washington Post, September 16, 2009
http://www.moveon.org/r?r=85672&id=18172-11381997-6Gfo9tx&t=17
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