So, Health Care Reform. Sick of this yet? Well, it’s not over yet and we can’t get off this hellish political merry-go-round until…well, I have no idea. So, that being established, let’s see where we are.
We have the House bill, the Senate bill, Obama* showing up every so often to rhetorically kick ass and take names…well, as much as one does that when one is at a ‘summit’ (PS I’ve never been to a summit, how do I get an invite? Ohhh, right! I have to wrongfully arrest a respected academic of color…preferably on his front porch). And, let’s see…we have filibusters, threats of reconciliation, and Boehner is very worried about abortion. So, you see, we clearly have made progress over the past 8 months.
While sarcasm is fun and cathartic, we have some real things to talk about here. I, for one, am a big single-payer girl. Ultimately, I think it is the only moral and just option as well as the only way costs will actually ever be controlled and care will be equally distributed. I have been known to angrily brush aside HCR as it stands now and insist that beginning again with half a backbone, one cajone, and just a few million private-insurance-lobbyist dollars less would be better than this pandering mess of a “reform” bill.** But, we have a very bad situation now for millions of Americans (those currently uninsured and those currently insured) and perhaps there is an opportunity here to do something that really matters.
To me, bad reform—at this point—would be legislation that changes nothing. Empty legislation that merely maintains the status quo with some minor alterations, a plan that doesn’t get at least some Americans insured, reform that allows private insurance to continue its disgusting march of corporate greed along the minimal competition freeway. (For example, legislation that would just address malpractice suits…to me, that’d be pretty bad reform). So, the bar is low. Radical reform is not my litmus test. I do mean radical as in root as in reform that actually addresses the roots of the problem…but perhaps we can save our long-term solutions' thinking caps for another day. I find it’s always best to put off thinking ahead.
So, with our framework of basically anything is better than nothing, let’s explore (and remember low expectations are key for being positively surprised)… The Urban Institute just released a report examining just who would be left out in the cold if the reforms on the table were abandoned. It’s a whole lot of people and it hits a whole lot of diverse demographics and it leaves me feeling a bit better about what’s on the table.
According to UI, the people with the most to lose if comprehensive health care reform does not happen are: 13.1 million self-employed people AND 47.8 million people employed in small businesses AND 26.9 million non-elderly persons working part-time or temporary positions (also sometimes considered underemployed) AND 96.2 million non-elderly people in families with incomes below 200% (about $44K for family of 4) the Federal Poverty Limit AND another 74.3 million people living in families with incomes between 200% and 400% the FPL AND millions of people with significant, costly health conditions. (UI, Blumberg, Feb 2010)
UI examined the groups of people who are currently uninsured and also the groups who currently pay the most for healthcare. This latter group is important because health care costs are rising and rising costs mean that fewer people will be able to maintain coverage. Currently, 18.4% of the non-elderly population is uninsured. UI’s estimates place this number at between 20.1% and 23.2% by 2019. So, one risk group is the employees of small businesses because they are less likely to be offered affordable employee sponsored health insurance, especially if they are low-wage earners. Health care exchanges and mandates for small business could make all the difference for affordable health insurance coverage within small businesses.
Another risk group are other individuals who do not have access to employee sponsored health insurance, like the un/deremployed, part-time, seasonal, and/or temporary workers. Currently these individuals go uninsured, purchase plans directly from insurers, or qualify for Medicaid. Those purchasing health insurance directly are often targeted by the various shameful shenanigans of insurance companies that we now commonly associate with the buzz-phrase: pre-existing conditions. HCR would not only make sure these people are insured, it would create affordable options, and it would protect these health insurance consumers from the unbelievably predatory and unfair practices of the health insurers.
Other risk groups are those with low-incomes and those with difficult, persistent, and costly health concerns. One of the best things HCR offers right now is an opportunity to at least begin restructuring how health care risks and costs are distributed and shouldered. When very high-risk individuals are shunned and removed from the larger pool, they are essentially excluded from any hope for affordable care. More comprehensively and equally distributed risk will lower the costs of health care for everyone—particularly those in already vulnerable positions (those who currently face the steepest costs).
So, let’s recap. Not only could this insure some of the Americans who are currently uninsured, but it will protect and create a quasi-public social safety net for millions of Americans. Whether or not you are currently reflected in one of these at-risk groups, you could very well move into one in the next ten years. Aging adults are especially likely to become a member of one of these groups. And un/deremployment will continue to be an issue facing millions of Americans in the coming years. This reform works for those Americans. And, it has the potential to—at least—temporarily lower health care costs. I am doubtful of its long-term sustainability for cost control because only a robust public option designed to undercut and compete with private insurance giants or a single-payer system can really make significant dents into the long-term cost of care. And, any program that continues to funnel government monies into a monopolistic private health insurance market will not be so effective at controlling the costs. BUT, this reform does do a lot for Americans now, Americans who cannot continue to be uninsured, underinsured, over burdened with cost of health care, or just a pre-existing condition or a pink-slip away from losing care for themselves and their families.
So, this is reform. It’s even—possibly—good reform. And walking away from this plan—a comprehensive health care reform plan that includes Medicaid expansions, subsidies for use on a health care exchange market, the restructuring and redistribution of health care risk, regulations on private insurance companies regarding adverse selection strategies, and cutting administrative waste—is walking away from a couple hundred million Americans.
*Note: I do love to see Obama display to the cranky, bumbling republicans just how smart he is, but I am not impressed with his overall HCR position.
**I have been especially known to take this position when I am stewing about the contempt for women’s rights that has been systematically woven into these attempts at reform. See Stupak-Pitts in the House bill and the Nelson abortion check provision in the Senate version.
To read the Urban Institute report, see pdf here.
