The Senate is currently working its way up to a vote on fixes to the health care reform bill. That, of course, involves working its way through a host of ridiculous amendments proposed by Republicans not so much to prevent the fixes as to just make everything difficult and time-consuming and to make the process feel as negative and horrible as possible. That is the strategy. It’s about flooding the media with their negative messages and about preventing anything else from getting done. But it can’t go on indefinitely, and mcjoan is already seeing signs that they’re “giving in to the inevitable–passage of this bill.”
In the mean time, the early responses to passage of reform are good. A Gallup poll found that people think it’s a good thing the bill was passed, 49% to 40%. A CBS poll that resurveyed people who had already been polled on health care reform found support five points higher than previously, though support still trails, 42% to 46%.
So it’s looking like a slog, and no doubt Senate Republicans and their allies on cable television will make it as painful as possible to get to the final vote for the reform bill fix. But we’re getting there.
The health care reform bill has a lot of pieces. Some of them may affect you, others not. Some kick in this year, others phase in over a period of years. What effect the bill will have on any given person is a complicated question. Here are a few resources to find answers.
Remember that there is a long list of provisions that go into effect this year. Once the Senate passes the reconciliation bill already passed by the House, those include:
SMALL BUSINESS TAX CREDITS
BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE
FREE PREVENTIVE CARE UNDER MEDICARE
HELP FOR EARLY RETIREES
ENDS RESCISSIONS
NO DISCRIMINATON AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS
BANS LIFETIME LIMITS ON COVERAGE
BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE
FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS
NEW, INDEPENDENT APPEALS PROCESS
ENSURING VALUE FOR PREMIUM PAYMENTS
IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)
EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE
COMMUNITY HEALTH CENTERS
INCREASING NUMBER OF PRIMARY CARE DOCTORS
PROHIBITING DISCRIMINATION BASED ON SALARY
HEALTH INSURANCE CONSUMER INFORMATION
CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM
Included on that list are things that will help almost everyone. Like ending rescissions: now, if you’re insured you won’t have to worry that your insurance company will drop you the minute you get sick and really need the coverage. People graduating from college won’t have to worry that if it takes them some time to find a good job in this tough economy, they’ll lose their insurance—and their parents won’t have to worry, either. If you’re on Medicare and have a lot of prescription medications, the closing of the Part D donut hole will mean an awful lot to you. If you’re like me and you have good insurance, but you’ve found that it’s a lot easier to find just about any kind of specialist than it is to find a primary care doctor who’s taking patients, an increase in the number of primary care doctors is good news. If you’ve had a major illness or accident that ran up big bills once in your life, you’ll know how important the lifting of lifetime caps and restrictive annual limits is. And so on.
Ok, so those are some widespread effects. But what about you specifically?
The Washington Post walks you through it with a tool that asks about your current insurance status, your household size, income, and marital status and then tells you what will change. Will you be eligible for a new kind of insurance? Will the costs be subsidized? Will your taxes rise?
You might’ve heard the House passed a bill Sunday night that was kinda important…
Well, there are still some fixes the Senate has to pass to improve the bill – that’s the famed reconciliation (which the House already passed) – but the fact is that health care reform has been passed. And President Obama is signing it in just a few minutes. Watch live here:
(We’ll have lots more on health care soon, promise.)
It’s not the bill many of us hoped and fought for, but nonetheless we may soon reach the end of years of inaction and a massive struggle for change.
The bill is compromised, yes, but it’s still worth it. Though important parts of reform won’t go into effect for a couple years, there are significant changes that will happen this year, from beginning to close the donut hole to requiring free preventive care in new plans to funding community health centers.
And in the longer term, it will extend coverage to 30 million more people.
AFL-CIO President Richard Trumka fought hard to make the bill better; now he explains why he thinks it’s time to fight to pass this bill.
Congress is about to enter the final stages of a legislative process that would allow it to pass both substantial health care reforms and fundamental improvements to the nation’s student loan programs at the same time.
Passing health care reform would make medical coverage available to more than 30 million more Americans while reducing premiums, making health care more accessible and affordable while expanding help for lower-income families, making prescription drugs more affordable for seniors, and eliminating the worst insurance company abuses.
Passing student loan reform — a bill known as SAFRA (Student Aid and Financial Responsibility Act) — would make more college loans available to more students at lower costs, increase Pell Grant scholarships, expand college access to more students, increase support for community colleges and minority-serving institutions, all while saving money by ending the huge, needless subsidies paid to banks and private lenders.
I’d say that’s a Win-Win.
By essentially combining these two reforms into one reconciliation bill it will only need 51 votes in the Senate. And, as Ezra Klein has reported, according to the Congressional Budget Office (CBO) it will reduce the federal deficit by $130 billion in the first ten years, and another $1.2 trillion in the subsequent ten years.
I’d say that’s another Win-Win.
But oh the frantic chorus of “No-No!” from the Republican Congressional leaders and their banker buddies. “Government takeovers,” they yell repeatedly, attacking both health care and student loan reforms. They oppose health care reform because they say it creates “government subsidies for entitlement programs.” Ahem. That just means they’re against helping more lower-income families get affordable health coverage.
And the hypocrisy is thick. Get this: they oppose the SAFRA student loan reforms because they want to protect the tens of billions of dollars in federal subsidies currently going to a broken entitlement program for private lenders and big bankers.
What would happen if student loan reform is not passed?
Source: Center for American Progress
A half-million students would face Pell Grant cuts. Eight million students would face 60% cuts in education aid.
But if it does pass, it would redirect the $61 billion the government would otherwise use to subsidize banks and private lenders in the next ten years to instead fund a 100% Direct Loan program — a program that would still be serviced by private lenders, but without the billions in bank subsidies.
The Center for American Progress just produced and posted a very informative, brief video that answers many of the key questions about SAFRA’s reforms.
Health Care for America Now! has a handy link to connect you to Congress. Tell Congress to pass health care and student loan reform now.
As the Congress gets down to the business of enacting, at long last, the most significant reforms of health care and health insurance in the last forty-five years, the American people are looking for members of Congress to express their interests, based on the common good, with the seriousness and depth of insight that the issue of health care reform demands.
You know, like this.
That’s Rep. Mario Diaz-Balart (R-FL) during the House Budget Committee markup of the health care reconciliation bill on Monday.
A psychologist friend of mine offered this analysis:
As health care reform finally comes to its final votes (we hope), AFSCME and Americans United for Change are running an ad reminding viewers why this issue is so important:
Today’s the kind of day I wish I were in D.C. Thousands of health care reform supporters, progressives, workers and union activists rallied in Washington to conduct a “citizens arrest” of the big insurance companies.
The rally, organized by Health Care for America NOW! (HCAN), began this morning at Dupont Circle followed by a march to the Ritz-Carlton hotel. That’s where the giant health insurance lobby group AHIP is having its annual meetings.
A piece of the health care reform issue we don’t hear much about is the very serious shortage of primary care physicians:
The annual number of American medical students who go into primary care has dropped by more than half since 1997. It’s hard to get an appointment with the doctors who remain. In some surveys, as many as half of primary-care providers have stopped taking new patients. The other half are increasingly overworked and harried. Clearly we need to find a way to increase their ranks, and both the congressional health-care bills and President Obama’s reform proposal make moves in that direction. But those efforts are somewhat limited, and a more comprehensive solution could be thwarted by the same thing that’s stalled the rest of health-care reform so far: politics.
The reason behind America’s doctor gap is a matter of money. The average income in primary care is somewhere in the mid-$100,000s, which sounds like a lot but is less than half what specialists such as radiologists and dermatologists make. Given that doctors may graduate with as much as $200,000 in med-school debt, it’s easy to see why primary care started hemorrhaging recruits more than a decade ago and why radiology and other well-paid, high-tech specialties took off in popularity.
The field has since entered a vicious cycle. As fewer people have entered primary care, the doctors who are left have been forced by tight schedules to shortchange some patients, forgoing the long, meandering chats that used to be a big part of checkups in favor of 15-minute, checklist-style appointments. The close relationships that general practitioners once had with patients drew many idealistic students into the field. Now recruiters face an extra-tough sell: they have to convince bright young would-be docs to pursue a career that won’t pay very well and won’t be as emotionally fulfilling as it once was.
Some medical schools around the country now have programs that pay a portion of the med student’s tuition, in exchange for them doing their training in rural areas. There is also the National Health Service Corps where scholarships and loan repayment are available to medical professionals who go to work in an underserved area. Programs like this are especially important in rural areas. From their website:
About the National Health Service Corps
Since 1972, more than 30,000 clinicians have served in the Corps, bringing high quality health care to places and people without access to even basic services.
Nearly 80 percent stay in the underserved area after fulfilling the NHSC service commitment; more than half make a career of caring for underserved people.
Last year, about 3,500 NHSC providers cared for 4 million people — changing their own and their patients’ lives.
Average hours dropped from about 55 to 51 hours per week from 1996 to 2008, according to the analysis, appearing in Wednesday’s Journal of the American Medical Association.
That’s the equivalent of losing 36,000 doctors in a decade, according to the researchers. And it raises policy questions amid a looming primary care doctor shortage and Congress considering an expansion of health insurance coverage that would mean more patients.
One can certainly suppose (correctly) that overwork and burnout may be reasons why doctors are working fewer hours, but money also seems to be a big motivator:
Payment issues may have played more of a role. The overall decrease in hours coincided with a 25% decline in pay for doctors’ services, adjusted for inflation. And when the researchers looked closely at U.S. cities with the lowest and highest doctor fees, they found doctors working shorter hours in the low-fee cities and longer hours in the high-fee cities.
One way to address the problem of doctor shortages is to have patients see nurses, physician’s assistants, and nurse practitioners for routine care – all of whom can detect a serious problem and pass it on to a doctor. In some rural areas this is already happening, out of necessity.
The American Medical Association and doctors groups don’t like this. Even though there is a serious shortage of primary care docs, the AMA is opposed to letting nurse practioners have a greater role in primary care.
The American Medical Association sparked harsh criticism from nursing groups when it released a report in October bluntly questioning whether nurse practitioners “are adequately trained to provide appropriate care.” To back up its claims, the report cites recent studies that question the prescription methods of some nurse practitioners, as well as a survey that reported only 10 percent of nurse practitioners questioned felt well prepared to practice primary care.
The nurses are fighting back:
Responding to the AMA in December, the American Nurses Association and more than two dozen other nurses’ organizations termed the report “misleading,” saying it “contains numerous factual misrepresentations.” Their letter rebuked the AMA for its “attempt to change the perceptions of NP practice as anything other than fully qualified professionals working within a legally established scope of practice.”
In addition to the common sense aspect, using nurse practitioners also saves money:
In September, the nonpartisan Brookings Institution’s Engelberg Center for Health Care Reform issued a report by 10 experts that said one way to curb health care spending is to encourage states to permit “greater use of nurse practitioners, pharmacists, physician assistants, and community health workers.” Meanwhile, a blue-ribbon committee working under the aegis of the Institute of Medicine and Robert Wood Johnson Foundation is planning to make extensive recommendations later this year on the future of nursing.
Instead of big, howling egos, it would be nice to see more creative solutions. A small town in northern NH was fortunate enough to have one solution given to them. A wealthy summer resident of Tamworth, NH started the Tamworth Community Nurses Association. Mrs. Elizabeth Whittemore left behind an endowment, so that all residents of Tamworth could have access to health care. That was over 80 years ago. The town of Tamworth still has a nurse that sees patients in her office or makes house calls. Free.
In the interest of full disclosure, I know JoAnn Rainville, the Tamworth Community Nurse. I live in a nearby town. The kind of care she provides, saves money. In rural areas, duplicating this kind of service makes sense, especially as we face a shortage of primary care doctors and the possibility of millions of Americans becoming insured.
So, Anthem Blue Cross totally needed to raise rates on individual policy holders in California by up to 39%. They were losing money, people! (On the individual market in California, while making giant profits overall.) Just trying to staunch the bleeding! (They told us.)
Internal emails tell a different story. You might need to sit down before reading this, but: The rate increases were to increase profits, not minimize loss. Who could’ve guessed?
This came out yesterday at a hearing held by the House Energy and Commerce Health Subcommittee, where Representatives Waxman and Stupak read out some internal Anthem emails.
– “The average increase is 23 percent and is intended to return California to a target profits of 7 percent, versus 5 percent this year.” [WellPoint email, October 7, 2009]
– “We’re asking for premiums that would put us $40 million favorable…if we get the increases on time, we will see an opt gain upside of $30 million downgrades and rate cap.” [WellPoint email, November 2, 2009]
– “[W]e needed to reach agreement on filing strategy quickly — specifically in the area of do we file wth a cushion allowed for negotiations.” [WellPoint email, 10/24/2009]
Company-wide profits aren’t enough for them. Profits in California aren’t enough for them. No, every single area of business has to be profitable for them. What’s next? How far does it get subdivided? “Well, yes, we were making money on individual policyholders, but we weren’t making money on individual policyholders over 60, so we had to raise their rates by 73%”?
This is why there needs to be meaningful competition and meaningful cost controls. This is why a public insurance option is the best choice – because when individual policy holders got their letters announcing a 39% increase, they’d have somewhere to go. And don’t you think maybe that would make Anthem rethink whether to send the letters to begin with?
