It’s Over! It’s Just Begun!

The battle for health care reform is over, for now.  When the Senate voted on the Reconciliation Act, three cowardly DINOs voted with the Republicans.

Blanche Lincoln, Ben Nelson, Mark Pryor

They should lose their funding from the Democratic Party.  They should be challenged by progressives in their next primaries.  They should be stripped of plum committee assignments.  They should be retired.

Yesterday, the House passed the amended version of the Reconciliation Act.

Congress on Thursday gave final approval to a package of changes to the Democrats’ sweeping health care overhaul, capping a bitter partisan battle over the most far-reaching social legislation in nearly half a century. The bill, which Democratic leaders hailed as a landmark achievement, now goes to President Obama for his signature.

“The American people have waited for this moment for a century,” the Senate majority leader, Harry Reid of Nevada, said at a news conference. “This, of course, was a health bill. But it is also a jobs bill, an economic recovery bill, was a deficit-reduction bill, was an antidiscrimination bill. It was truly a bill of rights. And now it is the law of the land.”

In a fitting finale to the yearlong health care saga, the budget reconciliation measure that included the final changes was approved first by the Senate and then by the House on a tumultuous day at the Capitol, as lawmakers raced to complete their work ahead of a two-week recess.

The final House vote was 220 to 207, and the Senate vote was 56 to 43, with the Republicans unanimously opposed in both chambers.

The reconciliation bill makes numerous revisions to many of the central provisions in the measure adopted by the Senate on Dec. 24, including changes in the levels of subsidies that will help moderate-income Americans afford private insurance, as well as changes to the increase [for those earning over $250,000] in the Medicare payroll tax that will take effect in 2013 and help pay for the legislation.

The bill also delays the start of a new tax on high-cost employer-sponsored insurance policies to 2018 and raises the thresholds at which policies are hit by the tax, reflecting a deal struck by the White House and organized labor leaders. It also includes changes to close the gap in Medicare prescription drug coverage known as the doughnut hole, and to clarify a provision requiring insurers to allow adult children to remain on their parents’ insurance policies until their 26th birthday.

Many of the changes were intended to address the concerns of House Democrats, as well as to bridge differences between the original House and Senate bills and to incorporate additional provisions sought by Mr. Obama.

The bill also included a broad restructuring of federal student loan programs, a centerpiece of Mr. Obama’s education agenda.

As the Senate voted, Mr. Obama was in Iowa City where he opened an aggressive public relations blitz to sell the health care overhaul with a campaign-style rally at the University of Iowa Field House.

Speaking to a crowd of about 3,000 Mr. Obama dared Republicans to follow through on their efforts to repeal the legislation, which would require them to win back big enough majorities in Congress to override his veto… [emphasis added]

Inserted from <NY Times>

GOP appeals are gushing to their brainwashed base, begging for contributions to help them repeal health care reform.  That is nothing but a cheap trick, trying to extract money from their Faux Noise sheep with a completely empty promise.  Even the GOP leadership is starting to admit it.

Throughout the week, many Republicans have said that repealing the Affordable Care Act should be part of the Party’s campaign platform for this year’s midterm elections. Yesterday, Senate Minority Leader Mitch McConnell (R-KY) said “repeal and replace will be the slogan for the fall.” Congressional Republicans such as Reps. Pete Hoekstra (MI), Michele Bachmann (R-MN), Zach Wamp (TN) and Sens. John McCain (AZ) and Jim DeMint (SC) have signed on to the cause as well.

But other Republicans are candidly acknowledging that the GOP’s new big agenda is mere political gamesmanship:

– Sen. Jon Kyl (R-AZ): “Our view is that we should repeal and replace the bill with the solutions that we think actually work. Obviously, the president will not sign a repeal bill that the Congress passes, so that’s more of a symbol. … Barack Obama is president. He would never sign a repeal law. We don’t have the votes to get it passed right now. We’re not going to waste our time on that.”

– Newt Gingrich: [Faux Noise Delinked] “What you have to do is be politically honest. If the Republicans win a majority in the House and Senate next year, they will not be able to repeal the bill. The president would veto it.”

House Minority Leader John Boehner (R-OH) proclaimed yesterday that the GOP should “repeal this bill,” yet seconds later, even he acknowledged that with Obama as President, “it’s going to be very difficult to repeal this bill outright.” Watch the compilation:

 

Republicans whined about repealing the bill before it passed but even then, National Republican Senatorial Committee head Sen. John Cornyn (R-TX) noted that the repeal effort would likely go nowhere “because obviously we don’t have the White House, we don’t have 60 votes in the Senate.”… [emphasis original]

Inserted from <Think Progress>

One of the biggest complaints I have heard is the time it will take to implement some of the benefits the bill contains.  An excellent editorial by Jonathan Kohn explains the delays.

HEALTH care reform, the most ambitious domestic policy initiative of our time, is now law. And already there is talk of how to make it even better. Some want to improve the subsidies and financial protections, so that people aren’t as exposed to high medical bills. Others would like to add some sort of public option, whether it’s a new stand-alone government-run plan or expanded access to Medicare.

Those are good ideas. But making the most out of the Patient Protection and Affordable Care Act will also depend on something a little less exciting: putting the existing plan into action. The challenges ahead fall into four categories.

DELIVERING THE DELIVERABLES President Obama promised that some of the benefits of reform would appear in the first year. For starters, within 90 days the Department of Health and Human Services must set up a high-risk pool as a temporary source of insurance for people who have pre-existing conditions.

Some of the new consumer protections will take effect within six months; first, though, federal officials have to translate that law into regulation. The government is also supposed to provide a new, easy way for consumers to compare benefits from insurer to insurer.

EDUCATING THE PUBLIC It’s one thing to create a health insurance program and quite another to get people to sign up for it. Today, many more people are eligible for Medicaid than actually enroll, in no small part because some states — wary of adding too many people to the rolls — make it hard to apply for and stay in the program.

That said, more than 97 percent of people in Massachusetts now have insurance, thanks in part to an aggressive public relations campaign that enlisted the Red Sox to raise awareness about the state’s own health care overhaul. A similar effort to increase public knowledge and to undertake direct outreach to individuals will be necessary. While states and nonprofit organizations will play vital roles, the federal government should probably take the lead.

HANDLING THE INSURERS Speaking of Massachusetts, that’s the one state with a fully working model of an insurance exchange: a place where individuals and small businesses can buy relatively affordable coverage, with clearly defined benefits and no exclusions or mark-ups based on the health of the people applying. And the model seems to work overall. But replicating that in 49 other states won’t be easy.

It requires appointing people to run the exchanges and figuring out how Americans will use them, but it also means preparing to regulate insurers more closely than anybody regulates them now. The law creates minimum standards for what insurance covers and requires insurers to spend most of their money on actual patient care, to name only two obvious changes. The states will have primary responsibility for enforcing these standards, but first the federal government will have to write them.

BENDING THE CURVE Dozens of new initiatives are intended to control, or at least reduce, the cost of medical care. But most of them require work to get up and running.

Everyone hopes that wider use of electronic medical records can improve quality while reducing expensive duplication. Again, somebody first has to set up a standard for the records. Studies show we’d save money if we stopped paying for so many treatments that don’t work (or don’t work better than the alternatives). But we can’t start paying for treatments more intelligently without better information about what drugs and procedures do work, not to mention which ones doctors and hospitals already use.

Progress on many of these goals is already under way. (Development of electronic records, for instance, began with the stimulus.) But there are obstacles ahead: some states are eager to do their part; others are busy suing the federal government because they don’t like the law. The Obama administration also needs to find the right people to manage these programs.

Getting reform right may ultimately require making sure one official is responsible for coordinating activity among the different agencies and levels of government. It should probably be someone who reports to the White House but is also accountable to Congress; someone with a head not just for politics but also for the world of insurance, regulation and medicine; someone who can push the many groups and institutions that will need pushing, while also listening to people’s concerns…

Inserted from <NY Times>

Considering what is involved in setting up the mechanisms to implement the most ambitious legislation in many of our lifetimes, the delays seem reasonable.  After all, to quote a famous politician, it’s a big f*ck*ng deal! 😈

So it’s over.  I have never witnessed such a contentious floor fight, but I remember I made a promise, and now is the time to keep it.

One positive aspect of the delays is that the mandate, in the absence of a strong public option does not take effect until 2014.  That gives us time to get it changed.

In addition, even as I type these words, there is a legion of insurance company lawyers dissecting every phrase, looking for loopholes  they can use to deny coverage to those with preexisting conditions, to dump sick patients, to deny covered procedures dying patients desperately need to save their lives, and to evade the requirement that they spend 85% of what they take in on direct benefits payments.  If you think they won’t find such loopholes, email me.  I want to talk to you about a bridge I just happen to have for sale.

While I do support a strong public option, that is a fallback position.  What this country really needs is universal, single-payer health care: Medicare for all.  I can almost hear GOP screams of “socialized medicine”.  What’s wrong with that?  We have socialized police protection.  Why?  Protecting our lives and property is far too important to leave it to greedy corporations, who would consider profit more important than our lives and property.  We have socialized firefighters.  Why?  Protecting us from fire is far too important to leave it to greedy corporations, who would consider profit more important than fighting fires.  With this in mind, health care is far too important to leave it to greedy corporations, who have proven over and over again, that they consider profit more important than our lives and health.  Furthermore, every penny that goes to insurance company profits is a penny that doesn’t get spent on health care.

Yes it’s over, but it’s just begun.