What's Next For Health Care Reform?
By Rachel Goldberg
Director of Senior Advocacy, B’nai B’rith International

For a while it looked like health care reform might have been frozen and buried along with the rest of official Washington during this year's record snow fall in the national capital. Now that the snow has finally melted, however, hopes for significant changes in how health insurance works in the U.S. are once again heating up as well. Months ago, the Senate passed a bill and began working with the House on possible compromises between the two versions, mostly using the Senate bill as a base. Leaders of both parties (and from both houses of Congress) then participated in a sometimes productive, sometimes contentious summit meeting Feb. 25, and the president released his final proposals (mostly for changes to the Senate bill, including incorporating several ideas raised by Republicans at the summit) on Wednesday, March 3.

B’nai B’rith has long supported comprehensive health care reform because lifelong access to health care is necessary for healthy aging, and access to health care requires we change the current system. In today's health care marketplace, too many people are priced out because they are too old, sick, or risky. Many of those with health insurance coverage can't afford to use it—their co-payments for visits and drugs make their insurance something they can use only under catastrophic circumstances.

So where are we now? Despite the attacks on current proposals, the truth is that there is a lot of good in them, and in the president's plan to improve on what already exists. Many have wondered why we can't scrap it and start over—start smaller. We would suggest there are two basic reasons. First, there is no reason to scrap the existing bills because so much in them fits with the goals of B’nai B’rith, including access to affordable coverage for everyone that they can really use and keep. Second, starting small isn't as smart as it sounds. The pieces of health reform fit together—if you take one away, the reforms start to fall apart. We need to have achieved coverage for more people, for instance, so that the larger customer base offsets concessions from insurance companies to end discrimination. Ending insurance abuses without expanding coverage simply doesn't work.

At this moment, the bill passed by the Senate is the most likely vehicle for health reform. That bill would require most Americans to have take responsibility for their health care by having health insurance, but would also make it dramatically more affordable for most of the uninsured to do so. By providing subsidies to lower income people, and limiting or ending premium "rating" based on age (limited) and health status and gender (both banned), this bill would achieve much greater affordability. If the House agrees to pass that bill, the president can sign it. But neither we, nor the House, were entirely happy with the Senate bill, so changes to that bill would be an essential part of any deal. The Senate does have a mechanism for passing budget-related bills without the need for a super majority, and the current plan is to use that mechanism (called reconciliation) to make sure that "fixes" to the Senate bill also get passed through the Senate without a filibuster. This has been used in the past for tax bills, and to pass the Medicare prescription drug benefit. The party in the minority usually doesn't support use of reconciliation because it takes away the threat of a minority filibuster, but it is certainly within the rules and has been used many times in recent years.

We expect to hear certain criticisms again, some of which make sense, and some demagoguery as well. We will probably hear that this bill would slash Medicare benefits—it doesn't—and improves the program in tangible ways that will benefit millions, especially by addressing gaps in drug coverage. We will certainly hear the most powerful and misleading criticism again—that this is a government takeover of health care. Such things have been proposed and rejected in the past. Government is not taking over health insurance or health care in this bill—it is simply forcing the insurance industry to stop taking advantage of its control over health care! There will still be legitimate disagreement over philosophy, and certainly the future of health will include additional measures, many of which will be pioneered through this bill in Medicare, to contain costs without sacrificing care.

What's next:

On Wednesday (3/3/10) the president took real ownership of what had been a largely congressional process and called for the legislation to be entirely done by the end of March. The combination of the Senate bill, which would expand coverage, end many forms of insurance discrimination, and allow individuals to buy in a group market, with the fixes in the reconciliation process, would move the health care arena forward in a way never seen before. We would finally be able to help most Americans to buy health insurance, and to have and hold on to insurance that actually allows them to receive preventive, diagnostic, and chronic care management services. We could stop making health care an emergency only event for millions, and make it possible for more people to live longer and healthier.

How Will It All Work Out:

No one knows for sure. Despite the democrats’ majority in both houses, and a mechanism in the Senate that would allow the changes to be passed with a 51 vote majority, even a party line victory is not clear here. Though most of the media focus has been on battles and conflicts between the parties, the democrats don't all agree on what adjustments should be made to the Senate bill, and that conflict could result in the House not agreeing to pass the Senate bill at all. At this point, though, with public support for many of the reforms contained in the Senate bill (which exists despite poll numbers expressing reform fatigue) and the president's strong push this week, the odds are in favor of a comprehensive health reform being a reality before Passover. Stay tuned.