As Congress reconvenes this week, its first order of business will be the Republicans' attempt to repeal health care reform. Congress, along with the rest of the nation, has just gone through 10 days of reflection and grief over the tragedy in Tucson, something that will stay with us for a while. Will we see civil discourse take place this week in Congress, or at least a more tempered debate? Or will memories fade in DC and the rancor and histrionics re-emerge?
Political theatre (of the absurd, one could argue) will surely play out in the House in the coming days as conservatives make their token effort to repeal the Patient Protection And Affordable Care Act (PPACA) - or "Obamacare" as it is referred to in certain circles. Even though the CBO has estimated the deficit would be reduced by $230 billion dollars over ten years with PPACA, clearly those numbers were not to the conservatives' liking (they called the CBO's estimate "inaccurate") as they continue their attack on health care reform. As this drama unfolds, Democrats, with a narrow majority in the Senate, will reject repeal efforts and the President will be at the ready with his veto pen, as he will not let the signature achievement of his presidency so far be lost. Though they will fail this time, the Republicans will no doubt continue their efforts to chip away at specific elements of the bill, while their right wing shills on the airwaves shriek away in an effort to recast it as a wedge issue in the 2012 campaign. They are on a mission to hand the President a major defeat.
Democrats know that the health care bill needs continued work and improvements, and of course the progressive sector of the party remains dismayed that no single payer proposal ever made it onto that infamous table for discussion. Even the Public Option was a non-starter, although it has re-emerged from the attic via a recently introduced bill by Rep. Lynn Woolsey (D-CA). It is known as the Public Option Deficit Reduction Act (HR191) and is intended to serve as a supplement to the PPACA bill. The CBO estimates that it will reduce the deficit by $68 billion dollars.
Health care reform will continue to be a work in progress as some of the glaring issues are addressed, such as how to deal with unrelenting insurance industry increases, which continue to skyrocket. Blue Shield in California has sought an astounding 59% increase in premiums in the individual insurance market, and across the country increases in premiums, co-pays and deductibles are already being felt by millions in this young New Year. The individual market consists of 17 million people, who will be hit the hardest by rising costs as the spigot of uncontrolled and unprecedented increases flows freely. The already overwhelmed and red ink stained states will be left to deal with this mess, with little hope of success. And what about those unharnessed big pharma prices? Where are the state insurance regulators?
There continues to be no bailout for Main Street to match the bailout we gave to Wall Street and banking to the tune of 12.3 trillion. Yet, we can't come up with 140 billion to assist the states with their shortfall? The Dodd/Frank financial reform bill failed in allowing the Federal Reserve to come to the aid of the states. Bernanke will not help, nor will the federal government - the states are on their own (see Ellen Brown's excellent article on webofdebt.com). All the more urgency for state banks to be created in every state emulating the Bank of North Dakota, which has run a surplus for 100 years, using its money to build infrastructure for the community and state and to offer loans for small businesses, education and other municipal needs. This has helped North Dakota keep its unemployment rate at 4% - less than half the national average - and allowing it to remain one of the only solvent states.
Last year, nationally, health care costs had their smallest increase in 50 years, rising at 4%, in no small part because people are cutting back on using a very expensive system they can no longer afford, even with insurance. Of course, such personal decisions to ration one's health care needs will likely lead to more serious illness that will be much more costly when these folks do eventually have to seek medical care.
According to Dr. Don McCanne in his January 11th entry on his Quote of The Day blog on Physicians For A National Health Program's website, conservative New York Times columnist David Brooks and liberal Robert Reich - former Secretary of Labor in the Clinton administration and now a public policy Professor at U of Cal-Berkley - both implied that opposition to the government mandate to purchase expensive private health insurance plans may drive us to a much more logical and effective solution: single payer (public insurance financed by taxes.) This coming from Brooks is huge. He recently also said on one of the Sunday political talk shows that medical malpractice could be addressed with medical courts. Is Brooks-y becoming enlightened? We know he isn't turning progressive, but he is beginning to see the logic in his two observations on health care. Both make sense.
The health reform story is far from complete, as additional issues will continue to crop up before the bill is finally implemented in 2014, with further elements being enacted through 2019. A major issue will be a sluggish economy continuing to drag employment down, as it will for a few more years at the very least. More lost job benefits, including health insurance, is one reason why last year 3.5 million enrolled in Medicaid. The states are staggering under deficit budgets and high unemployment as their tax bases continue to erode. Where are all those new Medicaid recipients to go when so many states are already cutting back on Medicaid services and enrollment? 47.7 million are now enrolled in Medicaid. The health reform bill will pay for at least a few years of expansion of Medicaid among Americans below 133% of the poverty level but concerns loom large about the eventual cost to the states, most of which are already in deep financial trouble. Leading the pack are New York and California, our most populated states. How will the federal government handle this in light of the many millions more that will join Medicaid through Obamacare? Continuous dialogue will be needed on health care in Congress, as will "fine tuning" amendments to the health reform bill.
A comment on my last blog post came from a regular reader who shared a story about her 19-year-old niece named Maggie, who struggles with Type 1 diabetes and was recently dropped - on her birthday - from Medicaid. Her mother was on welfare, a drug and alcohol abuser who deserted this girl and her siblings. Maggie has been an honors student at college and is considering dropping out and finding a job so she can pay for her medication. She deserves a helping hand so she can pursue her dream of becoming a RN and giving back to society many times over. Her illness is serious and Maggie needs medical care. Who will help her? Certainly not Arizona Governor Jan Brewer, who last week announced that almost 300,000 "poor people" could be cut from health care coverage in her state.