What’s Next? Progressives and Health Care

Kristin Teigen

With the passage of the health care bill this week, the progressive community can now take a breath and reflect. In many ways, we have a reason to celebrate. Over 30 million previously uninsured Americans will have access to health care, the insurance industry will no longer be allowed to use loopholes such as pre-existing conditions to deny care, middle class Americans will be given tax credits for insurance and through a competitive marketplace, the exploding costs of health care will start to be reined in.

But there is no rest for the weary. As we know, this legislation is far, very far, from perfect – a bill of this magnitude will remain a work-in-progress for some time, both in its implementation and through supplementary bills.

Yesterday, I was lucky to discuss the bill on a conference call between the leadership of the National Organization for Women and the Director of the White House Office of Publich Engagement, Tina Tchen. The clear message from both Tchen and the feminist community is that we have a long way to go to achieve full equity in the provision of health care in this country. As Tchen indicated, the White House will not rest, and neither can we.

What are the issues the progressive community must remain committed to?

First, as has been widely reported, the bill became a battleground for the forces opposed to abortion, including Michigan Democrat Bart Stupak. Stupak and friends tried to hold the legislation hostage to their agenda, attempting to prevent many forms of health insurance for women seeking an abortion. To blunt their attempts, President Obama signed an executive order that reiterated the current law, which is that federal funds are not to be used to pay for abortions. It is widely recognized that the legislation would not have passed if Obama had not taken that step.

What resulted from this and other compromises was legislation that allows some plans within the private health insurance exchange to offer abortion coverage but that it would be paid for with a separate check from the insured. For women whose finances are controlled by their husbands or parents or for whom an abortion is not foreseen (the vast majority) this bureaucratic requirement to pay for additional abortion coverage will dramatically limit access to care. Additionally, many states already have an exchange that does not allow the additional coverage at all except in the case of rape, incest or the health of the mother. The current legislation allows this practice to continue. Finally, the George Washington School of Public Health conducted of a study of the impact of separate abortion coverage on the health care industry and concluded that it would lead the industry to “drop (abortion) coverage in all markets in order to meet the lowest common denominator in both the exchange and expanded Medicaid markets.”

Second, the bill retains a 5 year waiting period for legal immigrants to join programs such as Medicare, effectively denying cost-effective health insurance programs to a significant number of American citizens. Not only is this an example of anti-immigrant intolerance, it’s just plain foolish as it will continue to force some of our citizens to use, as a last resort, emergency rooms, the most expensive form of care. Considering that this bill was intended to limit health care expenses, it is simply backward to not offer its benefits to immigrants.

We have our work cut out for us. As the legislation is implemented and amended, changes to abortion coverage need to be a key priority for progressives. Also, all American citizens, regardless of immigration status, need to be afforded the benefits of the legislation.

Now, some progressives have enjoyed pointing fingers at Barack Obama for these failings. This will get us nowhere. As Tchen acknowledged, these provisions are not ideal and were not what President Obama envisioned – they are committed to changing them. By hurling insults at Obama, we risk not being in the room as positive changes are discussed.

Instead, progressives should now focus on electoral and legislative strategies to improve what we have. One positive step would be to support Stupak’s pro-choice primary opponent, Connie Saltonstall, and other truly progressive candidates. Another would be to work with our current leaders to keep these issues on the front burner.

Clearly, there are other aspects of the bill that need to be changed as well. More coverage, more equity, more choice. Again, there’s no rest for the weary. As progressives, though, we’re used to that, aren’t we?

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    Americans will be given tax credits for insurance and through a competitive marketplace, the exploding costs of health care will start to be reined in.

    The Congressional Budget Office disagrees with the latter claim. That office estimates that health care costs under this legislation will increase at a faster rate than would have occurred had the legislation not passed.

    I am concerned that the rhetoric we are seeing -- this post and Kari's from yesterday for example -- suggests that many well-meaning progressives do not understand that this legislation IS NOT EXPECTED TO CONTROL RISING COSTS.

    Whatever else progressives want to do to address health care, they need to understand that issue, because most of the reforms you mention are irrelevant if the program itself is unsustainable.

  • Doug (unverified)

    "Also, all American citizens, regardless of immigration status, need to be afforded the benefits of the legislation."

    Speaking of sustainability, how does this work? As long as you can make it to the shores of America, regardless of your status, you are afforded healthcare?

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    Thanks for your perspective, although there are a number of other studies that dispute your claims...here's one...http://www.urban.org/publications/411887.html.

    And I'm not sure which CBO report you were looking at, but one that came out in November estimated that 57% of Americans would see their out of pocket health care expenses go down under the legislation. Those who choose what they deem to be "cadillac" plans would be the ones who see their premiums rise...

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    And Doug, the operative word there being "citizen."

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    Kristin - The "out of pocket" expense is reduced because the cost of insurance will be subsidized. However, according to the CBO the actual cost of health care (e.g., subsidy + out of pocket expense) will increase at a rate that is faster than would have been the case had the legislation not been passed.

    So, again, it is not the case that this legislation will start to "rein in explosive costs" (according to the CBO). It provides some meaningful consumer protections and a subsidy that will allow an expansion of coverage. But costs will increase at a faster rate than they would have had the legislation not been passed, and it's important that we don't obfuscate or ignore that point.

    Unless the actual costs of health care are contained, this legislation will not yield a system that is any more sustainable than the current one.

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    I guess it's just semantical -- I was referring to, i.e., the 39% jump in premiums that BC/BS was trying to enact, and the otherwise skyrocketing health care premiums...you're talking about medical expenses in general...the bill does promise to rein in the former, but I understand that it may not rein in the latter...

  • Bob Tiernan (unverified)

    Kristin Teigen:

    In many ways, we have a reason to celebrate. Over 30 million previously uninsured Americans will have access to health care

    Bob T:

    It would be more helpful if we see accuracy regarding these numbers and why these many people do not have insurance. Many (perhaps more than half) do not have it because they are in their late teens thru early 30s or so and feel they do not need it. They are also aware that if they do need spendy medical care it will most likely be due to a workplace accident or an auto accident and are already covered by their auto insurance (and that of the person at fault) as well as by workmans comp in the other example.

    Also, many of them would probably buy health insurance policies for the catastrophic things that insurance is really suited for but which is difficult due to government mandates on what must be covered (which makes the policies expensive for individuals). It would also help if individuals could get the same tax deduction privileges that employers have been getting for many decades. But such reforms might lead (or, might have led, since perhaps it's too late now) to vast improvements in this area without government getting credit for being in charge of it. That's why we didn't see these and other real reforms (from either party).

    Bob Tiernan Portland

  • Kurt Hagadakis (unverified)

    You raise a number of good points. In the next few weeks, there will be rallies around DC for things like population control, and there is a $1B appropriation in front of a House committee for worldwide reproductive planning.

    Have to bristle at "it's only semantic(al) (sic)". We share the same dictionary, thesaurus, syntax and grammar, so of course debate is always semantic! My nominee for the worst saying ever. Close behind those casting aspertions at "assumptions".

  • Kurt Chapman (unverified)

    Kristen, the CBO report "forgot" to mention the affects of eliminating the retiree plan RX subsidy of 28%. Non bargained plans will drop the coverage and boot the retiree RX to the feds. The CBO report didn't comment on the last minute "deal" that gave away the $500 million in Medicare savings to states like OR, WA and ID to support increased plan usage.

    also, the CBO report from November was commenting on a whole different plan. Seriously Kristen, this bill just shuffled through Congress is not about reform or cost control. It is about creating a cluster of such marvelous magnitude that the masses call out for yet more government intervention.

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    http://www.thefreedictionary.com/semantic (also semantical)

    Have a nice day.


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    Kurt H. that is.

    Kurt C., I don't agree, but I respect anyone who is willing to do his research...

  • Bob Tiernan (unverified)


    this bill just shuffled through Congress is not about reform or cost control. It is about creating a cluster of such marvelous magnitude that the masses call out for yet more government intervention.

    Bob T:

    Exactly. That's why I never paid much attention to the progressives dumping on this bill because in the end it will take us to where they want us to be -- single payer. Either they knew this all along and had to pretend otherwise, or they (or some) still have problems understanding how government interventions and distortions create more of the same under the guise of "correcting" flaws in the market economy.

    That's why it was easy for Obama to buy Kucinich's vote - for a plane ride a bag of M&Ms with the Presidential Seal.

    Bob Tiernan Portland

  • Bluecollar Libertarian (unverified)

    Kristin here I am a male and a Libertarian to boot and I have to argue for the right of mothers to choose midwives which is not legally acceptable in many states. What's the world coming to? While I do not agree with the present bill here's something that we do need to look at.

    Midwives deliver something in the neighborhood of 75% of infants in parts of Europe. Here in the good 'ol U.S. of A. only about 8% of infants are brought into the world with the help of midwives. Yet I have not read or heard of anything in this legislation to improve the situation for midwives, especially direct entry midwives. And in some states it is even difficult for nurse midwives to set up shop.

    If we are going to control costs then we have to have more providers to cover the 30 million or so previously uninsured. “Nurses and midwives (about 6 million) comprise the majority of health care professionals in Europe, accounting for about 60% of most health care budgets.” http://www.euro.who.int/nursingmidwifery


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