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?

By Kristin Teigen March 26, 2010