Published: December 21, 2009
The health care reform bill that Senate Democratic leaders have cobbled together to win support from all 60 members of their fractious caucus — the filibuster-proof majority needed to ensure passage — has drawn scornful attacks from a united Republican opposition. It is causing anguish among liberals who fear too much has been given away to a handful of conservatives.
The bill, which is moving toward a climactic vote this week, has some imperfections but is worthy of support from lawmakers who care about health care reform.
There is a lot to like in the bill. The Congressional Budget Office estimates that it would cover more than 30 million of the uninsured and would, by 2019, result in 94 percent of all citizens and legal residents below Medicare age having health insurance. That is a big improvement from the current 83 percent.
It also estimates that the bill would reduce deficits over the next decade by $132 billion and even more in the following decade. Despite all the exaggerated Republican rhetoric that the bill will lead to fiscal disaster, it has been carefully and responsibly drafted so that it is fully paid for without busting future budgets.
Important elements of the bill have been strengthened during the struggle. An independent board and other new entities would be given greater powers than previously planned to test and implement cost-saving measures free of political lobbying. Tax credits to help small businesses buy coverage have been expanded.
Insurance companies will be deterred from jacking up premiums just before the reforms take effect, prohibited from imposing lifetime limits on benefits and annual limits will be tightly restricted. Insurers will also be required to spend more on medical care and less on administrative costs and profits than they currently do.
The two big concessions that were made in the Senate were unfortunate, but not fatal. The original bill would have created a new public plan to compete with private ones. That was replaced with a likely weaker alternative: a couple of private plans that would be supervised by an obscure government agency that administers heath benefits for federal employees. The reform package should include a public plan, but the absence of one is not a good reason to vote against the bill.
The Senate flirted briefly with a proposal to allow people ages 55 to 64 to buy into the Medicare program to create competition to private plans on new insurance exchanges. The buy-in idea was intriguing, but it was never vetted carefully enough to analyze how it would work in conjunction with other reforms. Its elimination does not make the bill worth opposing.
In another concession, the Senate bill would allow states to ban the coverage of abortions by health plans sold on the new exchanges. Those exchanges will allow people who buy health insurance to choose from an array of private plans, with subsidies provided to help low- and middle-income people pay the premiums.
This amounts to deplorable interference by state governments into decisions that should be made by a woman and her doctor — and abortion rights groups are right to object. The implacable Republican opposition to reform, and obstruction from a handful of Democrats, have made this bill less effective and less fair than it might have been. Still, the United States Senate has a chance this week to get past the bickering and haggling that have robbed it of Americans’ trust and pass a historic piece of legislation.
