Micah Weinberg
Who could have guessed that Leslie Margolin, the president of Anthem Blue Cross, would become the poster child for health care reform?
When President Barack Obama unveiled his final reform plan this week, he mentioned how Anthem was planning to raise premiums by as much as 39 percent. These rate spikes may provide the momentum that pushes this seemingly never-ending effort over the finish line.
Still, when I think about the path forward on federal health care reform and what its passage or failure may mean, I don’t think about Ms. Margolin.
I think of Todd, a friend of mine in Austin.
Stories like Todd’s, though heartbreaking, have become all too familiar. A 35-year old filmmaker, he had health insurance through his partner, who lost her job in the economic downturn. Just as their COBRA benefits were about to run out, Todd learned that he has multiple endocrine neoplasia type 1, a rare, inherited disorder of the endocrine system. It creates cancerous tumors but can be controlled through extensive and costly treatment. Needless to say, this pre-existing condition prevents him from being able to purchase insurance, which is why he asked me not to use his last name.
Just because people like Todd exist does not mean that we are morally obligated to pass the bills pending before Congress. But we are all obligated, I believe, to be as forthright as possible in evaluating what passage or failure will mean for Todd and for us all.
What is the situation as it stands? Obama’s final plan incorporates many Republican ideas advanced at the bipartisan summit last week, but the passage of health care reform is not likely to incorporate any Republicans.
Republicans have gone “all in” in opposition to the bill and are promising to block it through a series of parliamentary maneuvers. But they’re bluffing. If the Democrats can secure 216 votes in the House and 50 votes in the Senate (Vice President Joe Biden would break the tie), they can pass health care reform on their own.
The procedure to do this is called “reconciliation,” the same type of majority vote that was used to pass welfare reform, children’s health insurance and both Bush tax cuts. It’s unclear, however, if Democrats have even a majority of votes. A major sticking issue is abortion. Some house Democrats led by Bart Stupak of Michigan have pledged to switch to voting “no” if they decide the final bill includes too few restrictions on federal funding for this procedure.
What would passage mean for people with pre-existing conditions who cannot currently get coverage? Financial assistance for buying insurance does not kick in for several years, but insurance companies would immediately be required to sell policies to everyone regardless of their health status. The bill expands “high-risk pools” for people who are not able to afford insurance right now. There are also special provisions for people with cancer to help ensure that they get the treatment that they need as soon as possible.
What if federal health care reform stalls? One option is to pursue an “incremental” approach, passing only those things that command broad agreement. Though appealing, this approach does not stand up to scrutiny. First, the elements of the current bill continue to poll as the most popular even as the process has led the public to be dissatisfied with the overall effort. Further, we’ve been pursuing an incremental strategy since the days of Teddy Roosevelt. If we keep doing what we’ve done, we’re going to keep getting what we’ve got.
If an incremental approach included high-risk pools, it could provide near-term help to people who need care but cannot buy insurance. But the expansion of high-risk pools (and other proposals such as buying insurance across state lines and medical malpractice reforms) would not change the bad incentives that cause insurers to discriminate against the sick.
If, on the other hand, we deal with only the issue of pre-existing conditions without including the other elements of comprehensive reform such as the individual mandate, this could cause premiums to skyrocket, making the recent Anthem rate increases seem modest in comparison.
The final option, therefore, is to take another approach to comprehensive reform starting, as the Republicans suggest, with a “blank sheet of paper.” But all the other non-incremental proposals, such as the Republican “blueprint” that would privatize Medicare, are deeply unpopular political non-starters.
The bipartisan summit revealed that everyone finally agrees that doing nothing is no longer an option. We can still, and may well, walk away from this particular approach to comprehensive health care reform and try something else. But as we have gotten this far, we owe it to ourselves to step back one last time and ask the question, “Will we really be better off?”