Tuesday, March 30, 2010

Health Care Reform: NOW It's Done

President Sarkozy

"Welcome to the club of states who don't turn their back on the sick and the poor," Sarkozy said, referring to the U.S. health care overhaul signed by President Barack Obama last week.

From the European perspective, he said, "when we look at the American debate on reforming health care, it's difficult to believe."

"The very fact that there should have been such a violent debate simply on the fact that the poorest of Americans should not be left out in the streets without a cent to look after them ... is something astonishing to us."

Then to hearty applause, he added: "If you come to France and something happens to you, you won't be asked for your credit card before you're rushed to the hospital."

mcjoan (Dkos): Obama Signs Reconciliation Bill

Now health insurance reform is done, or at least the first stage of it. President Obama signed the reconciliation fix to health insurance and student loan reform this morning, issuing this statement: (via e-mail):

“For a long time, our student loan system has worked for banks and financial institutions,” President Obama said. “Today, we’re finally making our student loan system work for students and all of our families.”

“This legislation is a win for students and parents struggling to make ends meet to fulfill the dream of a college education,” Education Secretary Arne Duncan said. “By ending subsidies to banks, we can make important investments that increase affordability and access to our nation’s universities and community colleges.”

Notice what's missing there? Yeah, health insurance reform. It's kind of anti-climatic for the procedure geeks among us, those who have been pushing reconciliation as the way this reform was going to have to be done since last summer. Without the bill Obama signed today, with no fanfare, there would have been no health reform signing ceremony last week. And certainly, there would have been no student loan reform, with Lincoln and Nelson steadfastly opposed.

So here's a hat-tip to those Senators, including Kent Conrad and Harry Reid, who had the foresight back in February of 2009 when they were writing the budget to allow for this eventuality--passing both education and health reform via reconciliation. And to the procedure geeks like David W. who wouldn't let it go.

Ezra Klein: How will health-care reform affect me?
A lot of the questions I've been getting on the new law are very specific queries about how the legislation will affect particular people in particular situations. I wish I could respond to all of them. I can't. But this article does a good job laying out a number of different scenarios and explaining the likely impact the law will have on them, for good and bad.
Greg Sargent:

* Is Senator Scott Brown stopping short of pledging full repeal of the health law? He calls on his fellow Senators to “work in a bipartisan manner to repeal the worst parts of this bill” and to “replace the worst parts of this legislation.” Hmm…

* Shorter Lamar Alexander: GOP has successfully maintained unified opposition, but it’s still entirely on the President to foster good bipartisan relations.

* Head-spinner of the day: New USA Today poll finds that big majority think new reform law expands government involvement too much — but a majority also says it won’t do enough to rein in the insurance industry.

Key takeaway: Public opinion is volatile and in flux, and public attitudes towards the new law are going to take some time to solidify. Get to work!

* P.R. 101: Insurance industry pledges not to try to exploit loophole in new law to avoid covering kids with pre-existing conditions.

The new Affordable Care Act includes provisions that prohibits private insurers from denying coverage to children with pre-existing conditions. As of a few days ago, insurance companies thought they'd found a loophole.

The new law, insurers said, would require coverage of pre-existing conditions for children covered by their family policy. But, the industry said, to get around the requirement, insurers could just stop writing insurance for sick kids altogether. That's not how policymakers interpret the new law, but industry lawyers were apparently fond of this reading.

Yesterday, Democratic officials were livid. Health and Human Services Secretary Kathleen Sebelius wrote to insurance lobbyist and AHIP president Karen Ignagni, insisting, "Now is not the time to search for non-existent loopholes that preserve a broken system." Sebelius added, "I urge you to share this information with your members and to help ensure they cease any attempt to deny coverage to some of the youngest and most vulnerable Americans."

At the same time, House Speaker Nancy Pelosi also pressed the industry: "The intent of Congress to end discrimination against children was crystal clear, and as the House chairs said last week, the fact that insurance companies would even try to deny children coverage exemplifies why the health reform legislation was so vital."

Perhaps realizing that this would be an unhelpful fight -- do insurers really want to fight to deny coverage to sick children? -- the industry backed down overnight.

In a letter to Health and Human Services Secretary Kathleen Sebelius, the industry's top lobbyist said insurers will accept new regulations to dispel uncertainty over a much-publicized guarantee that children with medical problems can get coverage starting this year.

Quick resolution of the doubts was a win for Obama -- and a sign that the industry has no stomach for another war of words with a president who deftly used double-digit rate hikes by the companies to revive his sweeping health care legislation from near collapse in Congress.

"Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition," Karen Ignagni, president of America's Health Insurance Plans, said in a letter to Sebelius. Ignagni said that the industry will "fully comply" with the regulations, expected within weeks.

I don't know if the resolution was the result of stern administration warnings or fear of a p.r. nightmare, but either way, it's the answer families and Democrats were hoping for.

Ezra Klein: Sebelius to insurers: Make my day

The health-care story of the day is that insurers think they've found a way to get around getting around Congress's intent to ban preexisting condition discrimination for children. Details here. This afternoon, Secretary of Health and Human Services Kathleen Sebelius sent a letter (pdf) to Karen Ignagni, head of the insurers trade association, saying, essentially, are you sure you want to try this?

In the letter, Sebelius says that she will issue regulations clarifying that the law says children cannot be denied access to their parents' plan and that the plan cannot exclude coverage for their preexisting conditions. "I urge you to share this information with your members," Sebelius says, "and to help ensure they cease any attempt to deny coverage to some of the youngest and most vulnerable Americans."

The politics -- and policy -- of this fight will be interesting. For the Republicans, this is a good issue in that it makes the bill look shoddily written. "If they can’t get these two things right," Sen. Mitch McConnell asked in his weekly radio address, "how can we expect them to properly manage the rest of it?"

Oddly, this is also a good issue for the Democrats. Why? Well, it lets them pick a fight with insurers who are trying to deny health-care coverage to sick little kids. Ignagni might as well kick an endangered puppy-panda hybrid in the face. On national television. While rooting for Duke to win the NCAA tournament.

The losers here are actually the insurers. As far as I can tell, their reading of the law is legitimate. And they have a lot to lose from a fight with the administration. It's not obvious that Sebelius actually can change this with a stroke of her pen, but there are plenty of other things she can do with a stroke of her pen that will make the insurance industry's life very, very difficult. And since this policy actually isn't a very big deal -- fairly few kids are uninsured because their preexisting conditions are keeping them off their parents' plan -- I'd guess that the administration and the insurers reach some sort of accord on this.


Josh Green posted an interesting item last night about Republican reactions to the success of health care reform, one week later. I've never fully been able to appreciate what it is about the Affordable Care Act the GOP hates so intensely, but Green noted Republican attitudes have begun to focus on one simple point.

I just returned from Capitol Hill, where the new health care law is still the preoccupying issue, and the Republican talking point du jour, which seems to have been issued with stage directions instructing that it be delivered in a tone of gravest concern, is that Democrats and President Obama have perpetrated a breathtaking assault on the body politic by passing a law that did not have widespread public support.

I agree that Democrats have taken a political risk, though most polls I've seen show people about equally divided on the issue. What lent such a surreal quality to my morning is that several of these folks have held an abiding interest in the intersection of governing and public opinion -- only they used to hold the opposite view.

Right. As Green explained several years ago, when he worked here at the Monthly, Republicans of the Bush era went to great lengths to reject the notion of governing based on polls. The very idea was mocked and dismissed as unworthy of true leaders. When policymakers choose to confront a great challenge, they can't just take the public's temperature and base their judgment on shifting whims and attitudes. Green noted, "Announcing that one ignores polls, then, is an easy way of conveying an impression of leadership, judgment, and substance."

Bush himself boasted repeatedly that was a president who governed "based upon principle, and not polls and focus groups."

Now, the point of Green's piece was that Bush wasn't telling the truth, and that his White House relied on survey data just like every other modern administration. The rhetoric was about creating a facade and cultivating an image, not reflecting reality. But the larger observation is still relevant -- Republicans rejected the notion that polls should dictate policy decisions. Such an approach is fundamentally weak and unprincipled.

Except now, that is, when Republicans have concluded that polls are all that matters, and to approve legislation that polls poorly is some kind of un-American act, betraying the consent of the governed.

By recent GOP standards, wouldn't President Obama deserve credit for standing tall and delivering on his campaign promises, even in the face of discouraging polling data? Isn't it more important to do what's right than what's popular?

Sargent: GOP Memo: We Are Kicking Butt In Local Press!

I noted here yesterday that the Dem leadership is circulating a memo to nervous rank-and-file Dems arguing that the new health reform law is getting reams of good local press coverage across the country — a sign, Dems say, that opinion may be turning.

But Republicans strongly reject this argument, and now they’re circulating a memo of their own among House GOPers that quotes dozens of local papers nationwide in order to make the opposite case.

A source sends over the memo, which was authored by the NRCC and will be sent to GOP staff and House candidates across the country. It features many local editorials and columnists lambasting individual House Dems for voting for the plan, as well as stories about Dems catching an earful from constituents.

“If Democrats think they’re winning the local spin war, we’d be interested to know what they think losing looks like,” NRCC spokesman Ken Spain emails. “The fact of the matter is Democrats are returning home to frustrated voters and a barrage of nasty headlines.”

The GOP memo paints a granular picture of continued voter unrest about the new law. It’s a reminder that public opinion on this law remains very volatile and unpredictable. While the health care debate may fade from national headlines, it seems likely that the battle to define the new law will continue to simmer in districts across the country, with unpredictable consequences for the midterms.

Also: Readers, tell me what you are seeing in your local press clippings and in your districts!

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