The passage of H.R. 3590 — the Patient Protection and Affordable Care Act — last Sunday, followed by President Obama’s signature on Tuesday, created a set of broad minimum improvements to health care and health care insurance practices in America, by enshrining a prior Senate bill into law.
These may or may not be followed by additional changes in H.R. 4872 — the Health Care and Education Reconciliation Act — now under debate in the Senate, chief among which are provisions delaying and reducing the so-called “Cadillac tax” on high-cost health insurance, a subject rightly of concern to unions protecting coverage for higher levels of work-related injuries and diseases. Passage of this bill seems likely, since the reconciliation process can’t be filibustered under Senate rules, and thus requires only a simple majority.* Even if Republicans vote unanimously against the bill (as is also likely), Democrats are likely to command that majority even if several Democratic Senators defect. [UPDATE: the Senate and House have passed bills fixing minor infractions of reconciliation rules, but without amendments for a public option or anything else; it's done.]
The legislation promises to improve access to health care for millions, and may well rank as a milestone in American social policy — it’s been billed by New York Times business writer David Leonhardt as “the biggest attack on economic inequality since inequality began rising more than three decades ago”, and by conservative writer David Frum as a conservative ‘Waterloo’ that will not be undone.
But the cost to liberal values and goals has also been high.
Public option dead, right to choose denied care
As rehearsed in a post earlier this month, neither House action included a public option — the popular idea of a federally administered health insurance plan to compete with private insurors that was a cost-saver in its own right, and a possible way station to a ’single payer’ health insurance system. Instead, an individual mandate to purchase health insurance will further fatten the bank accounts of health insurance companies.
Moreover, in the negotiations preceding Sunday’s vote, Rep. Bart Stupak (D) agreed to vote for the bill in exchange for an Obama Executive Order confirming that the executive branch would prevent federal funds from being used to pay for abortions — thus enshrining the so-called Hyde Amendment, passed annually, as a matter of permanent federal executive branch policy. Together with provisions in H.R. 3590 — inserted by Sen. Ben Nelson (D-NE) to the original Senate bill — researchers are predicting abortion insurance coverage will will not just be eliminated from insurance plans operating under health insurance exchanges, but will also decline overall. Dana Goldstein (of “The Daily Beast”) writes, “To get the health-care bill passed, a pro-choice president reneged on his pledge to support reproductive rights for rich and poor alike.”
In a second article, Goldstein captured how whipsawed liberal groups could be about the events of the past weeks with the example of Feminist Majority president Eleanor Smeal. On the one hand, Smeal vowed to go after Stupak by raising money for primary opponent Connie Saltonstall, –while on the other hand she celebrated the passage of a health reform bill won at the expense of reproductive choice: “If you turn down half a loaf, you get nothing,” Smeal said. “Given the realities of the vote count, I am glad that 15 million people will have access to Medicaid, most of whom will be women, and another 17 million will have access to these state insurance exchanges. I think to have nothing would have been horrible.”
Online and on the ground activists score the reforms
But quite aside from what’s not in the bill, there’s also the nagging feeling that what is there is less than meets the eye. Last Friday, Jane Hamsher of “firedoglake,” who was among the most steadfast supporters of a public option in the run-up to Sunday’s vote, published Fact Sheet: The Truth About the Health Care Bill, an itemized list of “myths” about the pending health care/ health insurance reforms, along with her footnoted rebuttals to each one.
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