By Robert Pear
The New York Times, March 25, 2019
On Tuesday, Democratic leaders, including Speaker Nancy Pelosi, will put aside, at least for now, the liberal quest for a government-run “Medicare for all” single-payer system and unveil a more incremental approach toward fulfilling those campaign promises. Building on the Affordable Care Act, they would offer more generous subsidies for the purchase of private health insurance offered through the health law’s insurance exchanges while financing new efforts to increase enrollment.
They would also reverse actions by the Trump administration that allow insurance companies to circumvent protections in the Affordable Care Act for people with pre-existing conditions. Insurers could no longer sell short-term health plans with skimpy benefits or higher premiums for people with chronic illnesses.
Ms. Pelosi said the legislation would “strengthen protections for pre-existing conditions, reverse the G.O.P.’s health care sabotage and lower Americans’ health costs.”
The legislative package… seems to answer a question facing Democrats since they took control of the House: How would they balance the expansive demands of their most liberal members with the needs of more pragmatic Democrats elected in seats that were held by Republicans?
Ms. Pelosi, the committee chairmen and many other House Democrats see the new legislative package as a more efficient way of achieving universal coverage, a goal shared by champions of “Medicare for all,” led by Representatives Pramila Jayapal of Washington and Debbie Dingell of Michigan.
The House Democrats’ bill would…
…turn back the president’s action by stipulating that short-term plans are included in the definition of “individual health insurance coverage” under the Affordable Care Act and therefore must comply with coverage requirements of the health law…
…would revise the law to provide more of both types of assistance.,, tax credits to help them pay premiums, and cost-sharing reductions to lower their deductibles, co-payments and other out-of-pocket costs…
…make subsidies available to some working families who are now ineligible… eliminate this quirk in the law, sometimes called the family glitch…
…provide money to publicize the insurance options and subsidies available under the Affordable Care Act and to help people enroll…
…block guidance issued by the Trump administration under which states can get waivers allowing them to use federal funds to subsidize insurance that does not comply with coverage requirements in the Affordable Care Act…
…seeks to lower premiums by setting up reinsurance programs…
…would provide federal money to states that want to set up their own insurance marketplaces but have yet to do so.
By Don McCanne, M.D.
So what do we know about politics?
Because of the persisting deficiencies in our overpriced and underperforming health care financing system, the majority of the people are now ready for the vastly superior model of single payer Medicare for All which would ensure affordable health care for everyone. But the Democratic leadership that now controls the House of Representatives is more politically astute than us so they will put aside single payer and move ahead with fine tuning the mediocre Affordable Care Act (ACA) with the dubious claim that it will move us closer to the deferred goal of Medicare for All. What could be wrong with this logic?
The number one rule is do not ever give away anything before you sit down at the negotiating table. With this maneuver they have given away everything except for a few tweaks to the Affordable Care Act. Oh my. But they’re master politicians.
Okay. It is agreed that if the House passes the Medicare for All Act of 2019 in this session of Congress it will be blocked in the Senate and would be vetoed by President Trump anyway. But would that be a futile gesture?
Let’s assume that the House does manage to pass a modest package of ACA tweaks and sends it on to the Senate. Isn’t that the deliberative body controlled by the party that has vowed for years to repeal Obamacare, i.e., the Affordable Care Act? Also, when the president has been busy slashing and burning ACA and only yesterday requested the courts to declare the entire Act unconstitutional, does anyone believe that he will sign on to a package of tweaks that move slightly in the opposite direction of where he has been headed? So wouldn’t the House passing a few ACA tweaks also be a futile gesture?
If the House Democratic leadership is honest about their claim that the ACA tweaks will eventually lead to single payer Medicare for All (a proposition that is very difficult to accept at face value) then which futile gesture should they choose, since either will be defeated?
The House can use the legislative process to further educate the nation on the reasons for the high costs and the cruel deficiencies in our system while demonstrating the solutions that will bring us the reform that we desperately need. The ACA tweaks barely touch on the problems and are even somewhat arcane from the public’s perspective, so this legislative package has virtually no instructive value that would help to increase the passion needed to push forward the movement for reform.
Contrast that with the Medicare for All Act. It is easy for people to understand what is meant by everyone being included (unlike the Affordable Care Act). They can understand what is meant by being affordable for everyone (unlike the Affordable Care Act). They can understand what is meant by health care being free at the point of service (unlike the Affordable Care Act). They understand that equitable means fair (unlike the Affordable Care Act). They understand what it means to have a program that covers you for your entire life (unlike the Affordable Care Act). And on and on.
The Senate and the White House remain barriers to any health care reform in this session of Congress. The plot of the Democrats seems to be to offer legislation that the Republicans will block so that they can use that in the 2020 elections, claiming the Republicans don’t care about your health care. But look at the measures listed above in the excerpts from the New York Times article. What percentage of the voters are going to be passionate about electing candidates that promise to pass those tweaks? Well, all we can say for sure is that it is not less than zero.
This is the time to greatly expand our educational efforts on single payer Medicare for All. We can do that by bringing the Medicare for All Act of 2019 to the committees that actually have the power to move the bill to the floor (instead of the committees that do not have that power), and then bring it to the House floor so that the nation can see on C-Span and cable news channels just what health care justice is all about. The policies are powerful and have tremendous support throughout much of the nation.
Think of entering the voting booth in 2020. Which is more apt to drive your vote? Comprehensive, affordable health care for everyone forever? Or excluding short-term health plans from the ACA exchanges?
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