The Wrapup… What we win… What’s next?…

Monday, March 22, 2010


* All House Democrats from California Supported Health Reform; All Republicans Opposed
* Major Victory for California Leaders, Starting with Speaker Pelosi, Key Chairmen
* Consumer and Community Groups Cheer Passage of Health Reform

* Reform Will Provide Immediate Relief for Children, Seniors & Small Businesses
* Crucial Package of “Reconciliation” Improvements Head to Senate
* Work Begins to Implement and Improve at the Federal & State Level

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HISTORY: On Sunday evening, the House of Representatives, by a vote of 219-212, voted to pass a comprehensive and historic health reform package that would provide more security and stability for those who have coverage, and new, affordable choices for those that don’t. It would prevent the worst abuses of the insurance industry, expand coverage to 32 million uninsured, and put in place the tools to control health care costs.

The House passed two measures: the health reform bill passed by the Senate late last year, which heads to President Barack Obama for his signature Tuesday; and a “reconciliation” package of changes and improvements, that will be considered by the Senate within the next week, under a budget process that requires a straight majority of 51 Senators for passage.

HOW IT HELPS: The bill was mainly a victory for health care consumers, for both the insured, and the uninsured–both who benefit. Under the proposal, most consumers will be required to have coverage, but with that requirement comes signficant reforms and relief to help people meet that requirement.

IF YOU ARE INSURED, nothing requires you to change your coverage; but it will make your coverage more secure and stable:
* It makes it more likely your employer continues to offer coverage, and set minimum standards for such coverage.
* It improves Medicare; It expands and streamlines Medicaid.
* It fixes the “individual market,” giving individuals the bulk purchasing power of large purchasers, preventing “junk” insurance, and stopping denials for health status.
* It provides the foundation to bring down the overall costs of health care.

IF YOU ARE UNINSURED OR UNDERINSURED, you will need to get coverage, but there will be new help and new options to ensure coverage is:
* AVAILABLE: No denials or different rates for pre-existing conditions.
* AFFORDABLE: Subsidies/affordability credits for low- & mid-income families, so you don’t have to pay more than a percentage of their income (based on a sliding scale up to 9.5%).
* ADEQUATE: Minimum benefit standards and a cap on out-of-pocket costs, so no one goes into significant debt or bankruptcy.
* ADMINISTRATIVELY SIMPLE: The Exchange provides choice and convenience, making it easy to sign up for and compare plans.
* ALSO: Other efforts attempt to bring down the cost of coverage.

THE SUPPORTERS: The passage of health reform also is a win for many who supported it, starting with President Obama and Speaker Nancy Pelosi of San Francisco, who is widely credited with keeping health reform alive even when others believed the effort to be dead. Other Californian House members of note were key leaders like Democratic Caucus Vice Chair Xavier Becerra; Education and Labor Committee Chairman George Miller; Energy and Commerce Committee Chairman Henry Waxman; Way and Means Committee member Pete Stark, who chaired the Health Subcommittee; and many others, including leaders of key caucuses.

All California House Democrats voted for health reform; all California Republicans voted against it. The supporters included several members from more competitive districts–including Representatives Dennis Cardoza, Jim Costa, Jerry McNerney, and Loretta Sanchez–that decided in the last several days, especially after a Congressional Budget Office analysis showed that the reform would actually reduce the deficit in the first ten years by over $130 billion, and reduce the deficit in the second ten years by over $1.2 trillion.

Appreciation also goes to many health advocates from around the state. This includes the many organizations that are part of Health Care for America Now, which Health Access California leads in California, working with the Alliance of Californians for Community Empowerment and the California Partnership. This broad coalition started an aggressive field operation in July of 2008 to both push for health reform and for key principles.

THE ELEMENTS: What did health and consumer advocates win? Here’s a top ten list:

* Near-universal coverage for all, largely through group coverage and its purchasing power.
* New consumer protections: New rules and oversight on insurers that include the abolition of underwriting and limits on age-based rates and on premiums dollars going to administration and profit.
* The biggest expansion of Medicaid since its creation 45 years ago, completing a commitment for millions in and near poverty.
* Sliding scale subsidies tied to income: Consumers will pay for coverage not based on how sick they are, but what they can afford.
* The end of most junk insurance and bankruptcies due to medical bills, with a cap on out-of-pocket costs.
* Fair share financing, including an employer assessment as important in concept as the minimum wage was for pay
* Assistance for small business, and their low-wage workers to be able to afford coverage.
* More sustainability and improvements for existing public programs, filling the donut hole in Medicare & simplifying Medicaid.
* The tools for cost containment and quality improvement in health care generally, from prevention to IT to bulk purchasing.
* Momentum to do more in the future, politically and policy-wise, in health care and beyond

NEXT STEPS: But to fulfill the promise of health reform, the work to implement and improve it begins today.

The Senate needs to pass the package of House-passed improvements this week. The reforms are crucial, including greater affordability subsidies for low- and moderate-income families; the closing of the donut hole in the Medicare prescription drug coverage for seniors; greater consumer protections; the narrowing and delay of an excise tax on high-cost health plans; and more assistance to states like California for its Medicaid program.

Even after passage of the reconciliation package, the work to implement and improve health reform will continue at the federal level, and explode at the state level. Many items that were not included in this round of reform at the federal level–like rate regulation and the public health insurance option–already are pending as state legislation. The state’s plans to renegotiate its Medicaid waiver will need to be rethought with the goals of health reform in mind. California will need to set up a new health insurance exchange. And the campaign efforts will need to continue, not just to defend health reform from the continued attacks, but to make sure it is implemented correctly.

That’s the challenge of the next week, the next months, the next years, and the next decade. For more information about how to stay involved, become a member, visit our blog, join our E-mail list, Twitter feed, and Facebook page, and continue to be involved with Health Access California and Health Care for America Now–California.

Health Access California promotes quality, affordable health care for all Californians.
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