Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
One reason people are skeptical of health care reform is that they don't believe it will help reduce their insurance premiums. On Monday, President Obama will give at least some of these people reason to rethink that skepticism.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
As President Obama has said, the rate hikes and practices of Anthem Blue Cross of California are the “coming attractions” of our health system without reform. It’s a general argument that the status quo is not sustainable--a reminder that, whatever people feel about the legislation, they should be far more worried and angry about the health care system without reform.
But as Anthem sought to defend their controversial rate hikes this past week--and announced they'd be delaying their increase for two months--it’s worth noting there are specific provisions in the pending health reform that would provide direct relief and remedy from precisely these sorts problems:
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
As an advocate for health reform in California, I’ve seen health reform proposals die. I’ve seen it die by vote, and I've seen it die by veto. In 2004, an expansion of employer-based coverage narrowly lost in a referendum, getting an excruciating 49.2 percent of the vote. In 2005 and 2006, Governor Schwarzenegger vetoed bills for universal children’s coverage, and a framework for a single-payer system. All of these were final blows.
This doesn’t seem to be one of those times. Not yet, at least.
I admittedly have déjà vu from our most recent effort. After years of opposing health reform--a position to which he has returned--Governor Schwarzenegger made 2007 his year of health reform, spending much of that year trying to involve Republican legislators despite implacable ideological opposition. Only by late summer did he give up, and start to negotiate directly with the Democratic majority. A proposal--with structural similarities to the federal bills--was finally negotiated through the fall and passed out of one legislative house in a special session in late December. But the proposal struggled in the second chamber, with opposition from both the left and right, as some argued it was time to move on and focus on budget and economic issues. The proposal died in a Senate Health Committee vote two years ago, in late January.
The similarities are a bit eerie, but the differences are why I have hope.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
While vacationing in Hawaii, conservative radio talk show host Rush Limbaugh had to visit a hospital for chest pains. At a press conference talking about his stay, he seemed to take a dig at efforts to reform the health care system, saying he was availed of "the best health care the world has to offer." Limbaugh continued,
Based on what happened here to me, I don’t think there’s one thing wrong with the American health care system. It is working just fine, just dandy.
But, as Ben Armbruster at ThinkProgress and Paul Abrams at the Huffington Post note, Hawaii's health care system is distinct from the rest of the country, in that they passed a version of health reform decades ago, in 1974. The Hawaii Pre-Paid Health Care Act includes a requirement for employers to provide health coverage to their workers. As you may know, a similar requirement on large employers is a key part of the reform now pending in Congress.
And the employer requirement seems, by and large, to have succeeded. It has increased coverage--just under 8 percent of the state's population is uninsured, second only to Massachusetts--and access to care. At the same time, Hawaii still has some of the lowest health care costs in the nation, despite its high cost of living and without an apparent decrease in quality--as Limbaugh himself discovered
But there are other lessons from Hawaii beyond Limbaugh's visit and unintended endorsement of reform.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
When Senate Majority Leader Reid held a press conference announcing the inclusion of a version of a public health insurance option in the merged Senate health reform bill, he didn’t mention the outcome of another major difference between the two Senate committee proposals--what would be responsibility of employers with regard to on-the-job coverage. And not a single reporter asked.
It’s strange that on-the-job coverage gets relatively little attention in the debate, even though more than half of Americans have health coverage through their employers. That's more than the Americans in programs like Medicaid and Medicare (around a third of the population) and much more than the Americans who buy coverage as individuals (less than a tenth of the population).
For all its flaws, employer-based coverage generally provides good benefits to workers and their families. It pools together shared contributions by employer and employees, leveraging group purchasing power for better premiums and/or a better level of benefits. Among other things, employers use their purchasing power to prevent any of their workers from being denied for pre-existing conditions. The workplace provides an easy place to sign up for coverage--and sometimes a useful ombudsman to deal with the insurer. It is also efficient way for insurers to get multiple customers at once, rather than incurring the expense of marketing and selling policies one at a time. That helps keep premiums down.
But despite its dominance, employer-sponsored insurance doesn’t extend to all workers. More than 80 percent of the uninsured are workers, or family members of workers. And without reform, on-the-job benefits are eroding. The percentage of Americans who get coverage through employers shrank by over 5 percent in the past decade. And in some states, like California, it’s about to go under the half-way mark--which is why the state has been exploring setting some minimum standard for health benefits. With the overall cost of health care rising, employers are scaling back coverage or in some cases dropping it altogether.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
A week ago, the U.S. Chamber of Commerce was upset when The Yes Men, a group of pranksters and activists, held a fake press conference, claiming that the Chamber has reversed their opposition to climate change legislation. It’s true that the Chamber was misrepresented. But the real question should be, who does the Chamber represent--particularly when it comes to health care reform?
The Chamber of Commerce has traditionally fought health reform at the state and federal level. Health policy experts find this maddening: Employers, who are the conduit for providing coverage to more than half the population, should have as much interest as any stakeholder in reforming the health system and bringing down health care costs.
But the Chamber has clear conflicts of interest. It claims to speak for employers. But it also represents--and speaks for--health industry groups that have a distinct, frequently opposing, set of interests.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
The new Census numbers are out and they show a grim increase in the number of uninsured in 2008 to 46.5 million--figures that are bound to be worse now 12 months into our current recession.
But this number has been under attack for the past year, as conservative columnists, blogs, and other voices repeat the argument that the Census figures are inflated. This inclination of health reform opponents to fight over this has been so great that President Obama didn't even want to engage the argument last week. In his otherwise excellent speech, he said there were “more than 30 million” who cannot get coverage. I interpreted this as a way to simply acknowledge the significant scale of the problem and focus on the solutions, without having people fall into a debate about numbers. Predictably, the health reform opponents have taken this as a victory.
Those who seek to minimize or dismiss the number of uninsured actually misunderstand the very nature of the problem. It’s better not to think of the uninsured as a discrete population, one that can be marginalized, than to think of uninsurance as a condition that can afflict anyone.
Most estimates of the uninsured are for a specific point in time, or over the course of only one year. When just looking at a two-year period, far more people--nearly 1 in 3--find themselves uninsured, as Families USA has calculated using Census data. And for every day they are uncovered--and most of them are uncovered for more than six months--they are likely to not get care and/or face the risk if not the reality of financial ruin. One trip to the emergency room without coverage can mean thousands of dollars of unexpected bills.
For those who say that two years is too long a period to evaluate, please let our Congress know--as they are busy fretting about the ten-year cost of health reform. If we are going to calculate the ten-year cost, we ought to calculate the ten-year benefit, of how many Americans will be prevented from falling into uninsurance, preventing the gaps that are disruptive to both quality care and a family’s financial stability.
President Obama understands this: This weekend, he cited a new Treasury Department report that indicates about half of non-elderly Americans went uninsured for some portion of 1997-2006. With the continuing erosion of coverage without health reform, the number who would benefit by not having such a gap in coverage over the first ten years of health reform is likely well over half the country. That’s not a problem, or a benefit, to minimize.
But let's go back to that conservative critique of the 46.5 million figure, which comes directly from the U.S. Census. Critics make three arguments here: 1) the number includes immigrants; 2) the number includes people who are eligible but not enrolled for public health programs like Medicaid and SCHIP; and 3) the number includes people who make more than a certain income, and supposedly could “afford” coverage. The implication is there’s really no major problem, that people are simply choosing to be uninsured.
This is wildly misleading, on multiple levels:
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access WeBlog and is a regular contributor to the Treatment.
Many people have suggested that state health care reform initiatives--both in Massachusetts, which enacted reform, and California, which didn't--could serve as the model for what happens nationally. But the most important lesson learned from the states may be procedural rather than policy.
Congressional leaders may, according to various reports, split reform into two bills. One would go through the reconciliation process, which is reserved for budget-related items and in which a simple majority can pass legislation, without threat of a filibuster. The rest of the package would go through the standard process, in which legislation effectively needs a supermajority of 60 votes, since that's what it takes to break a filibuster.
It may sound unusual, but such a strategy has been tried before in similar circumstances: Both California and Massachusetts leaders had to resort to similar parliamentary gambits in their health
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access WeBlog and is a regular contributor to the Treatment.
Color Commentator: Rush Limbaugh’s Race Obsession
