Well here we are folks, the moment we have all been waiting for (or dreading) has happened. The House of Representatives passed the Senate health care bill by a vote of 219-212 tonight following a full day of debate, the last six hours of which I caught. Following passage of the Senate bill, the Republicans mounted their last-ditch effort to derail everything by introducing a “motion to recommit”. Had this motion succeeded, it would have sent the reconciliation package back to committee, presumably to restore the Stupak Amendment. Fortunately, it failed by a vote of 199-232, due to the fact that Rep. Stupak and his bloc of anti-abortion Democrats had already been courted by the prospective Executive Order reaffirming the existing language prohibiting Federal funding of abortions. While the votes did not have as razor-thin a margin as they could have, it was a fitting and dramatic climax to the debate that has consumed the attention of Congress and much of the American public for over a year.
Now what? By and large, health care reform is a done deal. President Obama is expected to sign the Senate bill by Tuesday, and the reconciliation package that was passed by a vote of 220-211 is on its way to the Senate, where Senate Majority Leader Harry Reid has repeatedly assured everyone that he has the votes to pass it. There are still the inevitable legal challenges, which are pretty much a given in this toxic political climate; even if we were in more cordial times, some suits would be expected due to the historic nature of the bill. I would be a fool at best and self-discrediting at worst if I were to try to divine how the courts would rule, but fortunately we know now that one of the primary things that would have been challenged has been closed off.
In passing health care reform tonight, the House did not use the controversial “deem and pass” rule that was more popularly referred to as the ‘Slaughter Rule’. There are still other avenues of approach, most notably the insurance mandate according to the New York Times. According to the article, Virginia Attorney General Ken Cuccinelli would base his challenge on a conflict with a new Virginia law exempting residents from the mandate. I am no legal expert, but that seems to lie contrary to the Supremacy Clause of the Constitution. The Supremacy Clause, formally known as Article VI, Clause 2 of the Constitution, establishes Federal law to supercede any state laws. This is why Mr. Cuccinelli has also tacked on a Constitutional challenge, based on Congress’ ability to affect interstate commerce. I do see where an argument could be made that health insurance is only intrastate commerce, but we should leave it up to the courts to decide this matter.
There are also electoral challenges looming.
Another thing to watch is how this all plays out in the midterm elections. Over the last few days, we have seen the beginnings of the GOP using a potential repeal effort as part of their campaign. According to the Times article, Democrats are getting armed for a nationwide rhetorical battle, trying to cast the health care reforms as a benefit to their constituents. Among the things they will use is a district-by-district breakdown of how the numbers apply to constituents. Of course, with many of the more-publicized measures not taking effect until, there will be the perception that the nation pays first for a benefit that is years down the road, if it comes at all. However, there are a number of things that take effect immediately according to CNN- benefits that you can expect Democrats to point to. Among them:
- The end of caps on coverage. One of the more annoying of the insurance company practices is to place lifetime or annual limits on how much coverage you get. Normally this should be enough for routine matters, but what about the non-routine illnesses like cancer or HIV/AIDS? Often, the individuals with diseases like these are crushed by the expensive payments required for their treatments. It is not very likely that many people will be as grateful for this, though it will certainly be nice to have. Plus, the stories of people with these diseases are always the most emotional and strike a nerve with broad sections of the population. For example, just because I do not have cancer, I will likely be affected by the story of how Mrs. Smith can now afford her treatments without worrying whether she will be hit with tens of thousands of dollars in out-of-pocket payments.
- Narrowing the doughnut hole. One of the most common health care-related stories that people hear about is seniors not being able to afford all of their prescription drugs. As soon as President Obama signs the legislation, seniors will get a $250 credit toward purchasing their medications. This is followed up by reductions in the price of prescription drugs by 50 and 75% respectively. While this does not have the same emotional impact as the previous bullet point, it is something that a significant majority of Americans have had to deal with either personally or via family members, friends, and so on. When people’s parents and grandparents can better afford their medications this year than last, that is sure to have an impact on their feelings around November- particularly if the GOP is still pushing for repeal.
- Assistance for those with pre-existing conditions. One of the most touted pieces of reform was to fix the insurance companies’ tendency to refuse to cover anyone with pre-existing conditions, including many things from cancer to having gotten a C-section. This legislation eventually eliminates their ability to do this, but until then $5 billion is being set aside to assist these individuals to buy insurance. There is not much more to say about this one, except it is a stopgap measure until the practice is completely outlawed.
- Coverage for young adults. While this doesn’t affect me for several years, it is the number one benefit for us college students. Starting now, we are allowed to remain on our parents’ health insurance plans until we turn 26. With the uncertain economy now, especially for those looking for internships and entry-level jobs, not having to worry about the rent and paying for health insurance will be a welcome relief for many college graduates and other young adults. Think about it as a psychological and economic stimulus: with less money tied up in paying for life’s necessities, new college graduates will be able to contribute more to economic growth. Plus who wants to have to focus on anything more than finding a job fresh out of college?
But there are still things to wait for.
Of course, not everything will take effect immediately. As I stated above, most of the more-publicized provisions do not happen until at the earliest. However, they are worth the wait. Whether they will live through four years of political maneuvering and threats by Mitt Romney and others to just not fund it if elected will be another thing entirely. According to the CNN article linked here again, there are two notable things to wait for. The main one is the insurance exchanges, or the new way everyone will be buying health insurance. And everyone will be buying, unless they like giving money to the IRS. Coupled with the lower prices and illegality of denial based on pre-existing conditions, the mandate makes the exchanges highly compelling.
I wouldn’t mind paying for insurance that is still the same quality or better than what we can currently get that will be at a lower price than is available now, mandate notwithstanding. However, the government is serious about the mandate: the fines get pretty hefty after a relative one-year grace period. In, the penalty is only $95 or 1% of income, whichever is greater. In , though, they rise to either $325 or 2% of income, and in a hefty $695 or 2.5% of income. In addition, Medicaid would expand to cover childless adults living near the poverty line, and there would be tax credits to offset the cost of insurance. We will see when the system gets implemented in four years, but for now it sounds like something I can live with.
Aside from the exchanges and the mandate, many of the more important provisions go into effect relatively soon. You can expect the Democrats to be reminding us of these almost on a daily basis as the campaigns for the midterm elections increase, especially if the Republicans are still pushing a repeal effort. However, the rest of the country can finally move on and focus on creating jobs. We should keep an eye on health care reform from time to time, especially any legal challenges and the debate in the Senate over reconciliation. Come to think of it, I will miss having the health care debate to fall back on on a given slow news day; after its passage, there will undoubtedly be less to say about it than the near-hourly developments over the last couple of weeks. However, it is time to move on; this has been a long post to end a particularly long debate. Let’s see what Congress moves to next.