By Colleen M. Grogan
The American people are at an important fork in the road—forge ahead with a reconciliation of the healthcare bills that have passed each house of the legislature or wait (yet again) for a new Congress to tackle the issue. Obviously, the answer to that question depends on what’s at stake.
One area of bipartisan agreement is that the current health care system is broken. The ills of the American health care system can be summarized simply as twofold: first, we have the most expensive system in world and many American families—even those with private health insurance—cannot afford medical care when they need it; and second, we are not getting good value for our money. Despite all the spending, numerous comparisons with other countries suggest we fare poorly on many health outcomes. One can only logically surmise that if we continue to do nothing to address these issues the problems will grow and worsen.
Would a reconciliation of the House and Senate bills improve the current system? It is important to ask the question in this way rather than wondering if health care reform in its current form will solve all the problems on the table. The answer to the latter is emphatically no, but it is an unfair and unproductive question to ask. Even if we could pass a health care reform bill in one group’s image of perfection, many others would view the reform as flawed. As a result, asking this question allows the perfect to be the evil of the better good.
The much more important question, then, is whether we will realize some important improvements by the passage of health care reform in 2010, and the answer to that question is emphatically yes!
Here is what we will achieve. First, a Medicaid expansion up to 133% of poverty (or 150% in House bill) regardless of family structure is a huge philosophical shift and will mean that many more uninsured Americans will have access to health care coverage. Currently, a male working full-time but earning a poverty-level income is not eligible for Medicaid simply because he is a single male. These bills finally eliminate such arbitrary requirements and abolish silly notions of deservingness based on parental or marital status or age. These bills also create a federal income eligibility standard based on the argument that a person with the same income level shouldn’t lose health insurance coverage simply because they move across state lines. We have waited for such changes since Medicaid was passed back in 1965. Such Medicaid expansion will benefit low-income older adults as well. In addition, elders will benefit from more Medicare funding for preventive services.
Second, low, middle and even upper-income uninsured Americans will finally have access to relatively affordable coverage regardless of their health status. Both bills mandate that private insurance companies will no longer be able to charge higher premiums based on pre-existing health status. Similarly, if a healthy person becomes sick she no longer has to fear that a move or a job change will cost her health coverage.
Third, we will be able to better control health care expenditures after reform passes. The bills require more rational payments to private insurance plans participating in the Medicare program, and have the potential to effectively control payments to plans under the new Health Insurance Exchanges.
I’m a fan of National Health Insurance, but I’m also a pragmatist and I believe moving forward is better than falling further into our health care morass.
Colleen M. Grogan is a professor in the School of Social Service Administration at the University of Chicago. Her areas of research interest include health policy, health politics, and the American welfare state. Grogan is currently working on a book titled America’s Hidden Health Care System.