I often defend and smack around President Obama’s health care reform bill during the same breath. Was there the potential for bipartisan reform? Yes. Did Obama muscle it through, silencing the minority? Yes. President Obama should see how the Missouri Senate Republicans handled the tough issues of session, in which they which could have used the “nuclear option” on several issues. Instead, they compromised with the Democrats.
There are great things in the health insurance bill such as the elimination of lifetime caps on benefits, insurance eligibility for dependents, preexisting conditions. All of these things should be met with open arms. While the health insurance industry hates these provisions, they protect you and I, and are appropriate regulations.
Conceptually, I have no problem with requiring individuals to maintain some sort of health insurance coverage. Do I think it’s the federal government’s job to require this? No. This bill should have required states to pass a law requiring people to obtain some sort of health insurance option and tie Medicaid money to it. This carrot/stick mentality has been done with regards to auto insurance and seat belt requirements, the money being tied to transportation roads.
Being a fan of the open market, I would rather have seen the federal government approach closing the coverage cap differently. I would have liked to see a competitive bidding process by the insurance companies to cover these individuals as opposed to all of the administrative efforts being taken on by the federal and state governments.
When expanding a social entitlement or welfare program, I think that it’s equally important that each individual that benefits pays some for their benefits. Otherwise, it’s a total free service they are getting. This should be a stair-stepped proposal so that the more they make, the more they should pay. This idea is captured in the insurance subsidy, but not included for those included in the Medicaid portion.
Another “federalism” type problem with this legislation is the burden that this could potentially have for the states. The bill signed into law says the federal government will pay for 100% of the new enrollees on Medicaid until 2016. Then it decreases, and by 2020, the subsidy is approximately 90% by the federal government. According to the Christian Science Monitor Virginia will be on the hook by 2022 for an additional $1.1 billion. In Missouri, Lt. Governor Peter Kinder has said that it could cost the state over $500 million per year. More conservative estimates of $300 million were also mentioned during the legislative session.
Closing the “donut hole” was a bad idea, and was strictly meant (in my opinion) to convince the AARP to support the overall reforms. The hole had systematic problems, but the idea and purpose behind it was a good one. I think it’s important that doctors and patients be aware of the monetary costs (and that the government is paying for them) associated with prescribing more and more medications. On the same token, I understand that people with specific chronic illnesses were especially at risk for reaching the donut hole.
One of my biggest criticisms of the health insurance reform legislation is its neglect of focusing on preventive healthcare and end of life scenarios. To help direct health costs, we need to encourage a healthy lifestyle both in diet, exercise, and what we consume. Whether it’s smoking or obesity, if we lived a healthier life, the health insurance costs could decrease. In Medicare, over 25% of the total expenditures are spent within the last year of life for patients. This isn’t surprising, since Medicare is for the elderly, but we need to have a healthcare system that promotes families to talk about scenarios and family wishes. Congress missed a huge opportunity by not addressing preventive healthcare. Proposals could have been anywhere from a tax deduction if your health insurance company deems you (based on national standards) as a healthy individual to a mandated premium cost savings.