Much More Needed - Nurses' Union Leader Analyzes Healthcare Bill
Diary of a Wimpy Health Care Bill
By Rose Ann DeMoro
Executive Director, National Nurses United, AFL-CIO and
California Nurses Association and member of the Executive Council of the AFL-CIO
Posted: March 23, 2010 08:07 PM
Passage of President Obama's healthcare bill proves that
Congress can enact comprehensive social legislation in
the face of virulent rightwing opposition. Now that we
have an insurance bill, can we move on to healthcare reform?
As an organization of registered nurses, we have an
obligation to provide an honest assessment, as nurses
must do every hour of every day. The legislation fails
to deliver on the promise of a single standard of
excellence in care for all and instead makes piecemeal
adjustments to the current privatized, for-profit
When all the boasts fade, comparing the bill to Social
Security and Medicare, probably intended to mollify
liberal supporters following repeated concessions to the
healthcare industry and conservative Democrats, a
sobering reality will probably set in.
What the bill does provide
-Expansion of government-funded Medicaid to cover 16
million additional low income people, though the program
remains significantly under funded. This limits access
to its enrollees as its reimbursement rates are lower
than either Medicare or private insurance, with the
result some providers find it impossible to participate.
Though the federal government will provide additional
subsidies to states, those expire in 2016, leaving the
program a top target to budget cutting governors and legislatures.
-Increased funding for community health centers, thanks
to an amendment by Sen. Bernie Sanders, that will open
their doors to nearly double their current patient volume.
-Reducing but not eliminating the infamous "donut hole"
gap in prescription drug coverage for which Medicare
enrollees have to pay the costs fully out of pocket.
-Insurance regulations covering members' dependent
children until age 26, and new restrictions on limits on
annual and lifetime on lifetime insurance coverage, and
exclusion of policies for children with pre-existing conditions.
-Permission for individual states -- though weakened
from the version sponsored by Rep. Dennis Kucinich -- to
waive some federal regulations to adopt innovative state
programs like an expanded Medicare.
All of these reforms could, and should, have been
enacted on their own without the poison pills that
Where the bill falls short
-The mandate forcing people without coverage to buy
insurance. Coupled with the subsidies for other moderate
income working people not eligible for Medicare or
Medicaid, the result is a gift worth hundreds of
billions of dollars to reward the very insurance
industry that created the present crisis through price
gouging, care denials, and other abuses.
-Inadequate healthcare cost controls for individuals and families.
1. Insurance premiums will continue to climb. Proponents
touted a "robust" public option to keep the insurers
"honest," but that proposal was scuttled. After Anthem
Blue Cross of
hikes, the administration promised to crack down with a
federal rate insurance authority, an idea also dropped
from the bill.
2. There is no standard benefits package, only a
circumspect reference that benefits should be
"comparable to" current employer provided plans.
3. An illusory limit on out-of-pocket medical expenses.
But even in the regulated state exchanges, insurers
remain in control of what they offer and what will be a
covered service. Insurers are likely to design plans to
attract healthier customers, and many enrollees will
likely find the federal guarantees do not protect them
for medical treatments they actually need.
-No meaningful restrictions on claims denials insurers
don't want to pay for. Proponents cite a review process
on denials, but the "internal review process" remains in
the hands of the insurers, and the "external" review
will be up to the states, many of which have systems now
in place that are dominated by the insurance industry
with little enforcement mechanism.
-Significant loopholes in the much touted insurance reforms:
1. Provisions permitting insurers and companies to more
than double charges to employees who fail "wellness"
programs because they have diabetes, high blood
pressure, high cholesterol readings, or other medical conditions.
2. Permitting insurers to sell policies "across state
lines", exempting patient protections passed in other
states. Insurers will likely set up in the least
regulated states in a race to the bottom threatening
public protections won by consumers in various states.
3. Allowing insurers to charge three times more based on
age plus more for certain conditions, and continue to
use marketing techniques to cherry-pick healthier, less
4. Insurers may continue to rescind policies, drop
coverage, for "fraud or intentional misrepresentation"
-- the main pretext insurance companies now use.
-Taxing health benefits for the first time. Though
modified, the tax on benefits remains, a 40 percent tax
on plans whose value exceeds $10,200 for individuals or
$27,500 for families. With no real checks on premium
hikes, many plans will reach that amount by the start
date, 2018, rapidly. The result will be more cost
shifting from employers to workers and more people
switching to skeletal plans that leave them vulnerable
to financial ruin.
-Erosion of women's reproductive rights, with a new
executive order from the President enshrining a deal to
get the votes of anti-abortion Democrats and a
burdensome segregation of funds, that in practice will
likely mean few insurers will cover abortion and perhaps
other reproductive medical services.
-A windfall for pharmaceutical giants. Through a deal
with the White House, the administration blocked
provisions to give the government more power to
negotiate drug prices and gave the name brand drug
makers 12 years of marketing monopoly against
competition from generic competition on biologic drugs,
including cancer treatments.
Most critically, the bill strengthens the economic and
political power of a private insurance-based system
based on profit rather than patient need.
As former Labor Secretary Robert Reich wrote after the
vote "don't believe anyone who says Obama's healthcare
legislation marks a swing of the pendulum back toward
the Great Society and the New Deal. Obama's health bill
is a very conservative piece of legislation, building on
a Republican (a private market approach) rather than a
New Deal foundation. The New Deal foundation would have
offered Medicare to all Americans or, at the very least,
featured a public insurance option."
Unlike Social Security and Medicare which expanded a
public safety net, this bill requires people
-- in the midst of the mass unemployment and the worse
economic downturn since the Great Depression -- to pay
thousands of dollars out of pocket to big private
companies for a product that may or may not provide
health coverage in return.
Too many people will remain uninsured, individual and
family healthcare costs will continue to rise largely
unabated and private insurers will still be able to deny
claims with little recourse for patients.
If, as the President and his supporters insist, the bill
is just a start, let's hold them to that promise. Let's
see the same resolve and mobilization from legislators
and constituency groups who pushed through this bill to
go farther, and achieve a permanent, lasting solution to
our healthcare crisis with universal, guaranteed
healthcare by expanding and improving Medicare to cover everyone.
Leaders of the National Nurses United have raised many
of these concerns about the legislation for months. But,
sadly, as the healthcare bill moved closer to final
passage, the space for genuine debate and critique of
the bill's very real limitations was largely squeezed
out. Much of the fault lies with the far right, from the
streets to the airwaves to some legislators that
steadily escalated from deliberate misrepresentations to
fear mongering to racial epithets to hints of threatened
violence against bill supporters.
For its part, the administration and its major
supporters shut out advocates of more far reaching
reform, while vilifying critics on the left.
Both trends are troubling for democracy, as is the
pervasive corruption of corporate lobbying that so
clearly influenced the language of the bill. Insurers,
drug companies, and other corporate lobbyists shattered
all records for federal influence peddling and were
rewarded with a bill that largely protected their
interests, along with a Supreme Court ruling that will
allow corporations, including the health care industry,
to spend unlimited sums in federal elections.
Rightwing opponents fought as hard to block this
legislation as they would have against a Medicare for
all plan. As more Americans recognize the bill does not
resemble the distortions peddled by the right, and
become disappointed by their rising medical bills and
ongoing fights with insurers for needed care, there will
be new opportunity to press the case for real reform.
Next time, let's get it done right.
All Unions Committee For Single Payer Health Care--HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway,
(502) 636 1551