Friday, March 26, 2010

Much More Needed - Nurses' Union Leader Analyzes Healthcare Bill

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

healthcare behemoth.


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

accompanied them.


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 California announced 39 percent premium

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

costly enrollees.


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.


Distributed by:

All Unions Committee For Single Payer Health Care--HR 676

c/o Nurses Professional Organization (NPO)

1169 Eastern Parkway, Suite 2218

Louisville, KY 40217

(502) 636 1551





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