An Up-or-Down Vote on Health Insurance Reform

Today’s the big day, when the House of Representatives finally votes on health insurance reform. I’m not calling it health care reform, because it doesn’t really reform ‘health care’, it really provides only a way to pay for health insurance, which helps increase access to health care services.

The House has decided to not use a funky and not-well-understood parliamentary procedure of ‘deeming’ the Senate’s bill approved, but instead will have their own up-or-down vote, which is what we’re entitled to.

They will also be stripping the Senate bill of some of its more onerous language, including special deals that were made at the end to secure passage, and voting on amendments to the bill, as there are clearly differences between the two houses of Congress on what's good for us. Even with changes, arm-twisting by legislative leaders and the President himself, and after hundreds of thousands of calls and TV and newspaper ads, the vote is expected to be close but is predicted to be a win, according to one vote-tracker.

So what's in the health care bill that’s being debated today? I admit I haven't made it through the entire 2300 pages yet, and there's lots of gobblydegook and legalese and legislativese (which is harder to understand than legalese) but here's one recap:

• Coverage for most Americans (up to 95% of non-elderly folks);


• A requirement that everyone have insurance, or pay a penalty for not having it;


• A tax on businesses of 50 or more employees to help pay for covering their employees, if the business doesn’t offer coverage;


• A health exchange, or market place, where people can choose coverage;


• Options under the exchange for abortion, but it must be paid for with a separate check;


• Taxes on high cost ‘Cadillac’ health plans, and taxes on investment income for higher wager earners;


• Subsidies for low or middle income families to offset the cost of health insurance;


• Expansion of Medicaid and a larger share of the cost for new Medicaid patients to be paid by the Federal government; and


• Changes in Medicare-D drug coverage for seniors.

There are also changes to some other bills attached to this, as is typically the case with legislation at any level.

Because I have a job, I have great health insurance; my employer (a health insurance company) offers me a choice of plans, and I could have benefits even better than the ones I selected. I’ve been employed for decades beyond the limit for pre-existing conditions to matter to me; I can afford my copays; I can pick my doctors; I can get approval for medically necessary services; and there are clearly documented processes to follow if my doctor disagrees with my insurance company.

There are additional options available to me because I’m in New York, where the industry is highly regulated, where we have an aggressive State Insurance Department, and a history of active Attorneys General who have no qualms investigating health insurance carriers for real or perceived bad acts. If for some reason I feel I've been wronged by my carrier, I can readily find an advocate in Albany if I want one.

I'll be honest, as an employee of an insurance company, I worry about this bill - there will almost certainly be changes for my company if the bill passes. Where do we fit in the new scheme of things? How do we operate in a world of health insurance exchanges? What else will change for us, in the details of this bill? For all I know, if this legislation does pass, I could lose my job, and become one of the beneficiaries of the new rules.

As a taxpayer, I fear the cost of the bill. At $940 billion, according to the Congressional Budget Office, it's a whopper. And because anything that’s passed on from Washington to the states will be passed eventually to the counties, our taxes are sure to rise to help pay for this. That’s going to be hard on us, here in New York where we already have a budget deficit in the billions, and in other states with large populations of uninsured; it'll be hard for us here in Onondaga County in a tough economy funded in part by diminishing sales tax dollars, and in the City of Syracuse, where our share of everything goes up, even while our higher income folks move to the 'burbs leaving fewer of us to pay for schools and services.

But at the same time, I can’t see not passing this, because I can’t see us continue to go forward the way we are now. Today, we all pay for the uninsured, because those costs are passed on to us in higher taxes, higher fees, higher insurance premiums. Tomorrow, eventually, maybe we’ll pay a little less under the new rules, when everyone who can afford insurance has to get it, or pay for the privilege of choosing to be uninsured. And if we really do get the deficit reductions that are projected - $138 billion over 10 years - that'll help us in the long run as well.

In the end, there’s no such thing as a perfect health insurance reform bill -- and we still need to look at reforming health care -- but doing nothing would be perfectly awful. Here's hoping they do the right thing.