Cleaver: Health care bill offers best choices possible

In his EC from DC report, Fifth District Congressman Emanuel Cleaver explains why he supports the House health care bill:

This weekend, something that has not happened in our nation’s history will finally come to fruition. After 50 years of promise, hundreds of previous bills, and nearly a solid year of committee hearings and negotiations, The U.S. House of Representatives will consider and vote on a bill that will make quality, affordable health insurance available to all Americans.

The bill is not perfect, but little if any legislation ever is. But, I believe it represents the best legislation possible at this time. This bill will expand coverage to 36 million Americans, many of whom live in Missouri’s Fifth District.

The bill will strengthen Medicare, introduce competition into the insurance market, extend young people’s ability to stay on their parents’ plans until they are 26, and expand our nation’s health care workforce. It will prohibit insurance companies from denying coverage based on pre-existing conditions, close the Medicare Part D donut hole, and ensure mental health parity. In short, the benefits that it will bring to the Fifth District are many and varied but all result in lower costs and healthier citizens.

All three of our offices have taken calls on both sides for months, and the nation has seen the rhetoric get positively poisonous. Thousands rallied yesterday on around the Capitol building. Members of Congress, many colleagues I know to be kind and learned in person, stood yelling about death and killing, throwing and stomping on legislation in the shadow of the dome where so many difficult decisions have been made in our nation’s history.

The hyperbole and hysteria has been fanned. Some in our nation are scared that their benefits will be cut or they will lose the good care they currently have. There are legitimate worries. There are legitimate debates to be had. Please understand I do not mean “legitimate” to indicate only those debates favorable to my position. This piece of legislation is huge, its policies will be transformative and as a Member of Congress it is my responsibility to listen to all arguments, even those I do not agree with.

To be honest, I am more concerned that the vitriol and venom that some have injected into this important discussion have impaired two of our nations most fundamental qualities — a great ability to hear reason and a great willingness to help our neighbors. I think that this is the more realistic danger of this discourse. The damage done to our ability to conduct a civil dialogue may far outweigh any potential decrease in individual health benefits.

To be sure, our nation has had its fair share of heated and even violent debates. I am not trying to be Pollyannaish. However, in the world’s greatest democracy surely we do not have to stir hatred of the least among us to advance our own cause.

This is what I am hearing all too often in protests and phone calls: “I should not have to pay for THEM” and often, “It is not MY fault that THEY do not have health care”.

I believe that each individual is responsible for their own actions. However, that belief is not inconsistent with the also having a common obligation to one another as Americans and even more basically as human beings.

I am sorry that this conversation has boiled down to and US versus THEM matrix of decision making. It is simply not true that if we give those who cannot afford it a chance at good quality health care, it must necessarily lead to a reduction of benefits for those who enjoy their health care now.

The Constitution charges the federal government to provide for the general welfare of its people. This Congress is finally taking up an issue that both parties agree squarely threatens our common welfare. If we do not address rising health care costs now, the number of people who can afford health care will continue to decrease and the number of people taxpayers will need to support will increase. Additionally, our shared obligation to care for our seniors is threatened when health care costs raise over 10 percent a year for the Medicare program. It is simply unsustainable in very short order unless something changes.

There is a very clear and practical reason we must address health care costs now in a way that does more than just nibbles around the edges. It is rapidly becoming the largest single expenditure of the federal government. It currently costs the federal government $100 billion each year to cover the uninsured. That number is rising. Just as if your household was not making ends meet you would look to see where you were spending the most money, so too should the government.

There are two crises we are seeking to solve. 1) Too many Americans are unhealthy and dying because they do not have access to care or have been denied access to care. 2) Health care costs are eating up too much of the annual federal expenditures and unless something can be done to bring down costs, benefits will have to be cut.

I believe this bill will go a long way toward solving these crises.

For most of you, nothing will change in regards to your health care. Your doctor and insurance will stay the same and we hope that in a very short period of time you or your employer will see a decrease in your rates. For those with young adults in college or not yet on their own, they will be able to be on your insurance until they are 26. For those of you who are seniors, the dreaded coverage donut hole will be filled reducing your costs while maintaining your current benefits.

For those of you who do not have insurance, the days of using the emergency room as a primary care physician will come to an end. Just as state laws require drivers to have auto insurance to be on the road, you will be required to have health care coverage, which you can purchase through a national Exchange. There will be assistance for those premiums for those who cannot pay.

No American will be denied coverage because of a preexisting condition, nor can you be dropped from your coverage if you fall ill.

Ninety-six percent of Americans will be covered under this plan. The CBO projects that the bill will save $30 billion over the first 10 years. It has been endorsed by both the American Medical Association and the American Association of Retired Persons. It is a bill that I will be proud for history to judge.

We are getting lots of specific questions around these key provisions in the bill and I wanted to share some answers to a few of the most common.

Are Members of Congress exempt from this legislation?

I have to tell you, I have gotten this question a countless number of times. It seems that what most people are concerned with when they ask about this is whether or not Members of Congress are going to enroll in the public option.

I currently have insurance from Blue Cross/Blue Shield which was the plan I selected as part of my benefits, just as many of you do who work for companies that provide health care.

People who receive health insurance from their employer are not eligible to enter the Exchange under this legislation. However, bill has been changed to say that Members of Congress may enroll in the public option, if they so desire. We are the only group of citizens who currently have employer based insurance but have the opportunity to enroll in the public option. While not required, I imagine many will enroll. I will certainly look to see what it has to offer and who it compares to what I currently carry.

There is a perception that Members have “gold plated” health insurance. While it is certainly good, I am still fighting a 13 month battle over a claim that has been denied — just like many of you. My insurance is no different than that which is carried by hundreds of thousands of other federal employees.

Is this a slippery slope toward a government-run national health care system?

That isn’t going to happen with this bill. This bill is going to cover 36 million more Americans. The majority of those people are not going to enroll in the public option. They are going to enroll in private insurance, increasing private insurance participation by millions. I would say that all the people who oppose the public option because they suggest that it will lead to a government takeover of health care are themselves proof that it will not. Perhaps, in this case, distrust of government will guarantee the very thing that is feared will not happen.

A lot of our community’s seniors are concerned about the effect that this health care bill will have on their Medicare benefits. Can you explain how the bill will affect senior citizens?

The House bill will not cut basic Medicare benefits. The provisions aimed at cutting costs in Medicare are all targeted toward waste and fraud in the system. I will admit I had some concerns about these provisions in the first House bill, but in the new version, these provisions have been tightened to ensure that their impact falls on the intended targets and will not reduce Medicare benefits. In fact, this bill will improve Medicare. It will close the donut hole and lower costs for preventative services, as well as making the system more efficient and run more smoothly. I would never vote for any legislation that negatively affects seniors in our community.
Are House Democrats really making an effort to be bipartisan in this reform effort? Some have charged that they are unwilling to consider a Republican health care reform bill.

First of all, let me say that there is not really a Republican health care reform bill. They have only this week in a closed door process gotten together some ideas for a substitute amendment to HR 3962. Their amendment will not prohibit insurance companies from denying coverage based on pre-existing conditions, nor will it make any great strides to cover almost all Americans. Many Republican amendments have been folded into the bill at the committee level and many of their statements to the public have been considered and the bill has been amended as such. That said, they are clearly part of the debate, as is their substitute amendment.

The CBO just released its assessment of the Republican substitute amendment and says would cut the deficit by $68 billion over ten years, less than the Democratic bill, which cuts the deficit $129 billion over the same time frame. The CBO also says the Republican plan would leave 52 million people uninsured in 2019, more than the 46 million uninsured today.
I will vote against the substitute amendment.

Does this bill pay for health care for illegal immigrants?

No. In fact, on page 267, in Section 347 of the bill it clearly states, “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” I urge you to look it up for yourself. The full text of the bill is available here >>> http://docs.house.gov/rules/health/111_ahcaa.pdf

How does this bill treat abortion coverage?

The House bill explicitly states that no federal funds may be used for abortion coverage except in the cases of rape, incest, or when the life of the mother is endangered. Any person who chooses a plan that includes other kinds of abortion coverage will have to pay that part of their premium with their own private funds. No federal money is paying for abortions that are not already allowed to be covered by federal funds. Not all plans in the Exchange will cover abortion services for which federal funding is not allowed, and some may not cover any kind of abortion at all.

Now the top 10 things the bill will do:

1. REDUCES THE DEFICIT MORE—According to the CBO, the revised bill reduces the deficit by $30 billion over the first 10 years. (The original bill reduced the deficit by $6 billion over the first 10 years). The revised bill also continues to reduce the deficit over the second 10 years.

2. ENDS HEALTH INSURANCE COMPANIES’ BLANKET EXEMPTION FROM ANTI-TRUST LAWS—In order to open up health insurance markets to real competition, the revised bill ends insurers’ blanket exemption from anti-trust laws, bringing antitrust enforcement to the two most abusive practices of health insurers – price fixing and market allocation.

3. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE—The revised bill requires health plans to allow young people through age 26 to remain on their parents’ policy, at their parents’ choice.

4. CREATES A NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—The revised bill creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. The measure provides a cash benefit to help individuals with community-based services.

5. EXEMPTS SMALL BUSINESSES WITH PAYROLLS BELOW $500,000 FROM
EMPLOYER MANDATE—The revised bill exempts a greater number of small businesses from the employer mandate – exempting 86% of all America’s businesses. Specifically, the bill exempts firms with payrolls up to $500,000 (instead of $250,000) from the mandate and provides only a graduated penalty for not offering coverage for firms with payrolls between $500,000 and $750,000 (instead of firms with payrolls between $250,000 and $400,000.)

6. LIMITS THE “HEALTH CARE SURCHARGE” TO MILLIONAIRES—Under the revised bill, only the wealthiest 0.3% of Americans would pay a surcharge on the portion of their income above $500,000 (instead of $280,000) for individuals and $1 million (instead of $350,000) for couples, in order to help make health insurance affordable for middle class families.

7. ADDRESSING GEOGRAPHIC VARIATIONS IN MEDICARE PAYMENTS/MOVING TO MEDICARE PAYMENTS REWARDING QUALITY AND COST-EFFECTIVENESS—The revised bill provides that the Institute of Medicine (IOM), through two studies, will make recommendations on how to fix the current Medicare reimbursement system, including addressing current geographic variations. Under the bill, the Centers for Medicare and Medicaid Services (CMS) will implement the IOM recommendations on changes to Medicare payment systems unless disapproved by Congress

8. BEGINS CLOSING THE MEDICARE PART D DONUT HOLE IMMEDIATELY—The revised bill moves forward the effective date of reducing the donut hole by $500 and instituting a 50% discount for brand-name drugs in the donut hole, from January 1, 2011 to January 1, 2010. It also completes elimination of the donut hole by 2019 (instead of 2024).

9. IMMEDIATE HELP FOR THE UNINSURED (INTERIM HIGH-RISK POOL)—To fill the gap before the Exchange is available, the revised bill immediately creates an insurance program with financial assistance for those who have been uninsured for several months or denied a policy because of pre-existing conditions.

10. HHS NEGOTIATION OF DRUG PRICES—Under the revised bill, the Secretary of HHS is required to negotiate drug prices on behalf of Medicare beneficiaries.