Last night a group of neighbors gathered to watch the President’s speech to Congress. Health reform is very close to my heart. If we as a nation decide that ‘no we can’t’, if we accept that some will suffer, die, lose all their savings due to illness and the rest of us will stand by and watch, clutching our small advantages and knowing that we could fall out of the insured tomorrow–this is not the America of hope, but of fear.
The President is an eloquent speaker, and I expected a fine speech and was not disappointed. But what about specifics?
What this plan will do is make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a preexisting condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it the most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies — because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.
Now, that’s what Americans who have health insurance can expect from this plan — more security and more stability.
Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or you change your job, you’ll be able to get coverage. If you strike out on your own and start a small business, you’ll be able to get coverage. We’ll do this by creating a new insurance exchange — a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It’s how everyone in this Congress gets affordable insurance. And it’s time to give every American the same opportunity that we give ourselves.
Now, for those individuals and small businesses who still can’t afford the lower-priced insurance available in the exchange, we’ll provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can’t get insurance today because they have preexisting medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it’s a good idea now, and we should all embrace it.
Now, even if we provide these affordable options, there may be those — especially the young and the healthy — who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers by giving them coverage. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don’t sign up for health insurance, it means we pay for these people’s expensive emergency room visits. If some businesses don’t provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover preexisting conditions — just can’t be achieved.
And that’s why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise — likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still can’t afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we can’t have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. And the insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Now, let me be clear. Let me be clear. It would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.
This is a very moderate reform plan. I would like to see change now, because people need help now. But I’m a believer in harm reduction, and these reforms, if enforced, will make the insurance industry accountable. It may be that we will end up with insurance companies that make modest profits and serve the public– it may be that the industry will stop attracting pirates and profiteers. As long as Americans can get affordable, decent health care we will have met our goal.
The public option–in a sense it already exists but not for working adults. Children can get insured through Schip. If you are totally disabled you can apply for disability. People over 65 and Veterans have access to government insurance. Congress and federal employees enjoy a single-payer system. Making a public option available to people who are not well-served by private insurance protects them, and provides competition to the insurance companies.
A responsibility to get insurance–I remember when you could drive without insurance, and if you ran over someone tough luck for them. If we all have to do our part, and recognize the real cost we are already paying, we will be directly invested in keeping our insurance industry honest and accountable.
A phrase from the President’s speech, a quote from a letter by the late Sen. Ted Kennedy–‘the character of our country’. We can truly have fairness and security in health care. It’s not going to just happen with the signing of a bill. We have to keep working toward the goal, and keep government and industry honest. With the signing of a health care bill the work will begin.