Friday, September 30, 2011
Tuesday, September 27, 2011
Tuesday, July 19, 2011
A Policy Summary of The Defense of Marriage Act (DOMA )
The Defense of Marriage Act, also known as DOMA came into being amid a controversy over federalism and the Full Faith and Credit Clause in Article IV section 1 of the US Constitution. It was the mid-90‘s and at that time a court decision (Baehr v. Miike, originally Baehr v. Lewin) was issued from the Supreme Court of Hawaii suggesting that there was a right to same-sex marriage under the Hawaii state constitution (domawatch). Federal lawmakers became concerned that if Hawaii allowed same-sex couples to marry, how would that affect the other 49 states, federal laws, the institution of marriage, traditional notions of morality, and state sovereignty (domawatch.org, para 1). So instead of tackling the issues of federalism and the full faith and credit clause, Conservative lawmakers hastily reacted marginalizing an entire population of LGBT (Lesbian, Gay, Bi-sexual, Transgendered) Americans. The following summarizes what the Defense of Marriage Act is and how it affects the states and federal government, the actors and interests involved, how the law has affected LGBT Americans, and pending DOMA court cases. In addition, the Obama administration made news recently on DOMA which will also be discussed.
The Defense of Marriage Act was introduced on May 7, 1996 to the 104th Congress of the United States (LOC). The original sponsor of the bill was Rep. Bob Barr of Georgia’s 7th District (LOC). The Defense of Marriage Act is split into two distinct sections, the first provides states with the authority to deny Full Faith and Credit of one states’ “effects” - in this case a marriage certificate given to a same-sex couple - by another state. “No State, territory, or possession of the United States, or Indian tribe, shall be required to give effect to any public act, record, or judicial proceeding of any other State, territory, possession, or tribe respecting a relationship between persons of the same sex that is treated as a marriage under the laws of such other State, territory, possession, or tribe, or a right or claim arising from such relationship (LOC). This language allows the states to decided for themselves wether it wants to grant Full Faith and Credit on the status of marriage; but only to same-sex unions, heterosexual marriages cannot be denied.
According to Lectic Law, the Congress has exercised its power under the “Effect” Clause of Article IV (Full Faith and Credit) before, declaring what “effect” one State’s acts, records, and judicial proceedings shall have in another state (Lectric Law). The Parental Kidnaping Prevention Act of 1980 and the Full Faith and Credit for Child Support Act of 1994, are both instances where Congress has regulated how one State must act in accordance with another States’ action. The Defense of Marriage Act in essence says that the Full Faith and Credit clause found in the Constitution does not apply (unless States’ so choose) to LGBT Americans living in committed, loving, relationships who have a marriage license from another state.
The second portion of the Defense of Marriage Act is very straight forward, no pun intended. It amends the U.S. Code to define marriage for all federal purposes as a legal union of a man and a woman as husband and wife. DOMA also defines what the term spouse is for federal purposes. “In determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife” (LOC).
The Defense of Marriage Act’s definition of “marriage” can be rooted back to a 1974 Washington State case, where it was cited that over a century ago the US Supreme Court spoke of the “union for life of one man and one woman in the holy estate of matrimony” (Lectric Law). Using similar words and holding similar sentiment the proponents of the language in the Defense of Marriage Act, choose to cast a dark cloud over thousands of federal employees and their partners who happen to be identify as LGBT.
In the mid-90’s the partisan divide was tremendous. We had divided government much like we do today; with a Republican controlled House of Representatives and centrist Democrat as President. With the threat of a progressive interpretation of marriage pushing up against notions of federalism, it was Robert Barr, a libertarian-leaning Republican from Georgia’s 7th District that began to author legislation that would become the Defense of Marriage Act which preemptively deny rights afforded in the US Constitution to gays and lesbians. Barr along with 120 Democrats and 219 Republican passed H.R 3396 - The Defense of Marriage Act in the House on July 12, 1996. There were 342 yea votes, 67 nay votes, and 22 who did not vote on the bill. On September 10, 1996 the Senate passed the bill 85 (yea) to 14 (nay) and President Clinton signed it into law eleven days later September 21, 1996.
Social views of homosexuality were not as tolerant then as they are now. Visceral fears of AIDS still dominated much of how the public viewed gay Americans; especially gay men. About a year before Ellen Degeneres came out of the closet on prime time television, Democrats and Republicans from all eight Maryland Congressional districts voted for the Defense of Marriage Act. However, Govtrack, an online Congressional clearinghouse website, notes there was one Republican, Steven Gunderson of Wisconsin’s 3rd District who voted no. Other notable “nay” votes came from progressives Democrats like both Kennedy’s in Congress, Edward Markey (MA), Charlie Rangel (NY) , John Conyers (MI), Bernie Sanders (VT), Henry Waxman (CA), Maxine Waters (CA), and surprisingly even my representative (at the time) James Moran (VA).
The issue of LGBT rights comes with a host of emotion from both proponents and opponents alike. In support of their cause many different advocacy groups have begun the work to repeal the Defense of Marriage Act or fight to keep it existing law. Pro-gay rights groups come in many sizes, however, the Human Rights Campaign and Lambda Legal are two well organized groups actively lobbying and litigating , respectively, to end the Defense of Marriage Act. Lobbying efforts by HRC and Equality Maryland, a Baltimore-based LGBT rights group, have worked to get repeal legislation through Congress. In September 2009 Rep. Jerrold Nadler of New York introduced H.R 1116 - The Respect for Marriage Act to the 111th Congress. California Senator Diane Feinstein introduced S. 598 to the Senate and Rep Nadler re-introduced The Respect for Marriage Act in the House on March 16, 2011.
Opponents to repeal of the Defense of Marriage Act are familiar and should not come as a surprise. The same conservative, typically religious right wing organizations include; Family Research Counsel, Heritage Foundation, and Concerned Women of America, amongst others. All of these organizations have released statements defending the Defense of Marriage Act, however, I was unable to find direct funding to legislators attempting to kill the Respect for Marriage Act, which would effectively repeal the discriminatory DOMA law. It is noteworthy to mention that the original sponsor and drafter of the so-called Defense of Marriage Act, Robert Barr, now opposes the Defense of Marriage Act, as well as, the Federal Marriage Amendment, and supports the Respect for Marriage Act (Barr Youtube Video).
The affect the Defense of Marriage Act has had on the LGBT community has been hard not to notice. Since the federal government adopted the policy in 1994, and up until the Obama administration, gay federal employees with partners were denied offering health benefits to their spouse because of the language directly associated with the so-called Defense of Marriage Act. Since 1994 five states including the District of Columbia issue marriage licenses to same-sex couples (HRC). Because of this reality federal courts have heard and decided cases brought forth by gay-rights advocacy groups. A recent example is a 2011 case brought forth from Lambda Legal, representing Karen Golinski. Ms. Golinski is a federal court employee who is challenging the constitutionality of the Defense of Marriage Act on the grounds that her wife was denied spousal benefits (Alliance). “As part of an internal HR adjudication process, Chief Judge Alex Kozinski ruled that denying the benefits violated the court’s EEO policy and ordered that they be provided to the employee’s wife. The Office of Personnel Management, which administers federal employee health benefits, refused to comply and the employee filed suit in federal district court in California” (HRC, para 9).
According to the Human Rights Campaign, approximately five more cases are pending across the country challenging the Defense of Marriage Act. Gill v. Office of Personnel Management is a case where lawfully married same-sex couples in Massachusetts sued for denied benefits like federal employee health insurance, joint income tax filing, and social security benefits. In July 2010, a federal district judge ruled in their favor. The case is currently on appeal to the US Court of Appeals for the First Circuit (HRC para, 10). Similar to Gill is the Pederson v. Office of Personnel Management case involving couples from Connecticut, Vermont, and New Hampshire and is currently in federal district court in Connecticut. Another type of case dealing with estate tax is Windsor v. United States. The case involves a New York widow who is “subject to a significant estate tax burden that would not apply if her spouse was male” (HRC, para 11). In all of these cases the people involved have felt real injustice simply because of who they love.
In 2011 President Obama along with Attorney General Eric Holder issued statements officially reversed the position long held by the federal government regarding the Defense of Marriage Act. “The president and I have concluded that classifications based on sexual orientation” should be subjected to a strict legal test intended to block unfair discrimination, Mr. Holder wrote. As a result, he said, a crucial provision of the Defense of Marriage Act “is unconstitutional” (Savage, et al. para 2). The President additional instructed the Department of Justice to stop actively defending the law in court (Savage, para 1). The sudden shift in policy was welcome news to the LGBT community half way into Obama’s first term; the Obama candidacy promised repeal of DOMA, but had consistently defended the law for the prior two years since taking office.
It is fair to say that after the Defense of Marriage Act was signed into law public opinion began to shift even more in favor of, at the very least, tolerance for LGBT Americans and their rights. Many taboos were being exposed in pop culture during the mid to late 1990’s. There is no question that television shows like Ellen, and Will and Grace changed how middle-america viewed homosexuality. In the millennium, shows like Queer as Folk, pushed the envelope even further. Now seventeen years after the Defense of Marriage Act was enacted, there is movement from the grassroots of LGBT activism to the halls of Congress and the White House for repeal of the existing law. For now the Respect for Marriage Act sits in the House Judiciary Committee awaiting a mark-up hearing (LOC). If history is our guide to future events, the Defense of Marriage Act will be repealed, eventually.
Reference
Alliance Alert (2011). Lambda Legal: DOMA Under Fire in Equal Benefits Case. Retrieved March 25 2011 from http://www.alliancealert.org/2011/04/15/lambda-legal-doma-under fire-in-equal-benefits-case/
Bob Barr 2008. (2011). YouTube Video of Acceptance Speech for Libertarian Party Nomination for President. Retrieved March 25 2011 from http://www.youtube.com/watch? v=mjfDSPfL02w
Concerned Women for America (2011). CWA Defends The Defense of Marriage Act. Retrieved March 23 2011 from http://www.cwfa.org/content.asp?id=19878
DOMAwatch.org (2011). Legal Resource for News On Defense of Marriage Act. Retrieved March 25 2011 from http://www.domawatch.org/index.php
Family Research Counsel (2011). Search Results: Defense of Marriage Act. Retrieved March 23 2011 from http://www.frc.org/washingtonupdate/defending-doma-pros-and-leprechauns
Heritage Foundation (2011). Memo To White House, Don’t Stop, Start Defending DOMA. Retrieved March 24 2011 from http://blog.heritage.org/?p=52412
Human Rights Campaign (2011). Defense of Marriage Act FAQ. Retrieved March 22 2011 from
http://www.hrc.org/issues/marriage/15364.htm
Human Rights Campaign (2011). Respect for Marriage Act. Retrieved March 23 2011 from
http://www.hrc.org/issues/marriage/13530.htm
Lambda Legal (2011). Pending Legal Cases: Defense of Marriage Act. Retrieved March 22 2011 from http://www.lambdalegal.org/in-court/cases/baehr-v-miike.html
Lectric Law (2011). Summary of Defense of Marriage Act. H.R 3396. Retrieved March 20 2011 from http://www.lectlaw.com/files/leg23.htm
Library of Congress (2011). Bill Summary and Status of 104th Congress (95’-96’)
H.R 3396 Retrieved March 20 2011 from http://thomas.loc.gov/cgi-bin/bdquery/z d104:h3396:
Savage, Charlie and Stolberg, Gay Sheryl (2011). NY Times Online: In Shift, US Says Marriage Act Blocks Gay Rights. Retrieved March 23 2011 from http://www.nytimes.com/ 2011/02/24/us/24marriage.html_r=1&scp=1&sq=Defense%20of%20Marriage %20Act&st=cse
The Defense of Marriage Act was introduced on May 7, 1996 to the 104th Congress of the United States (LOC). The original sponsor of the bill was Rep. Bob Barr of Georgia’s 7th District (LOC). The Defense of Marriage Act is split into two distinct sections, the first provides states with the authority to deny Full Faith and Credit of one states’ “effects” - in this case a marriage certificate given to a same-sex couple - by another state. “No State, territory, or possession of the United States, or Indian tribe, shall be required to give effect to any public act, record, or judicial proceeding of any other State, territory, possession, or tribe respecting a relationship between persons of the same sex that is treated as a marriage under the laws of such other State, territory, possession, or tribe, or a right or claim arising from such relationship (LOC). This language allows the states to decided for themselves wether it wants to grant Full Faith and Credit on the status of marriage; but only to same-sex unions, heterosexual marriages cannot be denied.
According to Lectic Law, the Congress has exercised its power under the “Effect” Clause of Article IV (Full Faith and Credit) before, declaring what “effect” one State’s acts, records, and judicial proceedings shall have in another state (Lectric Law). The Parental Kidnaping Prevention Act of 1980 and the Full Faith and Credit for Child Support Act of 1994, are both instances where Congress has regulated how one State must act in accordance with another States’ action. The Defense of Marriage Act in essence says that the Full Faith and Credit clause found in the Constitution does not apply (unless States’ so choose) to LGBT Americans living in committed, loving, relationships who have a marriage license from another state.
The second portion of the Defense of Marriage Act is very straight forward, no pun intended. It amends the U.S. Code to define marriage for all federal purposes as a legal union of a man and a woman as husband and wife. DOMA also defines what the term spouse is for federal purposes. “In determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife” (LOC).
The Defense of Marriage Act’s definition of “marriage” can be rooted back to a 1974 Washington State case, where it was cited that over a century ago the US Supreme Court spoke of the “union for life of one man and one woman in the holy estate of matrimony” (Lectric Law). Using similar words and holding similar sentiment the proponents of the language in the Defense of Marriage Act, choose to cast a dark cloud over thousands of federal employees and their partners who happen to be identify as LGBT.
In the mid-90’s the partisan divide was tremendous. We had divided government much like we do today; with a Republican controlled House of Representatives and centrist Democrat as President. With the threat of a progressive interpretation of marriage pushing up against notions of federalism, it was Robert Barr, a libertarian-leaning Republican from Georgia’s 7th District that began to author legislation that would become the Defense of Marriage Act which preemptively deny rights afforded in the US Constitution to gays and lesbians. Barr along with 120 Democrats and 219 Republican passed H.R 3396 - The Defense of Marriage Act in the House on July 12, 1996. There were 342 yea votes, 67 nay votes, and 22 who did not vote on the bill. On September 10, 1996 the Senate passed the bill 85 (yea) to 14 (nay) and President Clinton signed it into law eleven days later September 21, 1996.
Social views of homosexuality were not as tolerant then as they are now. Visceral fears of AIDS still dominated much of how the public viewed gay Americans; especially gay men. About a year before Ellen Degeneres came out of the closet on prime time television, Democrats and Republicans from all eight Maryland Congressional districts voted for the Defense of Marriage Act. However, Govtrack, an online Congressional clearinghouse website, notes there was one Republican, Steven Gunderson of Wisconsin’s 3rd District who voted no. Other notable “nay” votes came from progressives Democrats like both Kennedy’s in Congress, Edward Markey (MA), Charlie Rangel (NY) , John Conyers (MI), Bernie Sanders (VT), Henry Waxman (CA), Maxine Waters (CA), and surprisingly even my representative (at the time) James Moran (VA).
The issue of LGBT rights comes with a host of emotion from both proponents and opponents alike. In support of their cause many different advocacy groups have begun the work to repeal the Defense of Marriage Act or fight to keep it existing law. Pro-gay rights groups come in many sizes, however, the Human Rights Campaign and Lambda Legal are two well organized groups actively lobbying and litigating , respectively, to end the Defense of Marriage Act. Lobbying efforts by HRC and Equality Maryland, a Baltimore-based LGBT rights group, have worked to get repeal legislation through Congress. In September 2009 Rep. Jerrold Nadler of New York introduced H.R 1116 - The Respect for Marriage Act to the 111th Congress. California Senator Diane Feinstein introduced S. 598 to the Senate and Rep Nadler re-introduced The Respect for Marriage Act in the House on March 16, 2011.
Opponents to repeal of the Defense of Marriage Act are familiar and should not come as a surprise. The same conservative, typically religious right wing organizations include; Family Research Counsel, Heritage Foundation, and Concerned Women of America, amongst others. All of these organizations have released statements defending the Defense of Marriage Act, however, I was unable to find direct funding to legislators attempting to kill the Respect for Marriage Act, which would effectively repeal the discriminatory DOMA law. It is noteworthy to mention that the original sponsor and drafter of the so-called Defense of Marriage Act, Robert Barr, now opposes the Defense of Marriage Act, as well as, the Federal Marriage Amendment, and supports the Respect for Marriage Act (Barr Youtube Video).
The affect the Defense of Marriage Act has had on the LGBT community has been hard not to notice. Since the federal government adopted the policy in 1994, and up until the Obama administration, gay federal employees with partners were denied offering health benefits to their spouse because of the language directly associated with the so-called Defense of Marriage Act. Since 1994 five states including the District of Columbia issue marriage licenses to same-sex couples (HRC). Because of this reality federal courts have heard and decided cases brought forth by gay-rights advocacy groups. A recent example is a 2011 case brought forth from Lambda Legal, representing Karen Golinski. Ms. Golinski is a federal court employee who is challenging the constitutionality of the Defense of Marriage Act on the grounds that her wife was denied spousal benefits (Alliance). “As part of an internal HR adjudication process, Chief Judge Alex Kozinski ruled that denying the benefits violated the court’s EEO policy and ordered that they be provided to the employee’s wife. The Office of Personnel Management, which administers federal employee health benefits, refused to comply and the employee filed suit in federal district court in California” (HRC, para 9).
According to the Human Rights Campaign, approximately five more cases are pending across the country challenging the Defense of Marriage Act. Gill v. Office of Personnel Management is a case where lawfully married same-sex couples in Massachusetts sued for denied benefits like federal employee health insurance, joint income tax filing, and social security benefits. In July 2010, a federal district judge ruled in their favor. The case is currently on appeal to the US Court of Appeals for the First Circuit (HRC para, 10). Similar to Gill is the Pederson v. Office of Personnel Management case involving couples from Connecticut, Vermont, and New Hampshire and is currently in federal district court in Connecticut. Another type of case dealing with estate tax is Windsor v. United States. The case involves a New York widow who is “subject to a significant estate tax burden that would not apply if her spouse was male” (HRC, para 11). In all of these cases the people involved have felt real injustice simply because of who they love.
In 2011 President Obama along with Attorney General Eric Holder issued statements officially reversed the position long held by the federal government regarding the Defense of Marriage Act. “The president and I have concluded that classifications based on sexual orientation” should be subjected to a strict legal test intended to block unfair discrimination, Mr. Holder wrote. As a result, he said, a crucial provision of the Defense of Marriage Act “is unconstitutional” (Savage, et al. para 2). The President additional instructed the Department of Justice to stop actively defending the law in court (Savage, para 1). The sudden shift in policy was welcome news to the LGBT community half way into Obama’s first term; the Obama candidacy promised repeal of DOMA, but had consistently defended the law for the prior two years since taking office.
It is fair to say that after the Defense of Marriage Act was signed into law public opinion began to shift even more in favor of, at the very least, tolerance for LGBT Americans and their rights. Many taboos were being exposed in pop culture during the mid to late 1990’s. There is no question that television shows like Ellen, and Will and Grace changed how middle-america viewed homosexuality. In the millennium, shows like Queer as Folk, pushed the envelope even further. Now seventeen years after the Defense of Marriage Act was enacted, there is movement from the grassroots of LGBT activism to the halls of Congress and the White House for repeal of the existing law. For now the Respect for Marriage Act sits in the House Judiciary Committee awaiting a mark-up hearing (LOC). If history is our guide to future events, the Defense of Marriage Act will be repealed, eventually.
Reference
Alliance Alert (2011). Lambda Legal: DOMA Under Fire in Equal Benefits Case. Retrieved March 25 2011 from http://www.alliancealert.org/2011/04/15/lambda-legal-doma-under fire-in-equal-benefits-case/
Bob Barr 2008. (2011). YouTube Video of Acceptance Speech for Libertarian Party Nomination for President. Retrieved March 25 2011 from http://www.youtube.com/watch? v=mjfDSPfL02w
Concerned Women for America (2011). CWA Defends The Defense of Marriage Act. Retrieved March 23 2011 from http://www.cwfa.org/content.asp?id=19878
DOMAwatch.org (2011). Legal Resource for News On Defense of Marriage Act. Retrieved March 25 2011 from http://www.domawatch.org/index.php
Family Research Counsel (2011). Search Results: Defense of Marriage Act. Retrieved March 23 2011 from http://www.frc.org/washingtonupdate/defending-doma-pros-and-leprechauns
Heritage Foundation (2011). Memo To White House, Don’t Stop, Start Defending DOMA. Retrieved March 24 2011 from http://blog.heritage.org/?p=52412
Human Rights Campaign (2011). Defense of Marriage Act FAQ. Retrieved March 22 2011 from
http://www.hrc.org/issues/marriage/15364.htm
Human Rights Campaign (2011). Respect for Marriage Act. Retrieved March 23 2011 from
http://www.hrc.org/issues/marriage/13530.htm
Lambda Legal (2011). Pending Legal Cases: Defense of Marriage Act. Retrieved March 22 2011 from http://www.lambdalegal.org/in-court/cases/baehr-v-miike.html
Lectric Law (2011). Summary of Defense of Marriage Act. H.R 3396. Retrieved March 20 2011 from http://www.lectlaw.com/files/leg23.htm
Library of Congress (2011). Bill Summary and Status of 104th Congress (95’-96’)
H.R 3396 Retrieved March 20 2011 from http://thomas.loc.gov/cgi-bin/bdquery/z d104:h3396:
Savage, Charlie and Stolberg, Gay Sheryl (2011). NY Times Online: In Shift, US Says Marriage Act Blocks Gay Rights. Retrieved March 23 2011 from http://www.nytimes.com/ 2011/02/24/us/24marriage.html_r=1&scp=1&sq=Defense%20of%20Marriage %20Act&st=cse
Monday, July 18, 2011
Sunday, July 17, 2011
Health Insurance Exchanges: Final Recommendations
Introduction
The Patient Protection and Affordable Care Act is a law which has changed health care in the United States. Yet over a year after the bill became law plenty of people still do not realize what has changed and how the law will affect their lives. Its name is long, but speaks to what the bill hopes provides; protection and affordability. After researching the health reform law over the semester, combined with course lectures and readings I have come to believe that the current health care law, but one including a strong public health insurance option, serves as the proper framework for health policy in America. I say this firmly believing in the ideals of federalism, and the fundamentals of public policy that I have learned. By that I mean the structure of reform being implemented in the current law is proper. It provides broad regulations and a minimum standard of care for States to follow, at the same allows for States to create their own rules governing the insurance exchanges created in the PPACA. Current health care law, but one including a strong public option, fits the logical, structural needs and the ideologically cautious political mood of the nation.
Why The Structure Of PPACA Works
Something was needed in order to gain bipartisan support of the health reform bill and the insurance exchanges are the basis for that support. As Robert Pear noted in his piece on health exchanges “the idea of an insurance exchange has bipartisan appeal” adding “liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses” (Pear, para 8, 9). The exchanges are “envisioned as a kind of ‘bazzar’ where insurers offer products side by side” (Pear, para 14). The bazzar Robert Pear refers to are in fact “structured web-based [insurance] markets” according to the Kansas Health Policy Authority (Allison). This website will be free and accessible to all and be required to be in operation in the States by 2014. Once functioning, all existing insurance regulations are to be required to be enforced (Allison).
The states have been granted the authority to decide how and who will run the insurance exchanges (Allison). This fact is far under reported and is important because the core purpose of the entity that runs the exchange will be to manage and rate plans according to quality and cost. Moreover the requirement of the exchange management entity to facilitate web-based determinations of eligibility for premium subsidies, as well as web-based selection and enrollment in health plans can work for or against public opinion of the health exchange depending on how they are managed.
The reasoning behind my position on this portion of my argument is two fold. First, this type of structure has worked at the state level before. There is a working model for a successful implementation of a health exchange for all 50 states. We also have two types of working models to choose to model from both offering distinct differences in approach; Utah and Mass (Pear). Second, the PPACA’s implementation is incremental in its approach according to Deborah Stone. If serious fluctuations were to happen quickly in the process of how health care became administered, the deductive argument against it is certainly the potential for a reduction in quality of care could occur (Stone). Frankly, The chance of that happening are just to great for any politician to take.
The Climate; Then And Now
A major factor in my decision to advocate for the current policy other all others was influenced by the highly partisan political environment the nation is currently experiencing. Ideology seems to have trumped practical reasoning in terms of crafting solutions to the problems the country faces. A Pew Research poll from April 2010 asked what issues US families talking about; second to the economy was health care reform. With health care consistently being one of the top issues Americans are interested in, something needed to be done to address the concerns of the public. Pew research again cites twenty seven percent, almost a quarter of the public polled, said they followed news of health reform closer than any other news story of 2009. This number accounts for all viewpoints, ideologies, and biases. I mention these figures to make the point that rancor from both Republicans and Democrats have seriously stunted the ability of our leaders to solve public policy problems Americans want solved.
The current implementation of the Patient Protection and Affordable Care has been undercut by a lack of enthusiasm from Democrats who were instrumental in its formulation. This current yet familiar reality is compounded by Republicans, who after the midterm elections, passed a health reform repeal bill which has gone nowhere in the Democratically controlled Senate. Moreover, the current partisan battle and concurrent House vote for Rep. Paul Ryan’s budget has pinned congressional Republicans against older constituents concerned about the future of the American Medicare system. The Ryan plan would fundamentally change the social contract from a premium for service structure to a voucher program. This is significant because the same anger and vitriol held toward Democrats before reform became law, is the same anger now held towards Republicans for their vote. A serious change to how health care is administered is a tough political, and practical policy to implement especially in the current climate.
A Strong Public Option
The position for a strong public option to be a insurance plan within the exchange framework was fought for by progressives and the President over the health care reform debate. I am one, however, who does feel that President Obama did not come out strong enough for the public option. As mentioned before, the debate over provisions in the final bill centered on falsehoods like “death panels” and the fake charge that the public option would amount to a government take-over of health care. The Pew Research found that over the debate fifty percent of people polled heard about the public option. The problem I feel is what they heard was not from the administration, but from surrogates or opponent. President Obama did make statements to the public specifically about health care fifty two times, most of which I saw. The public option was not the rallying cry for the President which I feel hurt the chances of it being established under the Patient Protection and Affordable Care Act.
My reasoning behind adding a public option to the current health care framework as the best course of action isn’t proven by an active model but my intimate involvement with the health care system. Due to medical conditions I am frequently having to make appointments, pay co-pays, and be seen by physician. Working or being a full time student with out a 9 - 5 job to help cover my health expenses have both proven difficult in dealing with insurance companies over the years. The loss of my employee-based health coverage and now being a part the Medicaid program in Maryland has been a decent experience, so my feeling about being on a federal instead of a state run plan is held in a favorable light.
Conclusion
Over the course of the semester I have been a student of the Patient Protection and Affordable Care Act while engaged in a intellectual conversation over how public policy is created in America. The redistributive nature of the policy tends to make it a progressive reform attempt. The PPACA has both positive and negative inducements to spur movement from the states and individuals to be proactive regarding compliance to the new law. The law is being implemented incrementally and holds true to the federalist system American public policy is known for. I am all for the current law and hope that progressive members are able to add a strong public option for Americans like me.
References Antos, Grace-Marie, Turner, Joseph R. (May 20, 2009) The GOP Health Alternative. Retrieved March 21, 2011 from http://online.wsj.com/article/SB124277551107536875.html
Catastrophic Health Insurance Plans (2011) Catastrophic Health Insurance Plans And Resources. Retrieved March 19, 2011 from http://www.catastrophichealthinsuranceplans.net catastrophiccoverage-explained
Conrad, Peter (2009) The Sociology Of Health And Illness. Eighth Edition. Retrieved March 21, 2011 New York, NY Worth Publishing.
CNNPolitics. (Aug 16, 2011) Democratic Senator: Public Insurance Option Dead. Retrieved March 19, 2011 from http://articles.cnn.com/2009-08-16/politics/us.healthcare_1_public option-insurance-option-health-care?_s=PM:POLITICS
Green Party of the United States. (2011) Green Party Platform. Retrieved March 17, 2011 from http://www.gp.org/platform/2004/socjustice.html#1004611
FamiliesUSA (2011) HSA’a Shop Til You Drop. Retrieved March 20, 2011 from
http://www.familiesusa.org/issues/private-insurance/hsas/health-savings-accounts.html
Heathcare.gov. (2011) Health Care.gov Glossary. Retrieved March 16, 2011 from
http://www.healthcare.gov/glossary/c/catastrophic.html
Health Care-now.org. (2011) What Is Single-Payer? Retrieved March 17, 2011 from
http://www.healthcare-now.org/hr-676/whats-single-payer/
Health Savings Account Info. (2011) Health Saving Info. Retrieved March 20, 2011 from
http://www.healthsavingsinfo.com/
Library of Congress. THOMAS. (2011) Bill Summary and Status of 111th & 112th Congress (2009-20012) H.R 676 Major Congressional Actions. Retrieved March 16 2011 from
http://thomas.loc.gov/cgi-bin/thomas
Mokhiber, Russell (Apr 16, 2009.) Top 10 Enemies of Single-Payer Retrieved March 15, 2011 from http://www.counterpunch.org/mokhiber04162009.html
O’Connor, Patrick. (Aug 4, 2009.) Liberal House Dems Hold Their Ground. Retrieved March 18, 2011 from Congressional Progressive Caucasus http://cpc.grijalva.house.gov/ index.cfm?sectionid=68&parentid=5§iontree=5,68&itemid=189
Rasmussen Reports (Jan 1, 2009) 34% Favor Single-Payer Health Care System. Retrieved March 19, 2011 from http://www.rasmussenreports.com/public_content/politics/current_events /healthcare/december_2009/34_favor_single_payer_health_care_system
Rasmussen Reports (Feb 25, 2010) 47% Opposed Public Option Health Plan. Retrieved March 19, 2011 http://www.rasmussenreports.com/public_content/politics/currentevents-
healthcarefebruary_2010/47oppose_public_option_health_plan_58_oppose_
if_workers_forced_to_change_coverage
Rubin, Donny (Mar 3, 2011) Health Savings Accounts. Retrieved March 20, 2011 from
http://www.therubins.com/ideas/hsa.htm
Shaw, Donny (Aug 20, 2009) What Is The Public Option. Retrieved March 16, 2011 from
http://www.opencongress.org/articles/view/1174--What-is-the-Public-Option-
Sreeizzle2012. (Dec 3, 2010) Single-Payer Is Ready To Go! Retrieved March 18, 2011 from http://www.dailykos.com/story/2010/12/03/925362/-Attention-Daily-kos-members-and -progressives!-single-payer-is-ready-to-go!
Stewart, et al. (2011) Public Policy: An Evolutionary Approach. Third Edition. Retrieved March 19, 2011 Thomas Wadsworth
WPTZ.com (March 25 2011) Vt. House Passes Single-Payer Health Care Bill. Retrieved March 19, 2011 from http://www.wptz.com/r/27317316/detail.html
The Patient Protection and Affordable Care Act is a law which has changed health care in the United States. Yet over a year after the bill became law plenty of people still do not realize what has changed and how the law will affect their lives. Its name is long, but speaks to what the bill hopes provides; protection and affordability. After researching the health reform law over the semester, combined with course lectures and readings I have come to believe that the current health care law, but one including a strong public health insurance option, serves as the proper framework for health policy in America. I say this firmly believing in the ideals of federalism, and the fundamentals of public policy that I have learned. By that I mean the structure of reform being implemented in the current law is proper. It provides broad regulations and a minimum standard of care for States to follow, at the same allows for States to create their own rules governing the insurance exchanges created in the PPACA. Current health care law, but one including a strong public option, fits the logical, structural needs and the ideologically cautious political mood of the nation.
Why The Structure Of PPACA Works
Something was needed in order to gain bipartisan support of the health reform bill and the insurance exchanges are the basis for that support. As Robert Pear noted in his piece on health exchanges “the idea of an insurance exchange has bipartisan appeal” adding “liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses” (Pear, para 8, 9). The exchanges are “envisioned as a kind of ‘bazzar’ where insurers offer products side by side” (Pear, para 14). The bazzar Robert Pear refers to are in fact “structured web-based [insurance] markets” according to the Kansas Health Policy Authority (Allison). This website will be free and accessible to all and be required to be in operation in the States by 2014. Once functioning, all existing insurance regulations are to be required to be enforced (Allison).
The states have been granted the authority to decide how and who will run the insurance exchanges (Allison). This fact is far under reported and is important because the core purpose of the entity that runs the exchange will be to manage and rate plans according to quality and cost. Moreover the requirement of the exchange management entity to facilitate web-based determinations of eligibility for premium subsidies, as well as web-based selection and enrollment in health plans can work for or against public opinion of the health exchange depending on how they are managed.
The reasoning behind my position on this portion of my argument is two fold. First, this type of structure has worked at the state level before. There is a working model for a successful implementation of a health exchange for all 50 states. We also have two types of working models to choose to model from both offering distinct differences in approach; Utah and Mass (Pear). Second, the PPACA’s implementation is incremental in its approach according to Deborah Stone. If serious fluctuations were to happen quickly in the process of how health care became administered, the deductive argument against it is certainly the potential for a reduction in quality of care could occur (Stone). Frankly, The chance of that happening are just to great for any politician to take.
The Climate; Then And Now
A major factor in my decision to advocate for the current policy other all others was influenced by the highly partisan political environment the nation is currently experiencing. Ideology seems to have trumped practical reasoning in terms of crafting solutions to the problems the country faces. A Pew Research poll from April 2010 asked what issues US families talking about; second to the economy was health care reform. With health care consistently being one of the top issues Americans are interested in, something needed to be done to address the concerns of the public. Pew research again cites twenty seven percent, almost a quarter of the public polled, said they followed news of health reform closer than any other news story of 2009. This number accounts for all viewpoints, ideologies, and biases. I mention these figures to make the point that rancor from both Republicans and Democrats have seriously stunted the ability of our leaders to solve public policy problems Americans want solved.
The current implementation of the Patient Protection and Affordable Care has been undercut by a lack of enthusiasm from Democrats who were instrumental in its formulation. This current yet familiar reality is compounded by Republicans, who after the midterm elections, passed a health reform repeal bill which has gone nowhere in the Democratically controlled Senate. Moreover, the current partisan battle and concurrent House vote for Rep. Paul Ryan’s budget has pinned congressional Republicans against older constituents concerned about the future of the American Medicare system. The Ryan plan would fundamentally change the social contract from a premium for service structure to a voucher program. This is significant because the same anger and vitriol held toward Democrats before reform became law, is the same anger now held towards Republicans for their vote. A serious change to how health care is administered is a tough political, and practical policy to implement especially in the current climate.
A Strong Public Option
The position for a strong public option to be a insurance plan within the exchange framework was fought for by progressives and the President over the health care reform debate. I am one, however, who does feel that President Obama did not come out strong enough for the public option. As mentioned before, the debate over provisions in the final bill centered on falsehoods like “death panels” and the fake charge that the public option would amount to a government take-over of health care. The Pew Research found that over the debate fifty percent of people polled heard about the public option. The problem I feel is what they heard was not from the administration, but from surrogates or opponent. President Obama did make statements to the public specifically about health care fifty two times, most of which I saw. The public option was not the rallying cry for the President which I feel hurt the chances of it being established under the Patient Protection and Affordable Care Act.
My reasoning behind adding a public option to the current health care framework as the best course of action isn’t proven by an active model but my intimate involvement with the health care system. Due to medical conditions I am frequently having to make appointments, pay co-pays, and be seen by physician. Working or being a full time student with out a 9 - 5 job to help cover my health expenses have both proven difficult in dealing with insurance companies over the years. The loss of my employee-based health coverage and now being a part the Medicaid program in Maryland has been a decent experience, so my feeling about being on a federal instead of a state run plan is held in a favorable light.
Conclusion
Over the course of the semester I have been a student of the Patient Protection and Affordable Care Act while engaged in a intellectual conversation over how public policy is created in America. The redistributive nature of the policy tends to make it a progressive reform attempt. The PPACA has both positive and negative inducements to spur movement from the states and individuals to be proactive regarding compliance to the new law. The law is being implemented incrementally and holds true to the federalist system American public policy is known for. I am all for the current law and hope that progressive members are able to add a strong public option for Americans like me.
References Antos, Grace-Marie, Turner, Joseph R. (May 20, 2009) The GOP Health Alternative. Retrieved March 21, 2011 from http://online.wsj.com/article/SB124277551107536875.html
Catastrophic Health Insurance Plans (2011) Catastrophic Health Insurance Plans And Resources. Retrieved March 19, 2011 from http://www.catastrophichealthinsuranceplans.net catastrophiccoverage-explained
Conrad, Peter (2009) The Sociology Of Health And Illness. Eighth Edition. Retrieved March 21, 2011 New York, NY Worth Publishing.
CNNPolitics. (Aug 16, 2011) Democratic Senator: Public Insurance Option Dead. Retrieved March 19, 2011 from http://articles.cnn.com/2009-08-16/politics/us.healthcare_1_public option-insurance-option-health-care?_s=PM:POLITICS
Green Party of the United States. (2011) Green Party Platform. Retrieved March 17, 2011 from http://www.gp.org/platform/2004/socjustice.html#1004611
FamiliesUSA (2011) HSA’a Shop Til You Drop. Retrieved March 20, 2011 from
http://www.familiesusa.org/issues/private-insurance/hsas/health-savings-accounts.html
Heathcare.gov. (2011) Health Care.gov Glossary. Retrieved March 16, 2011 from
http://www.healthcare.gov/glossary/c/catastrophic.html
Health Care-now.org. (2011) What Is Single-Payer? Retrieved March 17, 2011 from
http://www.healthcare-now.org/hr-676/whats-single-payer/
Health Savings Account Info. (2011) Health Saving Info. Retrieved March 20, 2011 from
http://www.healthsavingsinfo.com/
Library of Congress. THOMAS. (2011) Bill Summary and Status of 111th & 112th Congress (2009-20012) H.R 676 Major Congressional Actions. Retrieved March 16 2011 from
http://thomas.loc.gov/cgi-bin/thomas
Mokhiber, Russell (Apr 16, 2009.) Top 10 Enemies of Single-Payer Retrieved March 15, 2011 from http://www.counterpunch.org/mokhiber04162009.html
O’Connor, Patrick. (Aug 4, 2009.) Liberal House Dems Hold Their Ground. Retrieved March 18, 2011 from Congressional Progressive Caucasus http://cpc.grijalva.house.gov/ index.cfm?sectionid=68&parentid=5§iontree=5,68&itemid=189
Rasmussen Reports (Jan 1, 2009) 34% Favor Single-Payer Health Care System. Retrieved March 19, 2011 from http://www.rasmussenreports.com/public_content/politics/current_events /healthcare/december_2009/34_favor_single_payer_health_care_system
Rasmussen Reports (Feb 25, 2010) 47% Opposed Public Option Health Plan. Retrieved March 19, 2011 http://www.rasmussenreports.com/public_content/politics/currentevents-
healthcarefebruary_2010/47oppose_public_option_health_plan_58_oppose_
if_workers_forced_to_change_coverage
Rubin, Donny (Mar 3, 2011) Health Savings Accounts. Retrieved March 20, 2011 from
http://www.therubins.com/ideas/hsa.htm
Shaw, Donny (Aug 20, 2009) What Is The Public Option. Retrieved March 16, 2011 from
http://www.opencongress.org/articles/view/1174--What-is-the-Public-Option-
Sreeizzle2012. (Dec 3, 2010) Single-Payer Is Ready To Go! Retrieved March 18, 2011 from http://www.dailykos.com/story/2010/12/03/925362/-Attention-Daily-kos-members-and -progressives!-single-payer-is-ready-to-go!
Stewart, et al. (2011) Public Policy: An Evolutionary Approach. Third Edition. Retrieved March 19, 2011 Thomas Wadsworth
WPTZ.com (March 25 2011) Vt. House Passes Single-Payer Health Care Bill. Retrieved March 19, 2011 from http://www.wptz.com/r/27317316/detail.html
Health Exchanges - Policy Alternatives, Actor, Interests & Implementation
Policy Alternatives, Actor, Interests & Implementation
The health care policy debate was by no means a settled issue after President Obama signed the Patient Protection and Affordable Care Act (PPACA). Policy alternatives to the PPACA are insignificant and in just over a years time has pretty much come full circle. Using Stewart, Hedge & Lester’s political and ideological continuum, listing from left to right; a single-payer system, a “public option”, catastrophic coverage insurance, and private health savings accounts have at one point been seriously proposed as a policy solution to expand coverage, and to cut rising costs (Stewart, et al). Health insurance exchanges with an individual mandate fit tightly in the middle of those four alternatives. Republican’s control of message in the health care debate and gains in the 2010 elections have brought some of the more conservative alternatives to serious public debate. The following is an analysis of each of those alternative policy proposals, the vested actors and interests, and the likelihood of implementation.
Single-Payer
Since health care has been an issue on the popular (policy) agenda as a recurrent issue, the alternative proposals titles are for the most part familiar to most of Americans. The proposals are those that characterized the health care debate over the 2008 presidential election and heated health care town hall summer of 2009, except one - Single-Payer. Non-profit organization Healthcare-Now explains a single-payer system as “one entity—a government run organization—[that] would collect all healthcare fees, and pay out all healthcare costs (Healthcare-Now. para 1). “In a single-payer system, all hospitals, doctors, and other healthcare providers would bill one entity for their services” adding “everyone would receive comprehensive medical benefits” (Healthcare-Now, para 4 ). Using this framework the need for an easily accessible insurance exchange market wouldn’t exist because the government would be the sole insurer. It is noteworthy to mention that because most policy is implemented incrementally, shifting to single-payer would undoubtedly cause disruptions.
Traditionally it is the more progressive political parties, like the Green Party that favor a single-payer structure to receiving health care in the United States (Green, sec F, para 1.) Liberal Democrats too support a single-payer system. "A majority of [Progressive Caucasus] members prefer single payer," said liberal Democrat, Raul Grijalva of Arizona. In 2009 H.R 676 the “Expanded & Improved Medicare For All Act” was introduced to the 111th Congress in the House of Representatives by John Conyers of Michigan with 87 co-sponsors, including Grijalva on January 26th (Library of Congress). The following day it was referred to the House subcommittee on Health where it eventually died. Two years later, the same bill was introduced by Rep. Conyers Jr. to the 112th Congress and referred to the same committee where it “sits” currently with only 39 co-sponsors; including Rep Cummings of Maryland 7th District (Library of Congress).
Activists bloggers on left-wing sites like the Daily Kos mince no words about what will be needed to obtain a single-payer health care system. “Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement. It's going to require ongoing commitment, an enormous amount of effort, organizing, and education (Kos, para 3). The sentiment expressed speaks to the hard work needed to fulfill implementation of a single-payer system for all. An “enemies of single-payer” list was comprised with organizations like AARP, Kaiser Family Foundation, Lewin Group, PHRMA each of whom has a vested interest to keep the current private insurance market (Mokhiber). In terms of public opinion, in a January 1st 2010 Rasmussen Poll reports 34% of voters nationwide favor a single-payer health care system, 54% oppose and 14% are not sure (Rasmussen). However Vermont has chosen to reject that framework completely, by their House passing single-payer legislation (WPTZ) .
The “Public Option”
The public option [...] is a government-run health insurance plan, like Medicare, that would compete along side private insurers in a new health insurance exchange that the [PPACA] set up” (Shaw, para 2). A government insurance option has been on popular agenda for about as long as Medicare for all has been on the agenda. What’s the distinction? Health exchanges. “With a significant feature of the insurance exchanges [being] a public plan, the controversy [...] centers upon the extent to which [the public option] could compete with private insurance plans (Shaw, para ?). It was broad agreement between centrist Democrats and moderate Republicans in Congress on replacing the current system with non-profit insurance co-ops (exchanges) that pushed the public plan, an “option” in the exchange(s) to the front burner of the partisan health care debate (Shaw, para 1).
In late August 2009, President Obama gave his weekly web address. In it he took time and effort to “debunk” myths surrounding the health care debate. By that time the public option had the stained “government takeover of health care” perception, and Mr. Obama was trying to clear it up (Obama video). “This is one idea among many to provide more competition and choice especially in the many places where one insurer dominates the market place” (Obama video). “This alternative would have to operate like other insurers on the basis of the premiums it collects” adding “let me repeat, this is just and option” (Obama video). Interestingly, health exchanges did not arise to the level of controversy and were not discussed; most members of Congress who were honest brokers in the negotiations agreed health exchanges were a bridge to achievement.
The controversial “public option” was advocated for by President Obama’s in his health care reform attempt of 2009/2010 . The Democratic controlled House of Representatives of the 111th Congress passed their version of health care reform H.R 3962 that included a public option on November 7th 2009 (Library of Congress). However, most senate Republicans and a handful of conservative senate Democrats were not sure that voting for a “public option” was in their political interest. H.R 3962 was not working model for the senate bill. The “public option” so hoped for by progressives died in the US Senate. “The fact of the matter is there are not the votes in the United States Senate for a public option” (Conrad, para 1). “There never have been", conservative Democrat Kent Conrad in August 2009 (Conrad, para 1). Last month in a public opinion poll, Rasmussen reports (a significantly high) 47% opposed the public option (Rassmuen).
Catastrophic Coverage
“Cost of catastrophic illness” language found its way into a 1986 proposal during the second Reagan administration attempt to expand Medicare (Conrad, p. 311). In February 1987, a catastrophic care plan was sent to Congress with endorsement of the major provider groups like The American Hospital Association (Conrad, p. 311). On July 1st 1988 Congress enacted the Medicare Catastrophic Coverage Act with huge bi-partisan majorities in both houses of Congress (Conrad, p. 311). The bill capped the amount beneficiaries would have to pay for hospital and physician care, amongst other provisions (Conrad, p. 311). While the term is the same from the late 80’s the definition has since evolved.
Catastrophic insurance coverage currently is an option in the private insurance market. According to Catastrophic Health Insurance Plans, an online informational source, catastrophic coverage is also called a “high deductible health plan” (CHIP.net) because it’s characterized by low monthly premiums, but deductibles that can range between $1,500 and $5000, with a minimum of $500 (CHIP.net, para 2). “Some insurers describe these plans as those that only cover certain types of expensive care, like hospitalizations” (Healthcare.gov).
“There are two basic types of catastrophic plan: comprehensive and supplemental” (Jeffries, para 4). A comprehensive plan offers coverage comparable to more traditional health care plans” adding” there is still a high deductible and monthly fees are still relatively low” (Jeffries, para 4). A supplemental plan [...] acts as a supplement to other insurance plans (Jeffries, para 4). This type of alternative does not directly challenge health exchanges, but neither does the public option. In fact, catastrophic coverage would likely challenge the public option in terms of cost cutting for healthy individuals within the exchange structure. A hard number of exactly how many Americans currently hold catastrophic coverage has remained elusive in my research.
Private Health Savings Accounts
“A health savings account (HSA) are tax sheltered savings accounts coupled with high deductible health insurance plans (FamiliesUSA, para 1). [A]n alternative to comprehensive health insurance [like catastrophic coverage]; it is a savings vehicle that allows people a different way to pay for their health care (HSAI.com, para 1). However, in many cases “you must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs (HSAI.com, para 5). Using a Guy Peters typology, HSA’s would fall under a craftsmen type of policy due to a low knowledge level of the number of people who would actually participate positively and effectively in the plan, couple with the high knowledge of causation of why a different approach is need to address the current systems problems.
In the past Health Savings Accounts (HSAs) [were] promoted by President Bush and conservatives in Congress as a way to bring down spiraling health care costs. “Only if consumers have "skin in the game," they argue, will Americans start to shop around for cheaper health care” (FamiliesUSA, para 1). Currently, “four Republicans in Congress -- Sens. Tom Coburn (Oklahoma) and Richard Burr (North Carolina) and Reps. Paul Ryan (Wisconsin) and Devin Nunes (California) introduced [the] Patients' Choice Act, it provides a path to universal coverage by redirecting current subsidies for health insurance to individuals. It also provides a new safety net that guarantees access to insurance for those with pre-existing conditions by redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advance-able tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in HSAs (Antos and Turner, para, 3).
In 2008 Sen. John McCain offered a similar plan as his health reform proposals when he ran for the presidency (webMD). That model was roundly rejected for a more ideological, liberal, procedural, redistributive, and (controversially) regulatory policy approach. Again health savings accounts in terms of a true alternative to the exchanges of the PPACA do not match up. Chances are they will be offered as in option within the state exchange framework. Whereas “the [...] debate in Congress reform generated many proposals [on both sides] to change the rules on HSA’s, nothing seriously was done to the fundamentally change the structure and understanding of HSA’s Allan Rubin notes that “more than 10 million people are enrolled in high-deductible health plans linked to HSA, up from 6.1 million in 2008, according to a recent survey by America's Health Insurance Plans, an industry trade group (Rubins, para 7).
Conclusion
In an issue area as large as health care, when so many stakeholders and interest groups jockey to control the crafting of policy, legislators prefer to formulate incremental implementation. The common yet different alternatives to the health exchanges of the current health care reform law, with exception of single-payer, do not remove health exchanges as the compromise framework for health reform. The reason health exchanges trumped all others is due to both positive and negative inducement found in the law. Having both types of inducements in the PPACA it won enough bi-partisan support to pass both houses of Congress.
References Antos, Grace-Marie, Turner, Joseph R. (May 20, 2009) The GOP Health Alternative. Retrieved March 21, 2011 from http://online.wsj.com/article/SB124277551107536875.html
Catastrophic Health Insurance Plans (2011) Catastrophic Health Insurance Plans And Resources. Retrieved March 19, 2011 from http://www.catastrophichealthinsuranceplans.net catastrophiccoverage-explained
Conrad, Peter (2009) The Sociology Of Health And Illness. Eighth Edition. Retrieved March 21, 2011 New York, NY Worth Publishing.
CNNPolitics. (Aug 16, 2011) Democratic Senator: Public Insurance Option Dead. Retrieved March 19, 2011 from http://articles.cnn.com/2009-08-16/politics/us.healthcare_1_public option-insurance-option-health-care?_s=PM:POLITICS
Green Party of the United States. (2011) Green Party Platform. Retrieved March 17, 2011 from http://www.gp.org/platform/2004/socjustice.html#1004611
FamiliesUSA (2011) HSA’a Shop Til You Drop. Retrieved March 20, 2011 from
http://www.familiesusa.org/issues/private-insurance/hsas/health-savings-accounts.html
Heathcare.gov. (2011) Health Care.gov Glossary. Retrieved March 16, 2011 from
http://www.healthcare.gov/glossary/c/catastrophic.html
Health Care-now.org. (2011) What Is Single-Payer? Retrieved March 17, 2011 from
http://www.healthcare-now.org/hr-676/whats-single-payer/
Health Savings Account Info. (2011) Health Saving Info. Retrieved March 20, 2011 from
http://www.healthsavingsinfo.com/
Library of Congress. THOMAS. (2011) Bill Summary and Status of 111th & 112th Congress (2009-20012) H.R 676 Major Congressional Actions. Retrieved March 16 2011 from
http://thomas.loc.gov/cgi-bin/thomas
Mokhiber, Russell (Apr 16, 2009.) Top 10 Enemies of Single-Payer Retrieved March 15, 2011 from http://www.counterpunch.org/mokhiber04162009.html
O’Connor, Patrick. (Aug 4, 2009.) Liberal House Dems Hold Their Ground. Retrieved March 18, 2011 from Congressional Progressive Caucasus http://cpc.grijalva.house.gov/ index.cfm?sectionid=68&parentid=5§iontree=5,68&itemid=189
Rasmussen Reports (Jan 1, 2009) 34% Favor Single-Payer Health Care System. Retrieved March 19, 2011 from http://www.rasmussenreports.com/public_content/politics/current_events /healthcare/december_2009/34_favor_single_payer_health_care_system
Rasmussen Reports (Feb 25, 2010) 47% Opposed Public Option Health Plan. Retrieved March 19, 2011 http://www.rasmussenreports.com/public_content/politics/currentevents-
healthcarefebruary_2010/47oppose_public_option_health_plan_58_oppose_
if_workers_forced_to_change_coverage
Rubin, Donny (Mar 3, 2011) Health Savings Accounts. Retrieved March 20, 2011 from
http://www.therubins.com/ideas/hsa.htm
Shaw, Donny (Aug 20, 2009) What Is The Public Option. Retrieved March 16, 2011 from
http://www.opencongress.org/articles/view/1174--What-is-the-Public-Option-
Sreeizzle2012. (Dec 3, 2010) Single-Payer Is Ready To Go! Retrieved March 18, 2011 from http://www.dailykos.com/story/2010/12/03/925362/-Attention-Daily-kos-members-and -progressives!-single-payer-is-ready-to-go!
Stewart, et al. (2011) Public Policy: An Evolutionary Approach. Third Edition. Retrieved March 19, 2011 Thomas Wadsworth
WPTZ.com (March 25 2011) Vt. House Passes Single-Payer Health Care Bill. Retrieved March 19, 2011 from http://www.wptz.com/r/27317316/detail.html
The health care policy debate was by no means a settled issue after President Obama signed the Patient Protection and Affordable Care Act (PPACA). Policy alternatives to the PPACA are insignificant and in just over a years time has pretty much come full circle. Using Stewart, Hedge & Lester’s political and ideological continuum, listing from left to right; a single-payer system, a “public option”, catastrophic coverage insurance, and private health savings accounts have at one point been seriously proposed as a policy solution to expand coverage, and to cut rising costs (Stewart, et al). Health insurance exchanges with an individual mandate fit tightly in the middle of those four alternatives. Republican’s control of message in the health care debate and gains in the 2010 elections have brought some of the more conservative alternatives to serious public debate. The following is an analysis of each of those alternative policy proposals, the vested actors and interests, and the likelihood of implementation.
Single-Payer
Since health care has been an issue on the popular (policy) agenda as a recurrent issue, the alternative proposals titles are for the most part familiar to most of Americans. The proposals are those that characterized the health care debate over the 2008 presidential election and heated health care town hall summer of 2009, except one - Single-Payer. Non-profit organization Healthcare-Now explains a single-payer system as “one entity—a government run organization—[that] would collect all healthcare fees, and pay out all healthcare costs (Healthcare-Now. para 1). “In a single-payer system, all hospitals, doctors, and other healthcare providers would bill one entity for their services” adding “everyone would receive comprehensive medical benefits” (Healthcare-Now, para 4 ). Using this framework the need for an easily accessible insurance exchange market wouldn’t exist because the government would be the sole insurer. It is noteworthy to mention that because most policy is implemented incrementally, shifting to single-payer would undoubtedly cause disruptions.
Traditionally it is the more progressive political parties, like the Green Party that favor a single-payer structure to receiving health care in the United States (Green, sec F, para 1.) Liberal Democrats too support a single-payer system. "A majority of [Progressive Caucasus] members prefer single payer," said liberal Democrat, Raul Grijalva of Arizona. In 2009 H.R 676 the “Expanded & Improved Medicare For All Act” was introduced to the 111th Congress in the House of Representatives by John Conyers of Michigan with 87 co-sponsors, including Grijalva on January 26th (Library of Congress). The following day it was referred to the House subcommittee on Health where it eventually died. Two years later, the same bill was introduced by Rep. Conyers Jr. to the 112th Congress and referred to the same committee where it “sits” currently with only 39 co-sponsors; including Rep Cummings of Maryland 7th District (Library of Congress).
Activists bloggers on left-wing sites like the Daily Kos mince no words about what will be needed to obtain a single-payer health care system. “Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement. It's going to require ongoing commitment, an enormous amount of effort, organizing, and education (Kos, para 3). The sentiment expressed speaks to the hard work needed to fulfill implementation of a single-payer system for all. An “enemies of single-payer” list was comprised with organizations like AARP, Kaiser Family Foundation, Lewin Group, PHRMA each of whom has a vested interest to keep the current private insurance market (Mokhiber). In terms of public opinion, in a January 1st 2010 Rasmussen Poll reports 34% of voters nationwide favor a single-payer health care system, 54% oppose and 14% are not sure (Rasmussen). However Vermont has chosen to reject that framework completely, by their House passing single-payer legislation (WPTZ) .
The “Public Option”
The public option [...] is a government-run health insurance plan, like Medicare, that would compete along side private insurers in a new health insurance exchange that the [PPACA] set up” (Shaw, para 2). A government insurance option has been on popular agenda for about as long as Medicare for all has been on the agenda. What’s the distinction? Health exchanges. “With a significant feature of the insurance exchanges [being] a public plan, the controversy [...] centers upon the extent to which [the public option] could compete with private insurance plans (Shaw, para ?). It was broad agreement between centrist Democrats and moderate Republicans in Congress on replacing the current system with non-profit insurance co-ops (exchanges) that pushed the public plan, an “option” in the exchange(s) to the front burner of the partisan health care debate (Shaw, para 1).
In late August 2009, President Obama gave his weekly web address. In it he took time and effort to “debunk” myths surrounding the health care debate. By that time the public option had the stained “government takeover of health care” perception, and Mr. Obama was trying to clear it up (Obama video). “This is one idea among many to provide more competition and choice especially in the many places where one insurer dominates the market place” (Obama video). “This alternative would have to operate like other insurers on the basis of the premiums it collects” adding “let me repeat, this is just and option” (Obama video). Interestingly, health exchanges did not arise to the level of controversy and were not discussed; most members of Congress who were honest brokers in the negotiations agreed health exchanges were a bridge to achievement.
The controversial “public option” was advocated for by President Obama’s in his health care reform attempt of 2009/2010 . The Democratic controlled House of Representatives of the 111th Congress passed their version of health care reform H.R 3962 that included a public option on November 7th 2009 (Library of Congress). However, most senate Republicans and a handful of conservative senate Democrats were not sure that voting for a “public option” was in their political interest. H.R 3962 was not working model for the senate bill. The “public option” so hoped for by progressives died in the US Senate. “The fact of the matter is there are not the votes in the United States Senate for a public option” (Conrad, para 1). “There never have been", conservative Democrat Kent Conrad in August 2009 (Conrad, para 1). Last month in a public opinion poll, Rasmussen reports (a significantly high) 47% opposed the public option (Rassmuen).
Catastrophic Coverage
“Cost of catastrophic illness” language found its way into a 1986 proposal during the second Reagan administration attempt to expand Medicare (Conrad, p. 311). In February 1987, a catastrophic care plan was sent to Congress with endorsement of the major provider groups like The American Hospital Association (Conrad, p. 311). On July 1st 1988 Congress enacted the Medicare Catastrophic Coverage Act with huge bi-partisan majorities in both houses of Congress (Conrad, p. 311). The bill capped the amount beneficiaries would have to pay for hospital and physician care, amongst other provisions (Conrad, p. 311). While the term is the same from the late 80’s the definition has since evolved.
Catastrophic insurance coverage currently is an option in the private insurance market. According to Catastrophic Health Insurance Plans, an online informational source, catastrophic coverage is also called a “high deductible health plan” (CHIP.net) because it’s characterized by low monthly premiums, but deductibles that can range between $1,500 and $5000, with a minimum of $500 (CHIP.net, para 2). “Some insurers describe these plans as those that only cover certain types of expensive care, like hospitalizations” (Healthcare.gov).
“There are two basic types of catastrophic plan: comprehensive and supplemental” (Jeffries, para 4). A comprehensive plan offers coverage comparable to more traditional health care plans” adding” there is still a high deductible and monthly fees are still relatively low” (Jeffries, para 4). A supplemental plan [...] acts as a supplement to other insurance plans (Jeffries, para 4). This type of alternative does not directly challenge health exchanges, but neither does the public option. In fact, catastrophic coverage would likely challenge the public option in terms of cost cutting for healthy individuals within the exchange structure. A hard number of exactly how many Americans currently hold catastrophic coverage has remained elusive in my research.
Private Health Savings Accounts
“A health savings account (HSA) are tax sheltered savings accounts coupled with high deductible health insurance plans (FamiliesUSA, para 1). [A]n alternative to comprehensive health insurance [like catastrophic coverage]; it is a savings vehicle that allows people a different way to pay for their health care (HSAI.com, para 1). However, in many cases “you must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs (HSAI.com, para 5). Using a Guy Peters typology, HSA’s would fall under a craftsmen type of policy due to a low knowledge level of the number of people who would actually participate positively and effectively in the plan, couple with the high knowledge of causation of why a different approach is need to address the current systems problems.
In the past Health Savings Accounts (HSAs) [were] promoted by President Bush and conservatives in Congress as a way to bring down spiraling health care costs. “Only if consumers have "skin in the game," they argue, will Americans start to shop around for cheaper health care” (FamiliesUSA, para 1). Currently, “four Republicans in Congress -- Sens. Tom Coburn (Oklahoma) and Richard Burr (North Carolina) and Reps. Paul Ryan (Wisconsin) and Devin Nunes (California) introduced [the] Patients' Choice Act, it provides a path to universal coverage by redirecting current subsidies for health insurance to individuals. It also provides a new safety net that guarantees access to insurance for those with pre-existing conditions by redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advance-able tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in HSAs (Antos and Turner, para, 3).
In 2008 Sen. John McCain offered a similar plan as his health reform proposals when he ran for the presidency (webMD). That model was roundly rejected for a more ideological, liberal, procedural, redistributive, and (controversially) regulatory policy approach. Again health savings accounts in terms of a true alternative to the exchanges of the PPACA do not match up. Chances are they will be offered as in option within the state exchange framework. Whereas “the [...] debate in Congress reform generated many proposals [on both sides] to change the rules on HSA’s, nothing seriously was done to the fundamentally change the structure and understanding of HSA’s Allan Rubin notes that “more than 10 million people are enrolled in high-deductible health plans linked to HSA, up from 6.1 million in 2008, according to a recent survey by America's Health Insurance Plans, an industry trade group (Rubins, para 7).
Conclusion
In an issue area as large as health care, when so many stakeholders and interest groups jockey to control the crafting of policy, legislators prefer to formulate incremental implementation. The common yet different alternatives to the health exchanges of the current health care reform law, with exception of single-payer, do not remove health exchanges as the compromise framework for health reform. The reason health exchanges trumped all others is due to both positive and negative inducement found in the law. Having both types of inducements in the PPACA it won enough bi-partisan support to pass both houses of Congress.
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