How
can health care reform move forward? As the debate continues, we need to
examine the significance of the Massachusetts
election and determine what reforms voters across the country now support.
What Happened?
The
election of Republican Scott Brown to the Senate has caused an overnight shift
in the dynamics of the health care reform debate and the prospects for the
passage of comprehensive legislation. Brown
ran on a promise to stop the Democratic reform bill. But he supports his own state
of Massachusetts’
universal health care legislation which was implemented in 2006 and has
resulted in 98% coverage. “Instead
he argued that since Massachusetts’
citizens already have coverage, why should they help pay to expand coverage
elsewhere.” (NYTimes)
With
the loss of one seat, the Democrats have lost their filibuster-proof majority,
imperiling the health reform effort and their entire progressive domestic
agenda. There seems to be a Democratic consensus emerging that it is necessary
to craft a new bill based on the provisions from the original that have
bipartisan support. We should not take
the events of the last few weeks as a mandate to give up on health care reform
altogether. We must seek to understand public opinion on this issue and create
legislation that can build broad support, whether it is through a large
package or a series of incremental changes. And it is time to intensify
communication with voters.
What do voters
want?
Several
polls conducted this month give us a valuable and informed view of public
opinion. A poll conducted by the Washington Post, the Kaiser Family Foundation,
and the Harvard School of Public Health shows that while only 43% of MA voters support the national health care reform
package, 68% support Massachusetts'
own universal health-care plan. Both
plans include an individual mandate
to maintain health insurance, an insurance
exchange to assist people purchase coverage, and subsidies to help lower income families pay for their insurance.
The national Health
Tracking Poll conducted by the Kaiser Family Foundation in January found that
54% of respondents agree with the statement that "it is more important
than ever to take on health care reform now". The poll measured the
public's awareness of the specific provisions of the House and Senate proposals
and how each provision affects support for the plan. The results can be used to
find areas of broad support and identify policies that need to be better communicated.
What will increase
support?
The
provision that is most popular with people of all political persuasions is the
creation of tax credits for small
businesses (to help them purchase group insurance); 73% of those polled
said this provision would make them more likely to support the bills.
Interestingly, only 52% had been aware that the bills contained such a provision.
Health insurance exchanges and guarantees that the plan would not change most people’s existing insurance arrangements
were also very popular, especially with independent voters; 74% said the
inclusion of an exchange would increase their support for the plan and 69% said
that the fact that people would get to keep their coverage would also increase
their support.
What will increase
opposition?
The
aspects of the legislation most likely to increase opposition are the individual mandate to purchase
insurance (62% less likely to support the bill) and the $871 billion cost of
the plan over 10 years (51% less likely to support the bill). Although the
majority of those polled disliked the individual mandate, 63% said that making
insurance guaranteed issue would
increase their support for the plan.
In
fact, this is a major contradiction; guaranteed issue is not possible without
an individual mandate. There would be no reason for people to maintain insurance
if they could wait until they were sick to purchase it. The public needs to be
better educated about the relationship between these two reform provisions.
What’s next?
It
took 15 years after the defeat of the Clinton
plan for another serious attempt at health care reform. The crisis of rising
health care costs and the numbers of uninsured Americans will not allow us to
wait another 15 to try again. Since 1999, health insurance premiums for
families rose 131%, far more than the general 28% inflation rate. In California,
Anthem Blue Cross has just announced a rate increase of more than 30% on many
individual plans. Our wallets cannot sustain this rate of increase
indefinitely. We are heading into the eye of a health care storm which, if
we do not change course, will ravage the finances of families and businesses
and jeopardize the entire US
economy. The time for action is now.
See the Kaiser Health Tracking Poll
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