Tuesday, February 17, 2009

Good News/Bad News

People are finally combing through the voluminous stimulus bill to see just what it contains, and this article in the Los Angeles Times examined the health care access aspect. On this issue, the bill contains both good news and bad. First the good news:

...the aid package represents one of the largest federal investments in healthcare in history, totaling more than $147 billion, or nearly a fifth of the bill.

It includes $87 billion to help states shore up their Medicaid programs, which cover more than 55 million poor children, families and disabled people. States reeling from the economic downturn have been cutting services for months.

The legislation also commits $19 billion to increase the use of information technology in healthcare, a long-delayed objective that policymakers think is crucial to lowering costs and improving quality.

The National Institutes of Health will get nearly $10 billion for research into cancer, heart disease and other illnesses. And lawmakers directed more than $1 billion to boost government efforts to study the comparative effectiveness of medical procedures, pharmaceuticals and devices, another step deemed crucial to long-term health reform.

The additional money to Medicaid is to my way of thinking the most important of those listed insofar as it deals with immediate and pressing needs. That provision, especially when coupled with the recently passed SCHIP bill, will extend health care coverage at a time when most states were cutting back on services because of their own budgetary problems.

The other provisions are directed toward the future and may have the effect of preparing the way for a decent national single payer health plan, although that remains to be seen.

There is some bad news in the bill as well, however. In the final stages of the sausage making, to get three "moderate" Republicans on board, some rather important provisions were either scaled back dramatically or just cut out. One of those decisions was to limit health insurance subsidies to workers who lost their jobs after September, 2008, nearly a year after the recession began. Another closed access to Medicaid to laid off workers, forcing them to either find a new insurance policy for their policies (which is almost impossible, as I discovered last year before all the bad news hit), or to struggle with COBRA payments for as long as that short term fix was available.

But the cuts in aid highlight one of the most vexing healthcare issues confronting Washington -- the growing number of middle-class workers who are losing health coverage as companies cut their payrolls.

An estimated 3.6 million jobs have been eliminated since the recession began at the end of 2007, the Department of Labor said.

Unlike the very poor who rely on Medicaid, most of these people had not looked to the government for healthcare, instead securing insurance through their employers or buying it themselves.

Now without incomes, some are faced with paying more than $1,000 a month to buy a new insurance policy or to keep the coverage they had at work under the federal COBRA law, which requires workers to pay the full cost of their premiums, picking up what their employers once paid. ...

Republicans, meanwhile, rebelled at a proposal by House Democrats to open up Medicaid to those who have lost their jobs, a move conservatives worried would only further burden a government program already driving away many doctors because of the government's relatively low reimbursement rates.

Senate Democrats, who needed Republican votes to pass the stimulus legislation, did not include the Medicaid expansion in their version of the bill.

It was dropped in the final compromise, leaving an estimated 1.2 million people without assistance.

While I tend to agree that we don't want the perfect to be the enemy of the good, it still would have been better if all those unemployed had health care access covered until they could get back to work. Struggling to pay for food and housing is hard enough for a family. Adding another $1,000 per month for health insurance is going to be devastating.

I hope those millions of people remember that when the national health care issue rolls around again in Congress, as President Obama promised it will.

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