Originally Posted:  Summer, 2010


Health is the first requisite after morality.

–     Thomas Jefferson


Good health is a prerequisite to the enjoyment of the “pursuit of happiness.”  Whenever the miracles of modern medicine are beyond the reach of any group of Americans, for whatever reason – economic, geographic, occupational or other – we must find a way to meet their needs and fulfill their hopes.

–         President John F. Kennedy

Special Message to Congress

February 27, 1962

As I predicted at the end of my January 20th blog post, the House passed the Senate version of health care reform, along with a package of “fixes” that were then passed by the Senate under the rules of reconciliation.  President Obama signed the landmark bill into law on Tuesday, March 23rd, and the reconciliation bill one week later.  The Republican response has been, well, vitriolic, to say the least.  As conservative commentator and columnist David Frum writes, “Conservatives have whipped themselves into spasms of outrage and despair that block all strategic thinking.”


Several Republicans have come forward with promises to “repeal” health care reform, and lists of Democratic “targets” for the November elections have been put forward; in the case of Sarah Palin’s “Facebook” page, the Democratic targets – “targets” is her word – are marked with rifle scope symbols (!) on a map of the United States.  The FBI is investigating a threat received at the office of Representative Louise Slaughter (D-NY) warning that the children of Democrats who voted for the bill would be assassinated.  Bricks were thrown through windows at five separate Democratic offices around the country (including the Niagara Falls, New York office of Representative Slaughter), some with anti-health care reform messages written on the bricks.  At least ten Democratic Members of Congress received death threats.  One right-wing blogger posted what he thought was the home address of Democratic Congressman Tom Perriello of Virginia on the internet.  The address was actually that of the Congressman’s younger brother, who lives there with his wife and two sons (both under the age of 8 years old).  That evening, the family smelled gas and found that a propane gas line to their home had been cut and a threatening letter addressed to the Congressman had been left in the mailbox.  When informed on a radio talk show that the address he had posted was not that of the Congressman but was actually that of the Congressman’s brother, the blogger replied, “Oh well – collateral damage.”  Nice.  The FBI is now investigating this incident as a threat to a Member of Congress.


Clearly there is anger, but it is misinformed anger.  Conservative talk-show hosts like Rush Limbaugh, Sean Hannity and Glen Beck, along with some Republican Party leaders (Sarah Palin, Michelle Bachmann, and so on), have whipped up this anger through misrepresentations and outright lies about what is in the bill, and in my view, those who foment the anger bear some measure of responsibility for the violence that results.  If you start a brush fire, you are responsible for wherever that brushfire spreads and for whatever damage it causes – including deaths (I won’t hold my breath waiting for any of these conservatives to actually accept their share of the blame, however).  Frankly, I believe that, when these tea-partiers and others who are expressing this hysterical rage see for themselves that the sky is notfalling, that their kids with pre-existing conditions can now get health coverage, that they get a $250 rebate check because they have reached the Medicare Prescription Drug “doughnut hole”, their small business can get tax credits to help pay for health coverage for their employees, or they learn what is actually in the bill in some other way, they may very well redirect their anger toward those who have misled them.


How badly have they been misled?  The following list provides the truth about just a few of the misconceptions about the health care reform bill:


  • The plan will not allow federal funds to pay for abortion.  The legislation’s language expressly forbids this in very specific language, and President Obama’s Executive Order stating that this plan will not alter the “Hyde Amendment” (which has prohibited federal funding of abortion for more than a decade) clarified this point even further.
  • Illegal immigrants will not be allowed to purchase health insurance through the “exchanges” created by the bill.
  • There will be no “death panels” that would decide whether or not to “pull the plug on Grandma”.   The term “death panels” was coined by Sarah Palin to describe a provision that allows Medicare to be billed once every 5 years for consultation with a patient’s personal physician regarding the medical implications of various end-of-life options.  No one is required to actually get this consultation if they don’t want it, but now Medicare will pay for this consultation once every five years for those patients who do want to ask their doctor about the medical implications of their various choices when making this very important decision.
  • There is no provision that will ration health care
  • The plan does not constitute a “government takeover of health care”; it is primarily a package of reforms and regulations of the health insurance industry, along with measures to help people obtain private health insurance.
  • The plan will not “cut $500 billion from Medicare”; instead it will reduce the planned increase in Medicare expenses by about $500 billion over the next ten years – mostly by streamlining paperwork and through cuts in private “Medicare Advantage” programs – not through cuts in medical coverage for seniors.


The truth, as it always does, will eventually prevail, and when it does, I believe these Republicans and conservative activists and talk show hosts will find that they have some explaining to do.


Many leading Republicans have taken the position that they want to “repeal” the health care reform bill.  Really?  They want to reinstate the health insurance companies’ ability to deny coverage for those with pre-existing conditions?  They want to reinstate the health insurance companies’ ability to drop your coverage when you get sick or injured?  They want to kick college kids back off of their parents’ health insurance?  They want to allow health insurance companies to go back to charging women more for health insurance than men?  They want to stop the elimination of the Medicare Prescription Drug “doughnut hole”?  They want to allow the health insurance companies to reinstate lifetime limits on health coverage benefits?  They want to repeal the tax credits now available to small businesses to help them purchase health insurance for their employees?  Really?  Good luck selling that one!


Even many conservatives see the folly in trying to repeal the bill.  Columnist David Frum, for example, writes, “Do Republicans write a one-sentence bill declaring that the whole thing is repealed? Will they vote to reopen the “doughnut” hole for prescription drugs for seniors? To allow health insurers to deny coverage to people with pre-existing conditions? To kick millions of people off Medicaid?  It’s unimaginable, impossible.”  For once, I agree with Mr. Frum.


Despite all of this, the conventional wisdom remains that the passage of the health care reform bill will badly hurt Congressional Democrats in the coming elections, and will lead to huge Republican gains in the House and Senate.  While the Republicans are almost certain to gain seats – probably in both Houses – I disagree with the notion that passing health care reform will be the reason why; in fact, I believe its passage will actually mitigate the Democratic losses.


First of all, passing health care reform will not hurt the Democrats nearly as much as not passing health care reform would have hurt them in November.  The Democrats control the White House, and they hold large majorities in both Houses of Congress, including (for a while, anyway) a 60-vote “super-majority” in the Senate that could bypass Republican filibusters (this dropped to 59 seats with the election of Republican Senator Scott Brown of Massachusetts, who now fills the seat that had been held since 1962 by the late Ted Kennedy).  If the Democrats had not been able to pass their top legislative priority, something that has been among their major platform issues for almost a century, when they held this much control of Washington, it would have demonstrated a clear inability to lead, would have demoralized their base and would have depressed Democratic voter turnout in November.  The fact that they were able to push this through in the face of such intense opposition has instead demonstrated that the Democrats can get things done, it has energized their base (especially in combination with the Republican and “Tea-Party” response), and it will likely increase Democratic voter turnout in November.


Second, there are several key provisions of the legislation that took effect immediately when President Obama signed the bill, and many of these are very popular among voters, which could easily cause the Republican push to repeal the legislation to backfire.  For example:


  • Small businesses are now able to apply for tax credits to help them purchase health insurance for their employers.
  • Before this bill was signed, Medicare stopped covering drug costs after a plan and beneficiary had spent more than $2,830 on prescription drugs, and did
  • not start paying again until after an individual’s out-of-pocket expenses exceeded $4,550.This “doughnut hole” will now begin to close.  Seniors who have
  • already reached the “doughnut hole” for 2010 will soon receive rebate checks of $250 from the federal government.
  • People who have been denied health coverage due to “pre-existing conditions” will now be able to get coverage through high-risk pools.  These pools will begin to form immediately and will be fully operational within 90 days (no later than June 21st).
  • Health insurers will be forbidden to charge higher premiums based on gender (currently, women generally pay more for the same coverage).
  • Subsidies will assist in the purchase of health insurance for American families of four with incomes up to $88,000 per year, or 400% of the poverty level.
  • Medicaid will be expanded; it will now be extended to families of four that earn up to $29,000 per year, or about 133% of the poverty level.


There are more provisions that will take effect in 180 days (on September 23rd – just as the general election campaign for the November midterms is heating up), and many of these are extremely popular as well, again possibly causing the Republican repeal efforts to backfire.  These include:


  • It will no longer be legal for insurance companies to deny children coverage due to pre-existing conditions.
  • It will no longer be legal for insurance companies to drop your coverage when you become sick or injured.
  • It will no longer be legal for insurance companies to impose lifetime limits on your benefits.
  • Your children will be able to maintain coverage on your insurance plan to the age of 26 – a huge factor for families with sons and/or daughters in college who have not yet become settled in a career job that provides health benefits.


It is not insignificant – nor is it a coincidence – that all of these measures will take effect before the November election.  As the American people see these provisions take effect, support for the plan will undoubtedly grow.  President Obama’s approval rating is also bound to rise, due to this and several other factors.  To be sure, current approval ratings for Congressional Democrats are dismal – but those for Congressional Republicans are even worse!


Now that health care reform is completed, Congress will be able to move on to other issues – like financial services reform, immigration reform, energy policy, and so on.  President Obama and the Congressional Democrats have also signaled that Republican obstructionism will no longer hold up their agenda – in other words, it has finally occurred to them that:


  • if they are not going to get any Republican votes, there is not much point in granting concessions to the Republicans and,
  • they are going to be hit with negative ads during the upcoming campaign no matter what they do, so they should at least show that they can get things done – in other words, that they can do the job they were elected to do.


They have made it clear that they will use whatever parliamentary procedures are necessary to push their agenda through, and I expect several significant measures to pass between now and November. Financial services reform has been in the works since late last year, immigration reform took a giant leap forward when Democratic Senator Chuck Schumer of New York joined with Republican Senator Lindsey Graham of South Carolina to unveil a bipartisan immigration reform bill, and Senator Graham also joined with Democratic Senator John Kerry and Independent Senator Joe Lieberman to introduce a bi-partisan Clean Energy and Climate framework.  As these achievements accumulate, the approval of Congressional Democrats and President Obama will rise.  Conversely, if the Republicans continue to try to obstruct these efforts and continue to lose battle after battle, their approval will drop even lower than it is now.


Third, there has been so much misinformation regarding what is actually in the health care reform bill that many Americans who are opposed to it change their mind when told what the bill includes.  A recent Newsweek poll found that 49% of Americans were opposed to the plan when first asked, with 46% in favor (this 3% gap was within the margin of error for the poll, meaning that this poll – taken before the bill passed – found that Americans were basically evenly split on the issue).  The poll went on to ask respondents about eight specific policy proposals – most of which were widely favored – and then, after informing the respondents that all eight of these proposals were included in the plan, asking again if they approved or disapproved the plan overall.  The numbers changed to 48% in favor and 43% against. What this indicates is that many people are mistaken as to what is in the bill, they favor many of the bill’s actual provisions, and that opponents of the bill have been quite effective in convincing people to oppose it based on misinformation.  When people see the provisions listed above taking effect, and the catastrophe foretold by the Republicans does not materialize, the overall approval of the plan will rise even further.


There is another factor to consider regarding the public polling on health care reform.  Republicans have repeatedly cited polls that show a majority of Americans opposed to the bill, but this argument is based on a clear misreading of those polls.  One reason is that those who opposed the bill prior to its passage did not all come from the same end of the political spectrum.  For example, a CNN / Opinion Research poll conducted March 19-21 (just before the House voted on the bill) indicated that 52% opposed the bill while 39% supported it – which would seem to support the Republican claims.  However, looking deeper, when respondents were asked why they opposed or supported the bill, 13% said they opposed the bill because it was not liberal enough.  If those 13% are added to the 39% who supported the bill (and taken away from the 52% who opposed it), a combined 52% either supported the bill or wanted it to go even further, while just 39% actually agreed with the Republican position on this issue. Another example is the belief that a majority continues to oppose the bill; however, the first major poll conducted after the bill was passed (a USA Today / Gallup poll released Tuesday, March 23rd – the day President Obama signed the main bill) indicated that, by a margin of 49% – 40%, those polled said it was “a good thing” that the bill had passed.  I find the remarkable consistency between the 39% in the CNN / Opinion Research poll who agreed with the Republican position before the bill passed and the 40% in the USA Today / Gallup poll who disagreed that passing the bill was “a good thing” after the bill passed to be rather striking – and a possible indication that the Republicans are seriously mistaken about the public feelings on health care reform.


Fourth, President Obama is planning to make a full campaign-style effort to inform the people of what is actually in the bill.  It would be a mistake to underestimate the impact of any President traveling around the country promoting such a significant part of his agenda, and it would be an even bigger mistake to underestimate this impact when that President is Barack Obama.  As we saw during his election campaign, he is very, very good at this.  His first stop will be Iowa City, Iowa, followed by other stops around the country over the next several weeks.  It should be expected that he would receive wide media coverage as he explains and promotes the bill to the people in these various places, and I suspect more and more Americans will find they approve of the plan as they hear it explained by the President.


More provisions will take effect on January 1st, 2011.  While these won’t help the Democrats this November, I believe they will help the Democrats – and will especially help President Obama – in 2012. These provisions include:


  • Insurance companies will be required to spend 80-85% of the revenue from your premiums on actual health care.  If they do not, they will owe their policy holders a rebate for the difference.
  • Medicare recipients will begin receiving free preventative care – with no co-pay.


Additional provisions will take effect over time.  For example:


  • Beginning in 2014, health insurance “exchanges” would be created to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage.
  • In 2014 it will be illegal for insurers to deny coverage for anyone due to a pre-existing condition.
  • In 2014, it will be illegal for health insurance companies to impose annual limits on your benefits (a ban on lifetime limits will take effect in September of 2010).
  • The Medicare Prescription Drug Benefit “Doughnut Hole” will be closed entirely by 2020.
  • According to the Congressional Budget Office (CBO), the non-partisan agency that determines (or at least atempts to predict) the long-term costs of legislation, the plan will reduce budget deficits by $143 billion over the next ten years, and by more than $1 trillion over the following ten years
  • The plan will provide coverage for about 32 million Americans who don’t currently have health insurance


Overall, as the people see what happens as a result of the health care reform bill, the anger will fade and the people will become protective of their new rights in the health care arena, just as eventually happened with Medicare (which was also initially decried as “socialism” and “a government take-over of health care”).  Health care reform will become impossible to repeal, and will be seen for the landmark legislation that it truly is.  The bottom line is that the passage of health care reform is a major victory for President Obama and the Congressional Democrats and, despite their best efforts to portray it otherwise, a major defeat for the Congressional Republicans.  As David Frum, the conservative commentator and columnist, writes, “The ‘Waterloo’ threatened by GOP Senator Jim DeMint last year regarding Obama and health care has finally arrived all right: Only it turns out to be our own.”


Make no mistake – the Democrats will probably lose seats in both Houses of Congress in November.  There will be many factors that contribute to these losses (continuing high unemployment being foremost on the list), but the passage of health care reform will not be one of these factors – in fact it will help minimize those losses, with the probable result that the Democrats will retain the majority in both Houses.


© 2010 by David Bleidistel.  All rights reserved.