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The History of Health Reform

July 14, 2010

Health reform isn't over. We've got a long way to go with implementation -- and making sure the cost, coverage, and quality promises made by the new reform law are fulfilled over the coming years. The ups and downs of the debate made for an intense and exciting year. As the dust settles, we'd like to offer up our guide to what happened, The History of Health Reform.

HEALTH REFORM: We Don't Quit...

  • By
  • Paul Testa
January 29, 2010
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We just move on to Communications.

After two and half years, 400 blog posts, and innumerable cups of coffee, and one marathon (not the legislation) I’m leaving the Health Policy Program to share some new media magic with the rest of New America.

HEALTH POLITICS: Shifting Gears

  • By
  • Paul Testa
January 27, 2010
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With the President looking to shift gears to focus on jobs, the economy, education, and a host of other issues, the signature priority of his first year, health care reform, appears stalled -- or at least idling. Slate’s Timothy Noah invited his readers to figure out how to get it going again.

Inviting readers to submit their thoughts on how to pass comprehensive reform, Noah set a few ground rules (Snowe’s a no, so is revoking the filibuster), but mostly he was looking for fresh thinking. The results are in! Combing through some 570 submissions, Noah picked his top eight. The whole list's worth a read running the gamut from time machines that could take us back to 1974 to a well placed ambassadorship for a certain senator from Iowa. Our personal favorite was probably No. 6

HEALTH POLITICS: "Do the Right Thing"

  • By
  • Paul Testa
January 26, 2010
Do The Right Thing

Add another voice to the growing consensus of experts and stakeholders calling on Congress to pass a health reform bill -- former Senate Majority Leader Tom Daschle.

Speaking to reporters after an event at his Bipartisan Policy Center, Daschle said Congress should “do the right thing” by passing the Senate bill.

Doing so would require “political courage” but “You could argue that there is just as much political downside to not to pass this than to pass this,” Daschle argued. The Hill’s Walter Alarkon has more.

IN THE STATES: As the Dust Settles

  • By
  • Paul Testa
January 25, 2010
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As the world continues to wait for the dust to settle from Massachusetts’ special election, two pieces from last week are worth reading. First, Time’s Karen Tumulty provides an excellent narrative of how the longshot from Wrentham became the Scott heard round the world. Commenting specifically on how Massachusetts could elect a man who pledged to be the 41st vote against health reform to fill the late Edward Kennedy’s seat, Tumulty writes:

As I talked with voters braving the snow to get a glimpse of Brown in the days leading up to the election, the health care issue came up again and again. They were unsettled by the mounting costs of their state's program and even more so by the process they saw going on in Washington. Rather than being drafted with the common good in mind, they said, the health bill was turning into a series of backroom deals -- a Medicaid exemption for Senator Ben Nelson's Nebraska, tax breaks for unions, sweeteners for the hospital and drug industries. As a veteran of the Kennedy political operation put it, "They think there's a lot coming out of Washington -- and none of it is for them."

Second, The Washington Post, in collaboration with the Henry J. Kaiser Family Foundation and Harvard University's School of Public Health, takes a look at the numbers behind Scott Brown's victory in Massachusetts, and particularly the impact of health reform in voters’ decisions.

HEALTH POLITICS: Selling a Package Deal

  • By
  • Paul Testa
January 22, 2010

As Democrats struggle to find a way forward after Scott Brown’s upset victory in Massachusetts, the latest Kaiser Health Tracking poll should provide some comfort.

The survey conducted in January before the special election in Massachusetts, found that while Americans were divided over the current health care proposals, even critics became more supportive after being told what was actually in the bill. See the chart below:

IN THE NEWS: Health Wonk Review in 3-D!!!

  • By
  • Paul Testa
January 21, 2010
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Well not quite yet, but Jaan Sidorov hosts an Avatar-inspired edition of Health Wonk Review over at the Disease Management Care Blog.

HEALTH POLITICS: Massachusetts... and Louisiana

  • By
  • Paul Testa
January 19, 2010
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While all eyes are on Massachusetts, it’s important not to forget about the other ayes in Congress needed to pass reform.

While today’s special election may complicate calculations of Democrats watching the House-Senate-White House negotiations on the final form of the health reform bill, it should not kill this legislation. Centrist Sen. Mary Landrieu (D-LA) for one seems to understand that point. In her first video address of the new year (below) she lays out her six priorities for health reform, while emphasizing “This bill is important to people in Louisiana and across the nation.” 

COST: Financing Your New Cadillac (Tax)

  • By
  • Paul Testa
January 15, 2010
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They changed the tires, tweaked the engine and added some leg room, but at the end of the day, the new and improved 2010 Cadillac tax that emerged from negotiations between the White House, Congressional leaders and labor unions still has the features that made the 2009 model an attractive financing option.

The details of the revised excise tax on high-premium plans are as follows:

HEALTH POLITICS: Does He or Doesn't He?

  • By
  • Paul Testa
January 14, 2010
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For months, Barack Obama let Congress hash out the details of health care. Pundits and critics wondering when and how he would weigh in sometimes made him sound like the  Miss Clairol of health reform -- does he or doesn't he back a public plan? A national exchange? A Cadillac tax? Only his OMB director knew for sure.

Now the president is showing his true colors. He held an unusual eight-hour meeting at the White House yesterday with Democratic leaders from the House and Senate. How those preferences shape the final legislation remains to be seen, as the de facto conference committee produced a predictably vague statement following the Wednesday’s negotiations:

HEALTH POLITICS: AHIP Helped Fund Anti-Reform Ads

  • By
  • Paul Testa
January 13, 2010
Lucy and Ethel

Karen, you’ve got some ‘splainin to do.

In an op-ed this past October in the Washington Post, Karen Ignagni, the president and CEO of America’s Health Insurance Plans defended her group’s commitment to reform. Now, a piece in the National Journal reveals her organization was already channeling millions of dollars to help fund anti-reform ads. Peter Stone writes:

HEALTH POLITICS: The Benefits of Reform in 2010 .. and Beyond

  • By
  • Paul Testa
January 11, 2010

In his weekly address, President Obama focused his remarks on health reform, highlighting its importance to the economy and emphasing the immediate benefits of reform. See video of address below, and a transcript here:

HEALTH POLITICS: Deep Health Care

  • By
  • Paul Testa
January 7, 2010
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Follow the money.

It’s one of the most famous lines in journalistic lore, and The Washington Post's Dan Eggen takes us on that chase in his reporting on interest group financing that seeks to shape the health reform debate.

COST: Getting to Affordability

  • By
  • Paul Testa
January 5, 2010
Financial Question Mark

As the House and Senate begin the crucial process of reconciling the differences between their two bills, one of the biggest outstanding issues remains the question of affordability.

This is by no means a new issue. We’ve written on it before and for a complete rundown of the bicameral differences in the bills check out this 11-pager prepared by the House Tri-Committee staff. For a brief refresher, here are some of the key differences between the House and Senate on affordability:

  • Medicaid Eligibility: Both bills expand Medicaid eligibility. The House bill raises the income threshold for which adults under the age of 65 are eligible for Medicaid to 150 percent of the federal poverty level (FPL). The Senate bill raises the threshold to 133 percent of FPL.

  • Premium Subsidies: Both bills provide subsidies on a sliding scale for individuals and families with incomes under 400 percent of FPL to purchase insurance in the exchange. The slope or generosity of that sliding scale is one of the biggest points of contention. The chart below helps illustrate some of the differences:

HEALTH POLITICS: Post Holiday Sales

  • By
  • Paul Testa
January 4, 2010
Sale Tag

The New Year’s just begun and already the crowd inside the Beltway has shifted its focus to the 2010 midterm elections, some 301 days away. One key question for political palm readers is how health reform will play at the polls.

Many on the Republican side believe health reform is their ticket back to power, an issue that can mobilize their base while keeping liberals and progressives at home. As Politico reports, many Congressional candidates are campaigning on a pledge to repeal the bill, and even gubernatorial candidates like John Oxedine in Georgia are getting in on the action. (Personally, we prefer some of the Ox’s other forays into new media.)

Democrats, meanwhile, worry that a disgruntled base and wary center could produce some nasty results come November. The Washington Post’s E. J. Dionne, however, doesn't believe Dems are destined for a repeat of 1994, not if they strike the right tone on health reform:

HEALTH POLITICS: Moore Polls

  • By
  • Paul Testa
December 22, 2009
Demi Moore

Talking about the polling on health reform is like reviewing a Demi Moore film. Sure it's sort of fun to watch, but at the end of the day what's the point?

Depending on where you stand, you can find a poll to back up your position and a spin to dispute your opponent's.

If you’re the chairman of the Republican National Committee, for example, then recent polls showing declining presidential approval ratings and increasing opposition to reform are cause for rejoice. In just a few months you’ll be decking the halls of Congress with pink slips for Members who voted for “aye” on passage.

If you’re the White House Chief of Staff, such talk is on par with sugar plum fairies. The polls are an aberration, like the August town halls. The only way to avoid a day after Christmas fire sale in Congress on par with the midterms of 1994 is to pass reform. Besides, not all the polls are bad.

Handicapping political horse races is more difficult than betting on Ivy League Basketball (Our advice? Don’t bet against Cornell…), but there are two things to consider when looking at how health reform will impact the 2010 midterm elections.

HEALTH POLITICS: It's Beginning to Look a Lot Like...

  • By
  • Paul Testa
December 18, 2009

The calendar says December, but the polls on health reform are beginning to look a lot like August.

The latest Kaiser Health Tracking Poll shows public views on the positive impact of reform have dropped to their lowest levels since late summer. While a majority of respondents (54 percent) continued to believe it was more important than ever that Congress pass legislation, a declining number believe reform will benefit them (35 percent) or the country as a whole (45 percent).

Three-quarters of Democrats want reform now; two-thirds of Republicans oppose it; and a slim majority (53 percent) of Independents favor it. Seniors continue to be one of the most skeptical groups, and were twice as likely to believe they’d be worse off under reform.

Legislative sausage making is never pretty, but a plurality of respondents believe Congress is functioning as usual. Partisan rancor tends to produce negative results in the polls about any issue, and we’ll be interested to see where these figures stand after Christmas and into the new year.

HEALTH POLITICS: Primal Dean

  • By
  • Paul Testa
December 17, 2009
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Howard Dean is apparently not done screaming.

The outspoken former chairman of the Democratic National Committee begins his op-ed in Thursday’s Washington Post boldly stating: “If I were a senator, I would not vote for the current health-care bill.”

HEALTH REFORM: Make it Work

  • By
  • Paul Testa
December 15, 2009
Tim Gunn

Health care reform is beginning to feel like a season of Project Runway. What’s true on the catwalk also holds on the Senate floor, where one day you’re in and the next day you’re out.

COST: O(MB) RLY?

  • By
  • Paul Testa
December 14, 2009
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The Wall Street Journal editorial board calls cost control in current health reform proposals an illusion. Peter Orszag begs to differ. The director of the Office of Management and Budget takes the Journal to task, dispelling their claims on a point-by-point basis:

IN THE NEWS: Health Wonk Review @ Workers' Comp Insider

  • By
  • Paul Testa
December 10, 2009

Julie Ferguson hosts the latest edition of Health Wonk Review over at Worker's Comp Insider. Tom Emswiler's post on the impressive quality improvements made by Premier Inc.'s QUEST initiative. Check it out!

Issues:

HEALTH POLITICS: C to the B to the O

  • By
  • Paul Testa
December 10, 2009
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The closest Starbucks? Across the street at the Federal Center Metro station. The closest bar? We’d guess the 21st Amendment at the Capitol Holiday Inn, but we really don’t go out much in Southwest. Still, these are useful facts when you're in the world of health reform, where all eyes are focused on the fourth floor of the Ford House Office Building at 2nd and D SW.

HEALTH REFORM: More Support for the Freshman Cost Amendments

  • By
  • Paul Testa
December 9, 2009
Applause

Yesterday a group of 11 freshmen Democratic senators released a package of amendments designed to strengthen payment reforms in Medicare and Medicaid, expand the scope of reforms to include the public and private sector, and reduce the legal and administrative barriers to high quality care.

You can watch highlights from the press conference in the video on the right (Sen. Mark Warner (D-VA) claims the amendments are to the legislation what the iPhone is to cellphones), and read a section-by-section summary of the proposals here.

Health CEOs for Health reform announced its support for the amendments, as has a long list of stakeholders including AARP, AFL-CIO, National Partnership for Women and Families, Small Business Majority, and the experts at the Center for American Progress Action Fund. See the full list from Sen Warner’s website after the break:

HEALTH CARE: Reform for the Holidays?

  • By
  • Paul Testa
December 9, 2009
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In the context of our economic crisis, we’ve frequently noted how a 1 percentage point increase in the unemployment rate is associated with about a 1.1 million person increase in the ranks of the uninsured. Since last December, the unemployment rate has risen by 2.8 percent, translating roughly to an additional 3.0 million more uninsured. The fact is one of many that makes the case for health reform stronger in light of our troubled economy.

HEALTH POLITICS: The Week Ahead

  • By
  • Paul Testa
December 7, 2009
US Capitol

As the Senate continues its historic debate of health reform, here’s a look back at the weekend’s action and look forward at what’s to come. As always, you can follow the debate live with us on Twitter (hashtag: #senatedebate)

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