Health Care Reform PDF Print E-mail
Written by Source: The New York Times   
Wednesday, 22 December 2010 15:07


After decades of failed attempts by a string of Democratic presidents and a year of bitter partisan combat,  President Obama signed legislation on March 23, 2010, to overhaul the nation's health care system and guarantee access to medical insurance for tens of millions of Americans.

It was the largest single legislative achievement of his first two years in office, and the most controversial. Not a single Republican voted for the final version, and Republicans across the country campaigned on a promise to repeal the bill. After they took control of the House and expanded their ranks in the  Senate in the November elections, action on health care was at the top of their agenda.

Both sides agree that undoing the bill completely would be next to impossible, given the Democrats' veto-proof hold on the Senate, and that some parts of it are likely to prove quite popular. But there was also a recognition that ascendant Republicans in the Capitol -- and perhaps more importantly, in governor's office around the nation -- could seriously undermine, slow or whittle away at the bill.

On a separate track, nearly two dozen federal lawsuits have been filed trying to block portions of the bill, many put in motion by Republican governors and attorneys general.  They are focused on the so-called individual mandate, a requirement that all Americans buy health coverage or pay a fine (or tax, depending on who is describing it). The insurance mandate is central to the law’s mission of covering more than 30 million uninsured because insurers argue that only by requiring healthy people to have policies can they afford to treat those with expensive chronic conditions.

The first federal judges to rule in the matter, in Detroit and Lynchburg,  Va., upheld the mandate. The third, in Richmond, found that the mandate exceeds the regulatory authority granted to Congress under the Commerce Clause of the Constitution, but left the law in place while it is appealed, presumably to the Supreme Court.

At the same time, federal and state regulators have moved into high gear rolling out early provisions and laying the groundwork for the broader changes to come in 2014. In  September 2010, a number of important provisions took effect. Insurers were banned from dropping sick and costly customers after discovering technical mistakes on applications and required to offer coverage to children under 26 on their parents’ policies. 

The landmark bill signed by Mr. Obama will provide coverage to an estimated 30 million people who currently lack it. Its passage assures Mr. Obama a place in history as the American president who succeeded at revamping the nation's health care system where others, notably Harry Truman and Bill Clinton, tried mightily and failed. Republicans would like it to assure that Mr. Obama is a one-term president as well.

The measure will require most Americans to have health insurance coverage; would add 16 million people to the Medicaid rolls; and would subsidize private coverage for low- and middle-income people. It will regulate private insurers more closely, banning practices such as denial of care for pre-existing conditions. The law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office, which has also estimated that it will reduce the federal deficit by $138 billion over a decade.

The victory for Mr. Obama and the Democratic leaders of Congress came after a roller-coaster year of negotiations, political combat, hearings delving into the minutiae of health care and a near-death political experience after they appeared to have reached the brink of success. On Nov. 7, 2009, the House had approved its bill by a vote of 220 to 215, while the Senate passed an $871 billion bill on Dec. 24.

But even as the House and Senate worked to merge their bills, their fate was put in jeopardy on Jan. 19, 2010, by an upset Republican victory in a special election to fill the Senate seat in Massachusetts held for decades by the late Senator Edward M. Kennedy, depriving the Democrats of the 60th vote needed to block a Republican filibuster of a final bill. After weeks of uncertainty, Mr. Obama and Democratic leaders in Congress settled on a strategy in which the compromises needed to align the two versions were stripped down to only those measures that fit within a budget reconciliation bill, which under Senate rules could not be filibustered, a move that paved the way for passage.

The pivotal moment in the long legislative battle came in a dramatic Sunday evening vote, when the House on March 21 approved, 219 to 212, the health care bill that the Senate had passed in December. Later that week, the House and Senate completed passage of a set of fixes to the bills, compromises worked out as part of the complicated legislative maneuvering that allowed Democrats to achieve their long-sought goal despite having lost their filibuster-proof 60-vote "supermajority'' in the Senate in January.

Last Updated on Wednesday, 22 December 2010 15:13

ICD-10 Corner

9 benefits of ICD-10

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