By Nathan French
Having bet the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved his victory on Sunday night, bringing an end to a yearlong partisan struggle. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction,” President Obama said shortly after the historic vote. “This is what change looks like.”
The House voted 219-212 to send a sweeping overhaul of the nation’s health care system to be signed into law. “We tonight will make history for our country and progress for the American people,” Speaker Nancy Pelosi declared shortly before the vote. “Today we have the opportunity to complete the great unfinished business of our country.”
The Democrats passed the bill without a single Republican vote - and with the knowledge that it may well have ended the political careers of some who have voted for it at a time when the public remains deeply divided over the entire health care debate. “If we pass this bill, there will be no turning back,” warned minority leader John Boehner. “It will be the last straw for the American people.”
With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and also what has been hailed as the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid. Universal coverage is a goal that has eluded and perplexed presidents going back as far as Teddy Roosevelt, and Obama’s bill comes as close to that target as anyone has. The bill would provide health coverage to an estimated 32 million additional Americans, thus meaning that 95 percent of those who are legally in this country would have health insurance, up from the present 83 percent today.
The bill is big on promises, but many question if it can deliver. The bill makes promises to rein in health costs by reorienting the practice of medicine, making it more efficient; with health care providers rewarded on how well they treat their patients, rather than how much care they give them. Whether or not it will achieve that latter ambition, however, is far more uncertain.
In the early years of the health care change, most Americans will see only minor changes. It will almost immediately end some insurance company practices, such as denying coverage to children with pre-existing conditions. And dependent children under the age of 26 would be allowed to remain on their parents’ policies if they cannot get health insurance elsewhere. Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.
Beginning in 2014, more far reaching measures will begin to take effect. States would be required to set up new “exchanges,” or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers. Government subsidies would be available to those earning up to 400 percent of the present poverty line. Employers with 50 or more workers who do not offer coverage would be fined, and for the first time ever in history, most people would be required to obtain health coverage: either from work, or by purchasing it on their own, or pay a penalty. When questioned regarding the new health care system, a local physician who wishes to remain anonymous stated, “In all of this I am glad for one thing, and that is that I am nearing the end of my career.” Other local healthcare providers are also skeptical that no changes will be seen other than higher taxes, with no added benefits.
All of these big dreams and plans will be paid for in two ways: by supposedly reducing spending on Medicare by hundreds of billions of dollars and by imposing a set of new taxes, including a 40 percent levy on certain high-priced insurance policies.
But while the bill is headed toward becoming law, the fighting isn’t going away anytime soon. Republicans have already issued notice that they plan to campaign in this fall’s midterm elections on a pledge to repeal it. In dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance. Texas has joined suit in this fight against the new health care bill, and Texas Governor Rick Perry stated, “[The bill] has more to do with expanding socialism on American soil than it does fixing our health care finance and delivery systems.”
Texas will mount a legal challenge to the sweeping health care reform bill that the U.S. House approved Sunday night, Attorney General Greg Abbott said Monday. “The federal health care legislation passed violates the United States Constitution and unconstitutionally infringes upon Texans’ individual liberties,” Abbott said.
“To protect all Texans’ constitutional rights, preserve the constitutional framework intended by our nation’s founders, and defend our state from further infringement by the federal government, the State of Texas and other states will legally challenge the federal health care legislation.” It is clear that even with Democrats praising Sunday’s triumph for Obama, that the fight is far from over and we have not heard the last on the health care reform.