The president faces difficult choices as he prepares to deliver tomorrow’s State of the Union. His political capital is damaged.The Democrats’ filibuster-proof Senate super-majority is no more. And although the administration has been reluctant to acknowledge it, surely they received the message from Massachusetts voters who cite health care as their top concern and elected a man who campaigned explicitly on derailing Congress’s health care train.
Democratic leaders are struggling to figure out their next step. Should they try to concoct an alternative legislative path to force a bill to the president’s desk, or should they take a step back, scrap the current legislation, and take another stab at health care reform? They worry they’ll pay a political price for giving up on legislation that consumed so much of this administration’s first year, but pressing on–particularly using some legislative slight-of-hand–seems even riskier.
Yet there are other reasons why the president should urge Congress to go back to the drawing board on health care reform that have nothing to do with politics. For one, the bills currently passed by the Senate and House hurt those that they are supposed to help. In particular, the concerns of people of color and the poor have been given short shrift during these health care negotiations.
Consider what current legislation would do to Medicaid, a program that predominantly serves at-risk, minority populations. The Congressional Budget Office estimates that 15 million more Americans will be funneled into Medicaid by 2019. That means that the problems that plague Medicaid today will become even worse in the future. Medicaid’s reimbursement rates are so low–often below what it costs health care practitioners to see the patient–that many doctors won’t accept Medicaid patients. The proposed legislation does nothing to address that problem and will make it worse by flooding Medicaid’s roles.
Medicaid patients also lose out when it comes to access to preventative services. There was a political uproar when a government commission recommended changing standard procedure for women’s preventative services including reducing the number of mammograms women should expect to receive. The Senate responded by passing an amendment to limit the affect of those recommendations–but the amendment applies only to non-Medicaid populations. An oversight? Hardly.
Where is the outrage from Democratic leaders? Where is the concern that problems with access to health care will worsen? Unions get special treatment, and individual Senators negotiate explicit kickbacks for their constituents, but the minority community is ignored. Maybe part of the problem is the minority communities’ political power is limited, especial for blacks, since when we do vote, we overwhelmingly vote for Democrats no matter how poorly we are treated.
Two prominent African-American organizations have spoken out about other areas of the bill that will harm minorities. The United States Commission on Civil Rights sent a seven page letter to the President and Senate leadership expressing serious concerns about “racially discriminatory provisions” in the bill. Citing concerns about minorities in long term care facilities, they state:
“…these provisions permit a separate and unequal operating standard for long-term care facilities that serve racial and ethnic minorities, with the possibility that their residents will not be afforded the same levels of protection against abuse and other crimes as residents of nursing homes that have larger non-minority populations.”
Members of the Congressional Black Caucus also objected to aspects of the bill. In an open letter to Speaker Nancy Pelosi, they highlighted that cuts planned in the health care bill will “devastate the many hospitals that rely on [disproportionate share hospital] funds and that serve as a lifeline to low-income populations.” Neither letter has been responded to in any public way by the White House or the Democratic Congressional leaders.
This only scratches the surface of a bill that is chocked full of spending and special provisions for nearly all other major interest groups. Yet the Senate bill cuts nearly $120 billion in subsidies that are given directly to insurers in the Medicare Advantage program, a program used predominantly by non-white, low income seniors. Over 80 percent of Hispanic seniors making less than $20,000 per year use these plans, and Medicare’s own actuaries say that the bill will force millions to lose their current coverage. All others will see costs go up and benefits decrease.
Is this really the best we can do? The United States does need health care reform, but current proposals take us in the wrong direction with more government dictates and higher costs, but without addressing the root problems in the current system and without helping many who need it most.
It will take courage for President Obama to tell Congress to start anew with health care reform. Yet this is what the country needs. During this State of the Union, instead of soaring rhetoric and lofty promises about transforming the country, the president should show a commitment to listening to the American people, and pursuing changes that will have real impact and bipartisan support. There are simple, smaller, but important reforms that can help make health insurance more affordable and the health insurance marketplace more competitive. Sometimes the boldest proposals are ones that sound modest.