The acrimonious healthcare debate that came to a head with passage of historic healthcare legislation, The Patient Protection and Affordable Care Act, H.R. 3590, by Congress late yesterday, points to two ways to look at health in our country. Both are critical to the long term prosperity and existence of our government as we know it.
The first perspective has more to do with tone. For months, I have been filled with dismay over the twisting and omission of facts on the healthcare issue, misinformation calculated to work up average Americans into an angry frenzy. That frenzy came to a full lather when Americans’ wrath was turned on Congress this past weekend. My dismay turned to outrage when individual Congressmen were subjected to verbal and physical harassment. The act of spitting on Congressman Emanuel Cleaver II, D-Mo., just about summed up the contempt for true statesmanship and lack of respect for different viewpoints that has come to grip our country and that must be addressed if the United States wants the legislative process to remain healthy going forward.
In a sense, the American people have taken a cue from federal lawmakers who choose to incite rather than educate with words like ‘Armageddon’ and ‘baby killer.’ Or to focus on what they say is the back breaking cost of this new law, rather than tempering those estimates with other estimates such as the one cited in President Barack Obama’s address after the vote: the law will reduce the U.S. deficit by more than $100 billion over the next decade and by more than $1 trillion in the decade after that. Or if those Congressional Budget Office figures seem too partisan, by noting a July 21, 2009 article by Dan Eggen of The Washington Post listing the millions of dollars in lobbying efforts that had been effortlessly poured into swaying the debate.
In fairness, there are more level headed lawmakers in both parties who tried to keep the rhetoric to a bearable level and hopefully those voices will be heard more clearly going forward.
What gave me some hope for the 45 million uninsured Americans and more generally for Americans, was listening to a discussion by state insurance regulators earlier today. In a very rational way, three insurance commissioners explained how they would proceed now that health care reform is a reality.
Jane Cline, president of the National Association of Insurance Commissioners, Kansas City, Mo., and West Virginia insurance commissioner; Kim Holland, NAIC secretary-treasurer and Oklahoma insurance commissioner; and, Sandy Praeger, former NAIC president and Kansas insurance commissioner, tried to address the enormous amount of work that awaits state regulators as well as state legislators. Holland is a Democrat, Praeger a Republican.
Both Holland and Praeger agreed that in their respective legislatures there might be pushback over federal preemption or on other issues tied to the new law. They both described their roles as providing information to their legislatures to help those bodies make necessary decisions.
That emphasis on education is what Americans need to develop a clear view of how changes in healthcare will benefit Americans.
During the discussion, reporters noted that there would be efforts to reverse the new law and asked if work would be put on hold as a result of this possibility. Cline, Holland and Praeger said that work would proceed apace because some of the requirements take effect right away.
For instance, state regulators will continue work on standards for medical loss provisions which need to be in place by the end of the year. And, according to Praeger, it looks as if most of the enforcement of new regulations associated with the law will be left to states which will require the NAIC to work with the Department of Health and Human Services and HHS Secretary Kathleen Sebelius, a former NAIC president.
If carriers sell insurance across state lines, according to the commissioners, state compacts will have to be developed to create standards acceptable to states in the region of cross-selling.
And, according to Praeger, while the rate increase issue is not fully clear, it appears that states will continue to play a role in the process. There is the potential for some process of reporting rate increases to the federal government but approval of rates remains with state regulators, she adds. Praeger continues, “I think going forward some states with little oversight will have to meet some minimum federal requirements for rate approval. The bottom line is rates have to be linked to the company's financial condition so an arbitrary rate cap could be a problem.”