The Consequences of Repealing the Health Care Law

The Consequences of Repealing the Health Care Law

This column originally appeared in the Williston Observer on January 27, 2011.

Last week, the United States House of Representatives voted to repeal the Patient Protection and Affordable Care Act, better known in some circles as "Obamacare." The repeal vote, which passed on a party line vote (except for three Democrats who broke ranks), has largely been reported as symbolic for two important reasons.

First, the Senate, which is still (though just barely) held by the Democrats, will likely never even take up the repeal bill, let alone pass it.

Second, should the impossible happen and the repeal bill pass the Senate, the President would undoubtedly veto it. Given that, it would take an even more impossible two-thirds vote of Congress to override the veto.

So why even bother? Republicans have said it is because they made a promise to do so in their 2010 congressional campaigns, and the people had given them a mandate: repeal the health care law.

While I agree that the Republican sweep of the House was a message from the people, I don't think it had a thing to do with the health care law. The law, in fact, contains many provisions that people are either very happy about or would be if they thought about the bill as more than "Obamacare." The repeal effort is little more than a Republican gift to its real base - and that base is certainly not the people of the United States.

There are several key provisions that have not even gone into effect yet, but with repeal, the following important, existing features would disappear:

- Beginning almost immediately after the law took effect, children of covered persons could remain on their parents' policy until age 26, unless covered by their own policy. Previous insurance company rules dropped children at the age of 19, or when they graduated from college. This requirement is now insuring an estimated 1.2 million people.

- Insurance companies can no longer deny coverage because of pre-existing medical conditions. Being a Type 1 diabetic, this is of particular interest to me, and to three million others like me. And that's just diabetes - there are scores of other conditions and diseases that can exclude a person from individual coverage. I'm fortunate to be covered by a corporate policy, but many others are not so lucky, and they are now protected.

- Lifetime limits are eliminated, meaning that if you have a chronic condition that requires on-going treatment, you need not worry about running your benefit out. Annual limits are still legal, but they are being phased out over the next three years.

- In the law, breastfeeding mothers must be given time to either breastfeed or pump breast milk during the workday. Loss of this provision would force some mothers to make a tough choice between working and staying home; between using breast milk and formula, a choice that can cost money not only immediately (in the form of savings on formula) but also in the long-run (in the form of health benefits to babies whose mothers are able to breastfeed).

- The law aims the soften the financial blow of the so-called Medicare Part D "Donut Hole." Prior to the new health care law, seniors paid a coinsurance for drugs up to $2840. After that, and up to $4550, prescriptions were completely uncovered. The new law provides for a 50% discount for drugs purchased while in the $2840 - $4550 range, which can add up to considerable savings for those on a fixed income.

Different polls show different levels of support for repeal - but numbers that mean a "mandate"? A recent AP-GfK poll puts support for repeal at just 41%, with opposition to repeal at 40%. This one percent edge is hardly a mandate.

The "mandate" disappears when the details are examined. In the same poll, for example, support for a ban on the pre-existing existing condition exclusion stands at 50%, with 34% opposing such a ban (though the 34% who oppose make me muse at the respondents' misanthropy).

Repealing the health care law, even if it could be done, would be a bad idea. What Democrats have done and need to continue to do is highlight how important this law is to so many people. As more and more of its provisions take effect, more and more people will be affected by it. By increasing coverage, we will increase the overall health of Americans, and in doing so, provide a stronger, healthier workforce to help America meet the challenges that face us in the evolving global economy.

Shumlin's plans for success

Shumlin's plans for success

This column originally appeared in the Williston Observer on January 13, 2011.

Peter Shumlin is under no illusions about how tough he and even a friendly legislature are going to have it over the next two years. He said as much in his inaugural address almost two weeks ago, when he listed just a few of the fears of Vermonters, as he sees them:

"All across our state," Shumlin noted, "too many Vermonters are living in fear; fear that they might lose their jobs, face another pay cut, fail to keep their homes, send their children to college, afford health insurance or the secure retirement that they've always dreamed of."

The job of Vermont's government is to help relieve some of these fears while also doing its best to improve the lives of Vermonters in the long term. Toward this end, Shumlin wants to focus on improving the educational system and health care system in Vermont, as well as expanding broadband Internet coverage in the state.

These three issues, along with making Vermont's tax system more fair and supporting Vermont's agricultural industry, mark the five major points of focus that Shumlin said will be most important to his administration, and which he asked a joint session of the legislature to support.

Seeing the Vermont brand as a mark of quality that should be more heavily marketed in the major metropolitan areas that surround us - Montreal, Boston, and New York City - Shumlin has ambitions to grow jobs in the agricultural sector.

"The renaissance in Vermont agriculture is rooted in the growing concern by consumers across America about where and how their food is produced. Consumers are increasingly demanding locally grown, chemical free, high quality food," Shumlin said.

I know that I am spoiled, because when I go to my local grocery store, I think almost nothing of the cards that say this corn or that tomato was grown locally. It makes it easy for me to support local farms by buying food that I already know will be fresh, tasty, and of high quality. By leveraging the cachet of the "Made in Vermont" or "Grown in Vermont" label, we can make the list of staple Vermont products expand beyond ice cream, cheese, and maple syrup. The goal is to make even a lowly Vermont zucchini sought-after for a premium price.

I think that the answer to the nation's health care woes is a single-payer plan, or something approaching that sort of approach, and Shumlin wants Vermont to lead the way in showing the country that such a system is not only beneficial to the people, but to the state's treasury as well. By using technology, something I'm intimately familiar with in my work at GE Healthcare, Shumlin says that we can reduce costs and bring better outcomes. Combined with a state-sized pool of insured, rising costs can be reined in:

"That's why we must create a single-payer health care system that provides universal, affordable health insurance for all Vermonters that brings these skyrocketing costs under control. Let Vermont be the first state in the nation to treat health care as a right and not a privilege; removing the burden of coverage from our business community and using technology and outcomes-based medicine to contain costs."

As I noted, Shumlin is sure the issue is complex, but is equally sure that by bringing the right minds together, the challenge can be met: "I call upon single payer supporters to resist the temptation to oversimplify the challenge. I call upon skeptics to challenge us, but to join us at the table."

Shumlin addresses a concern that I have about any negotiation about a controversial subject - the tendency to under-emphasize unfortunate truths and over-emphasize minor features. We all do it, but when we're talking about the laws and policies of a state, or a nation, then these diminutions and exaltations become destructive to the process, and tend to push the sides further apart. I hope that Shumlin and his administration can bring the sides together and depolarize the debate, leading to productive discussion and compromise.

It is far too early to grade anything Shumlin has done, but his inaugural address reaffirms my belief that he is the right man for the job. I look forward to watching what he and the legislature bring to Vermont and Vermonters, and hope that in two years' time, they have helped pull Vermont out of our current economic doldrums and placed us on a path to success and national leadership.