Health reform appeared on the verge of death many times over the past few weeks, but early Christmas Eve morning the Senate passed the Patient Protection and Affordable Care Act on a party-line vote after major concessions were made to secure the votes of conservative Democrats. The Party’s fragile unity was amusingly underscored during the role call vote when Majority Leader Harry Reid, in a confused moment, voted “no” before quickly correcting himself.
Though this is the first time in generations of trying to overhaul our healthcare system that both chambers of Congress have passed a reform package, many progressives do not consider today’s vote a victory. The public plan died–at Joe Lieberman’s hand, no less–and the bill contains restrictions on abortion coverage that threaten women’s access to reproductive health services.
Despite these very serious shortcomings, however, the bill the Senate passed would reduce the number of uninsured Americans by 31 million by 2019. The Medicaid program will be open to new ranks of the country’s poorest residents, and the near-poor and middle class will get subsidies to buy insurance. The Senate also advanced some important delivery system reforms that could chart a path towards reining in costs.
As disappointed as progressives are with the compromises Democratic leaders made to get this bill through the Senate–and as tempting it is to believe they may have gotten a better deal if they’d pursued a more aggressive strategy–they are on the verge of doing many other lawmakers have tried and failed to do. And if this effort fails, another generation may pass before another chance will come to try again.
Before a bill reaches President Obama’s desk, of course, the Senate must merge its draft with the much more progressive version passed by the House. Given that Senate Democrats only narrowly blocked a Republican filibuster with the help of Joe Lieberman and other conservatives, it seems unlikely that the merged bill will include the provisions that were deal-breakers for right-leaning Democratic Senators. But there are less-hot-button issues that are still worth fighting on to ensure reform helps as many Americans as possible:
1) Affordability: The House generally does a much better job helping low- and moderate-income Americans afford coverage. For the very poor, it opens the Medicaid program individuals to who earn less than $16,245 per year, whereas the Senate only makes the program available to those earning less than $14,404. The Senate offers more subsidies to help the middle class buy coverage than the House, but the Senate’s subsidized insurance offers weaker coverage than that mandated by the House and leaves these Americans far more exposed to out-of-pocket costs.