Friday, January 07, 2011

EDITORIAL >Debating health care

It will be a grand bit of theater next week when the U. S. House of Representatives votes ceremoniously to repeal the Patient Protection and Affordable Care Act, the big health-insurance law that is being gradually phased in.

Republicans now have a substantial majority plus a few blue-dog allies on the Democratic side, so the outcome is foregone. It is altogether ceremonial because the repealer will then go to the Senate to die. But the play is the thing, as Shakespeare might say. A vote to repeal the law, Republicans believe, will be popular, if only momentarily. A substantial part of the population still believes that a committee of government bureaucrats will decide which sick people will get life-saving treatment and which will have to die, that the government will take over the medical system and ration care, that their Medicare coverage will be slashed, that large employers will fire people if they have to start providing health insurance, and that the law will add trillions to the national debt.

None of those is or was ever true, but they formed the story line of the insurance companies, the U.S. Chamber of Commerce and other right-wing groups that flooded the airwaves and newspapers with advertisements in 2009 and 2010 before the law’s enactment. The non-partisan Congressional Budget Office, which has enraged both parties with its warts-and-all analysis of health-care and other legislation, told the new House majority this week what it did not want to hear: Repealing the Affordable Care Act will enlarge the deficit by $230 billion over the next 10 years. (Democrats insist that it would enlarge it far more than that and Republicans say it would cut the deficit.)

The CBO said the Affordable Care Act will not produce some of the benefits its authors claim, such as generally lower insurance premiums for people who are already covered, but it said the very obvious was also true: If it is repealed, 32 million people who will get insurance under the law will lose it, Medicare recipients will pay much more for their medicine and lose the new coverage for mammograms and other health screenings, the economies forced by the new law will be lost, and people who are already covered and those who would get coverage under the law will lose the protections from insurance company abuses. Insurance companies will once again be able to stop coverage when people get sick, deny insurance to children and adults with pre-existing conditions and spend vast sums on executive salaries and advertising and pass the costs on to insurance buyers.

Arkansas’ congressional delegation, including our own new delegate, Tim Griffin, will vote to repeal. We assume that the number also will include Mike Ross, the returning Democratic congressman from south Arkansas. Ross strongly advocated a universal health-insurance law and supported the major parts of it, but in the end he said he was voting against the bill because many voters in his district told him to.

Ross, of course, could vote against repeal and say he would help amend the law to remove features he finds objectionable or add others that he thinks will lower costs, but the new speaker, John Boehner, will not allow that. When he took the gavel Tuesday, Boehner promised “a new day” in the House where the legislative process would always be open and amendments and debate entertained. The next day, he said it would not apply to the health bill. No amendments can be offered or debated. He explained that he would decide when the legislative process would be open and when it would be closed, which is how it has always been.

We have a lot at stake in the real battle over insurance reform, which will come after the repeal circus closes and the two houses work on amending the law, chapter by chapter.

No state will benefit as much as Arkansas when the law is fully implemented in three years. That is because Arkansas has about the lowest level of access to health care in the country, and in the six years after it is implemented, more than $12 billion will be pumped into the state to provide medical and hospital care, outpatient therapy and medicine for people who cannot afford it. It will be a bonanza for rural Arkansas and rural hospitals. Public insurance will be provided for adults whose incomes are so low that they cannot afford insurance, and hundreds of thousands of others will get a subsidy to help them buy insurance individually or through their jobs. A half-million Arkansans on Medicare will get increasing help in paying for their medicine and preventive care like colonoscopies and mammograms.

Everyone, whether they have insurance now or obtain it under the new law, will be protected from insurance abuses that make most Americans despise or fear the insurance industry.

The good thing about the coming battle is that all those things will have to be debated, this time without the din of a million commercials. It is not a debate that the Republicans should look forward to.