Volume 17, No. 1, Winter 2009
By Congressman Bill Delahunt
In the aftermath of the historic election of Barack Obama as President, many have been asking me if healthcare reform will remain a national policy priority. With the United States facing the worst economic conditions since the Great Depression while fighting two major wars and confronted with a spiraling deficit, there is growing concern that sufficient fiscal resources may not be available to reform our healthcare system.
This concern is legitimate. But I would counter that the current climate actually makes healthcare reform an even greater priority.
With unemployment on the rise, state Medicaid budgets are expected to increase significantly along with personal bankruptcies associated with healthcare. Emergency rooms and community health centers also will be under increasing pressure.
Therefore, in my view, the current economic downturn makes it even more important that we address the need for universal health insurance.
The real question is, can we afford not to do it?
I agree with Massachusetts Institute of Technology economist Jonathan Gruber, who argued in the New York Times that healthcare reform actually would be good “stimulus” for our economy. He pointed out that “the greatest fiscal threat facing this nation is the growth in the costs of healthcare.” He cited a recent projection by the Congressional Budget Office that said that the share of the economy devoted to healthcare will double by 2050 while costs have more than tripled as a share of our economy since 1950.
He also pointed out that “one of the most effective ways to spend would be to give states money to enroll more people in Medicaid and the State Children’s Health Insurance Plan. This would free up state money for rebuilding roads and bridges and other public works projects. This is spending that could create jobs.”
He also argues that most plans for universal healthcare call for investments in health information technology, including the computerization of patient medical records. And this would create millions of technology jobs to create a new healthcare information system.
Mr. Gruber’s final argument is that expanded insurance coverage also would bolster the demand for high-paying, rewarding jobs in health services and “stimulate more consumer spending, as previously uninsured families would no longer need to save every extra penny to cover a medical emergency.”
To get a sense of what may emerge as part of an overall plan, it would be wise to take another look at what candidate Obama outlined during his Presidential campaign:
Guaranteeing Eligibility: Require all insurance companies to cover pre-existing conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair and stable premiums.
New Affordable, Accessible Health Insurance Options: Create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance, whether the new public plan or an approved private plan. Income-based sliding scale tax credits will be provided for those who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.
Tax Credits For Families And Small Businesses: Provide tax credits to all individuals who need it for their premiums. Create a new Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit, small businesses will have to offer a quality health plan to all of their employees and cover a meaningful share of the cost of employee health premiums.
Large Employer Contributions: Large employers who do not offer meaningful coverage or make a meaningful contribution to the cost of quality coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement.
Coverage for all Children: By expanding Medicaid and the State Children’s Health Insurance Program.