An early look at next year's campaign messages on health care

Assuming the House and the Senate pass whatever health insurance bill comes out of the conference committee, Republicans and Democrats are likely to highlight the reform during next year’s campaigns. Recent polls have shown that most Americans don’t expect action by this Congress to improve the quality of their own health care or reduce its cost. Complicating matters for Democrats, key provisions of the bill won’t take effect until 2013 or 2014, giving Republicans plenty of time to exploit fears about the so-called “government takeover” of health care.

After the jump, Mariannette Miller-Meeks and Senator Chuck Grassley preview messages we’ll hear from GOP candidates across the country, while Senator Tom Harkin summarizes some “immediate benefits” of the health insurance reform.

Miller-Meeks is running against Representative Dave Loebsack again in Iowa’s second Congressional district. I assume she will win the GOP primary, but even if she doesn’t, the Republican nominee’s message on health care will probably sound a lot like this:

“The bill approved today will benefit insurance companies at the cost of the taxpayer and ordinary working, middle-income Iowans and Americans. It does not bend the cost curve down or control escalating health care costs,” the Ottumwa ophthalmologist said this morning. “It will increase health insurance premiums. Despite its tremendous cost, it does not provide universal coverage and, even more importantly, it fails to provide portable insurance for individuals so they’re able to keep their insurance coverage as they go from one job to another or one state to another.” […]

“The Senate bill is terrible. Unfortunately, the House bill is even worse. The entire process led by Harry Reid and Nancy Pelosi is a disaster for America because it’s going to cost trillions of dollars going forward and it’s going to make the health-care system worse instead of better. It’s already been widely reported that Nebraskans will never have to pay the increased costs for Medicaid. That was a deal that was cut to get Senator Ben Nelson to vote for it. We can only imagine how many more deals like that are going to have to be made at the expense of the American people so the Democrats can get the votes they need to take over our health care system.”

I don’t think Loebsack is vulnerable in his D+7 district, where Miller-Meeks couldn’t even crack 40 percent in 2008, but unfortunately I see a lot of Republicans getting traction with this kind of message.

When the drug industry’s lobbying arm PhRMA and insurance giant AETNA praise the Senate’s health reform bill (which won’t change much in conference), they reinforce the Republican talking point that this legislation wasn’t designed for the benefit of ordinary Americans. A public health insurance option would have been extremely popular, but Democrats failed to get that provision in the bill.

Senator Chuck Grassley claimed in his December 22 floor speech that by 2019, only 7 percent of tax filers will receive a subsidy for health insurance, while 93 percent “receive no government benefit” from the bill, and millions of middle-income taxpayers will in fact see a net tax increase. In other words, Republicans will be telling voters, “Democrats are only helping a tiny minority while making people like you pay more taxes.”

Next year, Democrats will need to make the case that health insurance reform is helping millions of people without forcing extra costs on Americans. Senator Harkin’s office listed some of the bill’s “immediate benefits” in a December 24 press release:

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions: the bill provides $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective in 2010, and coverage under this program will continue until new Exchanges are operational in 2014.

Access to Quality Care for Vulnerable Populations: the bill makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $10 billion investment begins in 2010 and extends for five years.

No Pre-existing Coverage Exclusions for Children: the bill eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the Managers’ Amendment prohibits health insurers from excluding coverage of pre-existing conditions for children, effective in 2010 and applying to all new plans.

Closing the Coverage Gap in the Medicare (Part D) Drug Benefit: the bill reduces the size of the “donut hole,” raising the ceiling on the initial coverage period by $500 in 2010.

Small Business Tax Credits: the bill will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.   Tax credits of up to 35 percent of premiums will be immediately available to businesses that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while businesses with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.

Free Prevention Benefits: The Patient Protection and Affordable Care Act will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect in 2010 and applies to all new plans.

No Lifetime Limits on Coverage: The Patient Protection and Affordable Care Act will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect in 2010 and applies to all new plans.

Restricted Annual Limits on Coverage: The Patient Protection and Affordable Care Act will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned.

Rural and underserved communities:  Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.  

Preventive medicine and public health training grant program: Amends and reauthorizes section 768 of the Public Health Service Act, the preventive medicine and public health residency program.

Loan repayment for faculty at schools that train physician assistants: Includes faculty at schools for physician assistants as eligible or faculty loan repayment within the workforce diversity program.

National diabetes prevention program: Establishes a national diabetes prevention program at the Centers for Disease Control and Prevention. State, local, and tribal public health departments and non-profit entities can use funds for community-based prevention activities, training and outreach, and evaluation.

Adjustment to Low-Volume Hospital Provision (“Tweener” Hospital Fix):  The amendment increases threshold for eligible hospitals from 1,500 Medicare Part A discharges per year to 1,600 per year.

Rural physician training grants: Authorizes grants for medical schools to establish programs that recruit students from underserved rural areas who have a desire to practice in their hometowns. Programs would provide students with specialized training in rural health issues, and assist them in finding residencies that specialize in training doctors for practice in underserved rural communities.

I hope new community health centers will be up and running quickly, because that provision should expand access to primary care and reduce unnecessary emergency room visits.

Harkin doesn’t mention the rule requiring insurance companies to spend 85 percent of their premium revenues either on medical care or on rebates to the insured. According to Bruce Webb, the Senate Manager’s Amendment contains that provision, which Webb explained in more detail here. If properly enforced, this sounds like an important regulation, though I don’t know how easy it would be for Democratic incumbents to convey this in a sound-bite format.

I would encourage Democrats to hammer on Republicans for their bogus claims about the health reform bill being too expensive. This story by the AP sums up the GOP’s hypocrisy (hat tip funluv1):

[W]hen Republicans controlled the House, Senate and White House in 2003, they overcame Democratic opposition to add a deficit-financed prescription drug benefit to Medicare. The program will cost a half-trillion dollars over 10 years, or more by some estimates.

With no new taxes or spending offsets accompanying the Medicare drug program, the cost has been added to the federal debt.

All current GOP senators, including the 24 who voted for the 2003 Medicare expansion, oppose the health care bill that’s backed by President Barack Obama and most congressional Democrats. Some Republicans say they don’t believe the CBO’s projections that the health care overhaul will pay for itself. As for their newfound worries about big government health expansions, they essentially say: That was then, this is now.

Six years ago, “it was standard practice not to pay for things,” said Sen. Orrin Hatch, R-Utah. “We were concerned about it, because it certainly added to the deficit, no question.” His 2003 vote has been vindicated, Hatch said, because the prescription drug benefit “has done a lot of good.”

Give me a break.

What do you think, Bleeding Heartland readers? Who’s going to make the more persuasive case to voters about health insurance reform: Republicans who say it costs too much without solving big problems, or Democrats who say it helps millions and pays for itself, no thanks to GOP obstructionists?

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