Yesterday the House of Representatives made history by passing HR 3692, The Affordable Health Care for America Act.  We are finally one step closer to joining the rest of the developed world in providing health care for our people.  The bill is not perfect, but I am proud that 218 Representatives, including Rep. Cao, saw that this is an amazing opportunity to make an impact in the lives of tens of millions of Americans, and a huge stride in the direction of steering our broken health care system in the right direction.  Rep. Dennis (It's not good enough because it's not my bill) Kucinich and 38 other "Democrats" voted no.

THE GOOD

Momentum, momentum, momentum - I think that the most important thing that the passage of the bill does is create/sustain political momentum for health reform as well as other progressive initiatives as well as creating some momentum for reforming health policy.

Universalish Coverage  - are people still left out?  Yes, but are millions more covered?  YES!  This will represent the largest ever expansion of Medicaid ever as well as the inclusion of tens of millions who have been left out of the health care system.  Coverage will also be more secure, and you won't have to worry about losing coverage if you lose your job, lose your spouse, can't marry your spouse, your job stops covering benefits etc.

Affordability - individuals up to 400% FPL will pay for health care based on how much they can afford - not how much health care they use.  There will be affordability subsidies and a cap on out-of-pocket costs.  And prevention services will be free!  Those who are financially eligible will participate in an Insurance Exchange where they will go to choose from participating private plans and the public option. 

Insurance Regulation - Insurance companies will no longer be exempt from anti-trust laws, they must cover all standard benefits and will no longer be able to sell junk insurance that covers nothing and bankrupts families, and they will no longer be able to deny people due to pre-existing conditions or charge more based on gender or other factors!  All insurances

Public Health Insurance Plan - The "Public Option" will be available for those who choose to be covered by the federal government's insurance plan, rather than a private, profit-driven one.

Fiscal Sustainability - Bends the cost curve, steers the health care system away from fiscal demise through reduction of waste and employer assessment.  Health Reform will pay for itself and reduce the deficit!

Special Funding for Special Populations  - Increased reimbursement for providers in rural and high need areas, increased funding for communities of color and other populations who suffer from health disparities. 

THE BAD

The Public Option  - The Public Option was created with the hopes that the government would be able to set the rates that they paid to providers.  This rate would be at Medicaid +5 percent.  The government manages costs by setting rates instead of having to negotiate rates.  (In return, providers benefit from increased volume of clients.)  In a significant concession made during the debate, rates will now be negotiated by the government on behalf of the Public Option, and how good that rate ends up being will likely depend on how many customers are being promised.  This is of course significant because the Senate is considering a plan that would let states "opt out" of a public option.  That would reduce the buying power of the plan as a whole.

The 5 Year Bar - Attempts to lift the 5 year bar were not successful, which means documented immigrants would still have to wait 5 years before being eligible for health care affordability subsidies or the Public Plan.  This is disappointing, but I'm not sure many advocates believed that the health care bill would be more progressive on immigration than existing immigration policy.  

THE UGLY

Stupid Stupak - The Stupak Amendment expands the Hyde Amendment which currently prohibits federal funding of abortion.  Presumably, under existing law (the Hyde Amendment), the Public Option would not be able to pay for abortions.  However, people up to 400% of the FPL would be purchasing insurance from the Exchange and choosing from participating private plans or the Public Option.  Under the Stupak Amendment women who chose private plans would not be able to have abortions covered, even if the private plan offered it.  In fact, anyone who got any kind of subsidy (no matter how small) would not be allowed to purchase a private plan that covered abortion.

Anti Immigrant Language - In response to the Joe Wilson outburst, the Senate inserted language in their bill that would exclude undocumented immigrants from purchasing insurance through the exchange with their own money, completely unsubsidized.  In addition to being based on fear and hate, it is absolutely ridiculous from a policy perspective.  Allowing people to buy in to the exchange or public option without any subsidies means increase business for insurance plans.  This increases the purchasing power of the exchange and the Public Option at no cost to the federal government because these folks would be buying in without subsidies.  This language is NOT in the house bill that passed, but is pretty likely to end up in the conference bill.

What's Next?

The Senate is still awaiting CBO scoring of their bill.  Then, they must avert filibuster in order to pass the bill.  While the Senate bill is currently more progressive than we initially expected it to be, it is less progressive than the final version of the House bill.  Once the Senate passes their bill, both bills go to Conference Committee where the Administration and the Leadership weigh in.  

While the passage of the House Bill was an important step - it is not over yet.  We have a lot more work to do.  No one ever said that changing our Country would be easy - in fact I seem to recall the President telling us that it wouldn't be.  Please don't dismiss this bill as not being good enough.  And please don't think our work is done.  There is still a long way to go and a lot of opportunity for us to fight for what we believe in!