Signed, Sealed, but Not Delivered: Six Big Flaws Need Fixing to Make New Law Meaningful Health Care Reform

This health care reform bill passed late last night and soon to be
signed into law is a seriously flawed piece of legislation, for it fails
to achieve the goals of real health care reform. Now that it is
essentially the law of the land, the country needs to work diligently at
the federal and state levels to correct many of the most egregious
problems with the legislation before the reform package fully goes into
effect in 2014. The six main areas that need to be fixed are: cost
control, enforcement, individual mandate, abortion, competition, and
immigration.

1) Lack of Real Cost Control

This bill does not create real cost control and will not bring down
premiums for most Americans. Congress and state legislatures need to
adopt real cost control measures like: drug re-importation, Medicare
direct drug price negotiation, a public insurance option, Medicare
buy-in, or a central provider reimbursement negotiator (all-payer
system). These changes would save the government and regular Americans
hundreds of billions of dollars over the next decade.

The bill also needs to provide a better pathway for states to opt-out
of this bill so they can experiment with better health care models that
could truly bring down cost.

2) Dangerously Weak Enforcement

There are some good new regulations, but regulations are only as good
as the strength of the agency tasked to enforce them. This bill is
dangerously lacking in this area, leaving enforcement mainly up to the
same state insurance commissioners that now often lack the will,
funding, or power to hold the private insurance companies honest. Only a
national exchange and a federal insurance commissioner would have the
power to make sure the new regulations are more than over-hyped window
dressing.

3) Individual Mandate

The individual mandate, which uses the IRS to force people to buy a
product from a poorly regulated, private industry, is an affront to the
American people. The policy is not needed, and must be corrected before
it has a chance to go into effect. People must be offered the choice of a
public alternative, or the individual mandate must be repealed.
Alternatives like a back premium payment system could achieve a similar
policy goal to an individual mandate without a massive expansion of the
IRS or government coercion.

4) Abortion

This bill is a massive rollback of a woman's right to choose. It
would take away the abortion coverage of millions of Americans. The
system of exchanges and affordability tax credits could easily be
modified to ensure federal funds are not used to pay for abortions,
while still not taking away the ability of women and small businesses to
buy insurance packages that cover abortion. Having an individual
mandate that forces women to buy insurance, but also a law that prevents
them from getting insurance that covers a legal medical procedure, is a
disgusting abuse of women's rights.

5) Lack of Health Insurance Competition

The bill will do almost nothing to address the problem of lack of
competition in the health insurance market. Repealing the anti-trust
exemption and adding a public option would be two big steps toward
solving the problem. Creating an all-payer system would make it easier
for new insurers to enter new markets. Requiring a standardized
insurance package, instead of a confusing set of choices based on
actuarial value, would allow Americans to do real apples-to-apples
comparison shopping. Finally, adding much stronger risk adjustment
mechanisms would force insurance companies to compete on quality instead
of on avoiding the sickest Americans.

6) Immigration

Under this almost-law, undocumented immigrants would not be allowed
to buy insurance on the new exchanges, even if they are willing to pay
the full cost of the insurance with their own money. This policy is not
only cruel and immoral, but fiscally irresponsible. The more
undocumented immigrants that pay for their own health care, the more
taxpayers save by not being forced to pick up the cost of undocumented
immigrants' uncompensated care when they use the emergency rooms.

The White House and Democratic leaders have made many promises about
health care reform throughout this long and winding process--from
guaranteeing affordable, quality care for everyone to pledging tougher
regulation of the medical industrial complex that created this broken
system in the first place. If the majority party wants to honestly
deliver on these promises--not to mention if they want to remain in the
majority--then a concerted and immediate effort is required to prove that
this week's legislation is truly the first step toward reform, and not
the last.