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Posted on
12/31/2009 5:24 PM EST
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Health insurance market expansion program
Somehow, between 2008 and 2009 the health insurance companies went from being blood-sucking vampires to becoming the victims of Big Government. |
Angelo Falcón
When we look back on 2009 in the Latino community, most of us will probably and reasonably see it as the year when Sonia Sotomayor became an Associate Justice of the US Supreme Court. To me, I don't know, the most emblematic event occurred on July 21st. That was the day when Gidget, the Taco Bell Chihuahua, died of a stroke at age 15. Gidget represented a time when the corporate sector still used stereotypes to sell to the American people and were eventually forced by Latino advocates to stop this practice despite its popularity (with the help of a major lawsuit). Gidget's death made me think of 2009 as the Year of "Yo Quiero . . ."
The Latino community in 2009 is saying loud and clear, "yo quiero . . ." real heath care reform, but it looks like we're all getting what I prefer to call a "Health Insurance Market Expansion Program." Somehow, between 2008 and 2009 the health insurance companies went from being blood-sucking vampires to becoming the victims of Big Government, a transformation I am still waiting for someone to fully explain to me.
As this "Health Insurance Market Expansion Program," the legislation being worked on in Congress now has many improvements over the current health insurance system, including contributing to reducing the federal budget deficit. In exchange for expanding their markets by over 30 million new customers through mandated coverage, the health insurance companies will have to limit their profit rates, ignore pre-existing conditions, have to participate in exchanges, they don't have to pay for all abortions, and so on.
They also get a lot of protections: their ability to raise their rates is not affected, they can charge more to older and sicker customers, they don't have to face new public sector competition from either a public option or a Medicaid expansion, and so on. Some details need to be worked out next month between the two chambers of Congress--like will this be paid for with a tax on sun tanning salons, union health plans, "Cadillac" health plans and/or the rich--but it looks like this is more or less a done, if no doubt rocky, deal.
If you are having trouble following all these provisions of and changes in the various bills and amendments (and if you are a human being, you should be), check out the very useful summaries and comparisons by the Kaiser Family Foundation.
There are those who think that it might still be possible to bring in the public option or the Medicaid expansion back in to the legislation during the conference session, but we will have to wait and see about that. Basically, it appears that efforts to decommodify health care have failed. One casualty, many analysts have concluded, is health cost containment (as well as quality control) that will probably create what some call a substantial "expectations gap" for many Americans, especially in the short run.
This is bad news for Latinos, who have the highest percentage of people without health insurance (31 percent or 15 million Latinos in 2008) and collectively have among the lowest incomes in the United States ($15,674 median per capita income in 2008, which is only 55 percent that of non-Latino whites). But to add insult to injury, this legislation continues to treat large segments of the Latino community as nonentities and/or second class citizens, you know, like dogs.
In this legislation, Latinos and others who are in this country as permanent legal residents will be required to wait five years before they can participate in Medicaid (although there is a provision that the poorest of these could get some basic health services during this waiting period). The 5 million United States citizens in the territories, mainly from Puerto Rico, are excluded from the exchanges in the legislation and continue to be shortchanged in Medicaid reimbursements. And, of course, the undocumented largely remain outside of and e-verified out from the health insurance system. It bears watching closely how the Congress and president treat the undocumented in this legislation because it will have important implications for the success of a fair comprehensive immigration reform bill this coming year.
Advocates in, like Senator Robert Menéndez (who got in some help for so-call mixed families who have undocumented members), and the Congressional Hispanic Caucus, as well as the National Council of La Raza, Latinos United for Healthcare, the US Hispanic Chamber of Commerce, and others, are working hard to change these inequities in the forthcoming conference negotiations (that will include Rep. Xavier Becerra, and senators Harkin and Baucus, who should all hear from you). Let's give them our full support and hope they are successful, but it will be a truly heavy lift at this point.
On balance, the argument being made by the Obama administration is that this legislation represents progress and should not be easily dismissed. This may be the case, but it seems disingenuous for those people in the administration and the Congress who raised expectations about more sweeping and equitable changes in the health insurance system to tell those they stirred up to now calm down. The way that internal congressional politics is now covered by the media, especially by cable news, has created an unanticipated transparency that relentlessly reveals an unsavory wheeling and dealing that was there all along but was never so evident to the public. Its' political impact in the 2010 elections will be interesting.
Once the dust settles and the health insurance bill is passed, it will be up to President Obama to tell the Latino community how he plans to fix things in ways that make health care more accessible and affordable to Latinos and all Americans (and, as a community, we need to insist that he do so). But as he does so, we should all never forget President Bill Clinton's promises to our community back in 1996 when he championed the so-called bi-partisan welfare reform bill that created so many new hardships for the Latino poor and immigrants that are still with us. Back then, he promised to fix things after the bill was passed and never did. I tell you, these politicians sometimes treat us Latinos like dogs . . .
You know, after thinking about it, forget about 2009 being The Year of "Yo Quiero . . ." -- "The Year of the Wise Latina" feels better. I think Gidget, que descanse en paz, would agree.
Angelo Falcón is president of the National Institute for Latino Policy (NiLP) and editor of the Latino Policy eNewsletter.
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