Six months after the passage of health care reform, it is easy to forget how far we have come in such a short time. With the daily drumbeat of attacks on the law, full of distortions and appeals to people’s fears, it is no wonder that many Americans still have serious doubts about whether they will be better off.
So this is a good time to remind ourselves of what has gone right with the law and how much better our health care will be in the coming years if we give the new law a chance and work together to make it a success. It will take years to make the law’s most important changes. But by the time they are in place, if all goes well, most Americans truly will be better off. And they will not want to go back to what we used to have.
For one thing, the implementation of the law has been encouraging in its early stages. Right after President Obama signed the legislation into law in March, the Department of Health and Human Services faced a formidable series of deadlines. By the summer, it had to launch a new temporary high-risk pool program for people with pre-existing conditions, start a program to help businesses cover the health care costs of early retirees, and develop a Web site to help people research their health insurance options.
By September, it had to issue rules on several important new consumer protections, including coverage for young adults and children with pre-existing conditions. It had to help businesses and health insurers understand what they had to do to keep “grandfathered” status for their health plans, which will exempt them from some of the new rules. And it had to start gathering feedback on the biggest changes to come in 2014, like the creation of the new health insurance exchanges in all of the states.
Somehow, it has done all of these things, and mostly on schedule. The early programs have begun, the rules are out, and the Web site HealthCare.gov has lots of user-friendly information about the law and people’s current insurance options. They have only missed a few minor deadlines, and nothing that would put the success of health care reform in jeopardy. For the most part, where the Administration hasn’t gotten it exactly right, they’ve released additional guidance, clarification and have worked with stakeholders to try to make it right.
The states are rising to the challenge, too. Yes, there is resistance by the governors and attorneys general in many of the states. But what you don’t hear about is the diligent work that is going on behind the scenes, by the state officials who are focusing not on the politics of reform as their political leaders are but on the practical questions of how to make the law work.
Throughout the country, many states including a few of the ones that are suing to overturn the law — have set up task forces to prepare for the implementation of the biggest changes, including the exchanges and the expansion of Medicaid coverage. HHS has just given grants to 48 states and the District of Columbia to start planning the exchanges. Even Virginia, which is challenging the constitutionality of the law, has set up a group of state officials to plan for the implementation of the law while the state lawsuits work their way through the courts.
And the National Association of Insurance Commissioners should be commended for working through one of the most difficult issues: how to implement the new medical loss ratio requirements. This was an almost impossible balancing act. How do you make large group health insurers spend at least 85 percent of their premium revenues on health care services — 80 percent for individual and small-group insurers — without getting paralyzed by arguments over the complexities of what should count as medical costs? After months of work, however, the commissioners have proposed a solution that may make all sides reasonably happy which means HHS will have a good blueprint to work from when it writes the regulations.
It is also worth reviewing the important changes that are already taking place. The biggest improvements in the health insurance marketplace will not begin until 2014, but already, there are new measures that will protect consumers from dangerous holes in their coverage.
If you’re an adult with a pre-existing condition, and you have been unable to obtain health insurance for six months or longer, you can now apply to temporary high-risk pools in all of the states that can help you get coverage. The pools — some run by the states, others by the federal government — will act as a safety net until 2014, when health insurers won’t be able to turn you down if you have a health problem.
And as of Sept. 23, the six month anniversary of the law’s enactment, a whole new set of protections is phasing in: coverage for children with preexisting conditions, coverage for young adults through their parents’ health plans, a ban on lifetime limits on people’s benefits, more generous annual limits on their benefits, better appeal rights, and the end of the practice of “rescission” — cancelling people’s coverage retroactively when they get sick. These are not all of the changes the law will make to give people more reliable health coverage. But they are an important start that will keep many of the most vulnerable patients from falling through the cracks — as long as the administration and health insurers work together to find the right balance on the regulations.
There is no point in pretending that everything is going perfectly. There certainly are places where the law could have done more — like providing more funding for the high-risk pools — and issues to watch closely, like what will really happen to premiums as these new protections begin. And there are many things that will have to go right in the coming years, especially the creation of the new exchanges and the experiments in new ways to deliver and pay for health care. The success of those efforts will depend on collaboration among stakeholders across the spectrum.
But it should not be a surprise that we will have to make changes and improvements along the way. No major reform, from the establishment of the Federal Reserve to the creation of Social Security, Medicare and Medicaid, ever happened perfectly on the first day. The new law is easily as significant as those achievements. We should work through whatever problems we find, but we should never lose sight of what we have already accomplished.
Six months ago, we broke through decades of stalemate to give ourselves the chance for the better, cheaper, more reliable care all Americans deserve. It may take years to find out how close we have come. But we will only get there if we give the law time to work. Now is not the time to repeal it or starve it of funds. Now is the time to give the new law a chance.
Tom Daschle, a former senator and Senate Majority Leader from South Dakota, is a senior policy advisor to the law firm of DLA Piper. His book on the passage of health care reform, “Getting It Done: How Obama and Congress Finally Broke the Stalemate to Make Way for Health Care Reform,” will be released Oct. 12 by Thomas Dunne Books/St. Martin’s Press.