By John Sawyer
It’s been one heck of a month since Congress adjourned at the beginning of August. Beyond the shout-downs at Congressional town-hall meetings across the country, health center advocates celebrated the largest and most written-about National Health Center Week on record, with more than 800 events held nationwide. For the first time ever, a sitting Secretary of Health and Human Services addressed the NACHC Community Health Institute and EXPO, and Secretary Sebelius showed herself to be a “true believer” in health centers. And just as the self-described cause of his life entered the final stages, the nation’s health centers lost our “founding father”, Senator Edward Kennedy.
Today, Congress returns to Washington. Tomorrow, President Obama addresses a joint session of Congress, and the nation, in a late-inning push to find a deal that will make meaningful health care reform a reality. So where do we stand?
On the substance of reform, many would say (and I’d generally agree) that there’s overall agreement on perhaps 80% of what must be done. We should regulate insurance companies so they don’t discriminate against those with pre-existing conditions or folks who lose their jobs. We should require that everyone purchase coverage, and create a new national marketplace where they can do so (with subsidies to help lower-income people with the cost). We should expand the Medicaid program to cover more of those in need, and we should invest in prevention and wellness programs.
The other area of general concensus is that in order to ensure that the promise of expanded coverage becomes the reality of quality care for all, the nation must invest in the growth of programs like Health Centers and the National Health Service Corps. Each proposal released this far (four out of five Congressional Committees have acted) includes a call for significant growth in the primary care safety net through these vital programs. Every health center advocate will be called on to do his or her part in the months ahead to make sure that investment is included in the final bill, and that it is matched with guarantees that health centers will be full and fair participants in any new system.
The sticking points boil down to two big ones:
First, the politics of a “public option”, the proposed new government-run insurer that would compete against private plans in the new Exchange. In the House, the (more liberal) leadership says a bill can’t pass that chamber without one, while in the more moderate Senate, some leaders say it can’t get the 60 votes needed to overcome a filibuster if it does have one. Meanwhile, because it falls into a classic left vs. right debate over public vs. private solutions, the “public option” has been brought to center-stage by Democrats and Republicans alike, despite the fact that the reform proposals comprise much much more.
The second major sticking point is on cost – both the cost of the bill itself, and whether or not it does enough to bring down the overall costs of health care in this country. There is little concensus as of yet on how to pay for reform, which (largely because of the subsidies mentioned above) would cost in the neighborhood of a trillion dollars over the next ten years. And while efforts at promoting more efficiency and higher quality in the health care delivery system are in the bills at the margins, these provisions often don’t save that much money, and can be some of the most controversial (witness the “death panels” debacle of the summer).
So as he addresses the Congress and the nation on Wednesday, President Obama must not just make the case that reform is needed or that his preffered solution is the right one. In the words of one Sunday-morning commentator this week, he must “grab a deal”, threading the needle of ugly Congressional process, high-stakes national politics, and a highly personal, if mind-numbingly complicated, subject.
We’ll be in touch with all of our advocates in the days, weeks and months to come. We are keeping our “eyes on the prize”, that is to say the ACCESS For All America goal to preserve, strengthen and expand the role of health centers within the health care system in order to bring access to high quality, affordable primary and preventive care to every patient in need. After decades of debate, should health reform pass, its success could well depend on our own.