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This Week in Health Care Reform EasyToInsureME health insurance

JANUARY 22, 2010

This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday's Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat's 60th vote in the Senate opens up the legislation to a Republican filibuster - something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama's desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called "reconciliation," which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee's bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under "reconciliation" procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats - hesitant to push through such a huge partisan bill in light of the Massachusetts election - urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a "fail-safe mechanism" in the final bill. This mechanism would give Congress "the tools to keep costs under control should the current savings estimates fail to materialize."

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional $10 billion or more, over and above the $80 billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to $90 billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night's Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a "step backward."

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

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Open to EVERYONE: What do you want in Adoption Reform?

Since several people have been blocked from answering the original question, I thought I would post the question open to everyone to respond. (Since I prefer not to censor people.)

The question was actually list of 5 questions. Here are my responses.

1) All adoptions should be open (if i'm correct, to what degree of openness?)
On a legal level, if an adoption is an open adoption, the open adoption agreement needs to be legally enforceable. On a more personal level, I do believe open adoption is preferable.

2) If I'm incorrect about #1, is it that you want guardianships instead of adoption?
I feel that in a number of cases that guardianship is preferable to adoption. This is particularly true in the case of family members who are taking over the care of a child.

3) All OBC are made available at any time (prior to 18).
I am for all OBC's being made available to adult adopted citizens, just as they are available to all adult non-adopted citizens. Equal treatment under the law.

4) for profit agencies and private adoptions should be abolished.
For profit agencies are money-driven. Something as important as the issue of having a child leave his/her family to become a part of another family should not be facilitated by organizations who may be skewed in the direction that will make them the highest profit. Private adoptions cause a number of problems, are they are normally pre-birth matches. I have previously discussed the problems I see in pre-birth matching for all parties involved, including the PAP's.

5) The baby should stay with the mother for an extended period of time prior to relinquishment;
I do believe it is best that a mother and child spend some amount of time together prior to relinquishment. Giving up one's own flesh and blood is a decision of great gravity. It should not be taken lightly. It is one thing to make such a decision when the child is yet unborn and not a full reality in the mother's life, so to speak. It is another for that mother to make that decision after the child has become a more complete reality in her life. This practice is utilized in Australia and works well to keep families together who don't necessarily need to be apart.

ETA:
With regard to Shelly's response which states:
"Now as for sealed vs open records.. this DOES get a little trickier.. say what you will, adoptees have rights, but SO DOES the birth mom.. I MAY hesitate to PROHIBIT her from remaining anonymous to her child, IF THAT'S what she wants!!.. Again, extensive medical records should always be provided.. the adoptee NEEDS to know what problems, diseases, etc.. are in his/her genetics.. but as far as being able to be tracked down.. if a bmom really doesn't want to be "found" I don't know that it would be a good idea to FORCE her to give contact info, etc.. when you put one person's right up against another's.. it's always tricky.."

I realize you are stating support for equal access, but I just want to point out a few items regarding birth records and "rights."

Under the law, original birth certificates do NOT seal when parents relinquish their children. They remain unsealed and, in fact, remain the relinquished children's only legal birth certificates. Therefore, there is no guarantee or "right" of anonymity under the law. In fact, there is no anonymity at all. Birth certificates only seal if and when an adoption finalizes by the court. In Ohio and California, the adoptive parents and the adoptee can decide whether or not the original birth certicate seals. The first parents have no say in that.

There is also no Constitutional right to anonymity. First parents already have the very same privacy rights as all other citizens. Adult adoptees do not.

So, it's not an issue of one person's RIGHTS against another person's RIGHTS. Anonymity may be a desire in some cases, but it's not a right in any state. Unconditional access to one's birth record, however, is a right in every state -- unless a person happened to be adopted (in which case the record seals) -- as adopted persons do not have that right in 44 states. Two of those states never sealed records from adoptees, and the hard work of reformers got records reopened in the other four.

Getting one's OBC is not about finding someone. It's about equal rights. People are going to find each other all the time, closed records or not. It already happens all of the time. In 4 of the 6 states with open records, the first parents can state whether or not they want contact. With closed records, there is no way for first parents to communicate that preference.

ETA:
Shelly: Yes, I know you hold a stance of support of OBC access for adoptees. That is why I started off my reply following the quote of your paragraph with the sentence:

"I realize you are stating support for equal access, but I just want to point out a few items regarding birth records and 'rights.'"

I wanted you to know I understood your stance before adding the additional comments.

Thanks,
Laurie

Health-care overhaul leaves Democrats in stable condition
After steering the landmark health-care reform bill through Congress, the Democratic Party's leaders have emerged mostly unscathed, according to a new Washington Post poll, but they have not received a notable boost in approval ratings.

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