Patriotism with a Public Option

November 12, 2009

Introduction

Let me start this post with a few housekeeping matters.  I am definitely going to try to limit what I write this time, as I realize six or seven pages can seem a bit overwhelming.  Frankly, there is so much about which I could blog, but I will have to do it in shorter but more frequent posts.  I'm sure many of you will be thankful for that.  Yet, I cannot guarantee this post will be the beginning of that trend.

Veterans Day for All

This blog post, however, is dedicated to veterans, both present and past, who have done more heroic and seen more horrific things than my feeble mind could ever imagine.  Though you may not get this blog post update until today, it was written on Veterans Day with the full weight of what that day encompasses in the forefront of my mind.  However, even as we celebrate what veterans have done for us, we must realize what we have not done for them.  That leads me to my next point.

I discovered just tonight that a recent Harvard study showed that 2266 veterans died last year because they did not have health insurance.  Many of these veterans could not afford private health insurance and, yet, were not considered "disabled enough" to receive benefits from the Veterans Administration, according to Paul Rieckhoff of Iraq and Afghanistan Veterans of America (IAVA).  There is a bill in the Senate at this very moment, which could ease some of these issues for our veterans.  Unfortunately, Senator Tom Coburn (R-OK) has put a hold on this legislation, which effectively ends its progress toward becoming law until this senator is satisfied.

The legislation is Senate Bill 1963, entitled "The Caregiver and Veterans Omnibus Health Services Act."  This bill enhances VA health care for female veterans, allowing for new training for VA mental health providers on how they can better serve veterans who experienced military sexual trauma.  It supports family caregivers of veterans with severe disabilities by giving them access to counseling, support, and a living stipend.  It expands mental health services to rural areas where veterans often have to drive hundreds of miles to seek such care.  Further, it improves traumatic brain injury care and provides additional programs for homeless veterans.

Despite all these potential benefits, Sen. Coburn is playing politics with this bill.  Nearly every veterans group in the country supports the legislation, and it is bipartisan.  Still, Coburn sees fit to stall this legislation until he believes the government can adequately pay for it.  He also thinks it is wrong that this bill only applies to Iraq and Afghanistan veterans.

I would remind the senator nearly 5000 Iraq and Afghanistan veterans have already paid for this bill with their lives.  Does he believe the veterans who came home deserve to pay more than they already have?  Many now have newly acquired disabilities with which they will have to live and adapt for the rest of their lives.  They have suddenly entered two minority groups, one of which I am quite sure they thought they would never see.  I am convinced, despite the senator's resistance, that our government can find the money.  In fact, I am equally certain both sides of the aisle will agree it is our moral and patriotic duty to do so.  For more information, go to http://iava.org/and click on the Legislative Dispatches tab.

Option Routes

Last Thursday, November 4, I went to a rally here in Springfield sponsored by MoveOn.org.  We were trying to gain support from Rep. Aaron Schock on the Affordable Health Care for America Act, which was set for a vote on Saturday night.  It barely passed by a vote of 220-215.  (If you know me, you will not be surprised that I watched the entire voting process on C-SPAN until the wee hours of the morning, which is one reason this post is late in coming.)  One Republican voted for the act.  It wasn't Schock, though he was voted Hottest Congressional Freshman by Huffington Post readers in case you were wondering.  The Republican who did vote for the health care bill was Louisiana Rep. Anh "Joseph" Cao, who comes from a very poor and predominantly Democratic district.  Apparently, those of us in Schock's district are not poor enough or Democratic enough.  Yet, I digress.

Something that really caught my attention at the rally, which received quite a bit of support from passersby, was the lack of knowledge many people displayed regarding the public option in the health care bill.  I don't expect people to follow politics as incessantly as I do.  In fact, if people did, it would truly frighten me.  Still, I was surprised that people asked us about signs supporting the public option and this thing called "choice."  To me, and again, consider the source, this was not a tremendous leap in logic.  Then, I realized people had lives and do not necessarily have time to do endless Internet searches on the public option, its pros and cons, and who gets affected most by it.

Therefore, I thought I might do that myself for those who have questions but not the time to get them answered.  This is my attempt to explain the public option in simple and straightforward terms.  It will not be complete.  It will not satisfy many people.  It will come from a liberal or progressive perspective.  Further, I will not be addressing the entire bill, particularly its funding sources, the expanded agencies, or any other controversial aspects of the legislation.  Yet, if this explanation helps just a few people, I think it will be worth it.

First, it is necessary to say this.  By definition, the public option is optional.  No one needs to worry about being forced to accept some government program that will tell you where and when you can go to receive health care.  It is simply a proposed health insurance plan offered by the U.S. federal government as a Qualified Health Benefit Plan.  No one would have to take it, and as it stands currently, most people would not even qualify for it.

So, you ask, who does qualify for it?  Moreover, if it is a government plan, who pays for it?  First, you have to be a citizen, as undocumented immigrants are not covered in any way by this bill via the public option or any other process.  If you are a citizen whose employer does not cover you with their insurance policy, you could choose the public option.  If you are not covered by any other state insurance plan, you could choose the public option.  If you do have insurance through your employer but want something different or better, you could choose the public option, though many in that situation will not.  (Trust me that this is not going to turn into a Jeff Foxworthy routine.)  As for how the public option is funded, it is financed completely through premiums paid by those getting the coverage, though the premiums would be far lower than private health insurance premiums and likely based on some kind of scale based on a person's ability to pay.  I hasten to add that last point is strictly based on my interpretation of how someone would pay premiums.  Further, in the House bill that just passed and in the Senate Health, Education, Labor, and Pensions Committee bill, there are clauses that require repayment of "seed money" to the Department of the Treasury over a 10-year period.  This means taxpayers are not on the hook for the public option, though I am sure many of you will disagree.

The idea of choice comes into play when you consider that many states have only one company or a small set of companies controlling the entire local health insurance market.  There are no antitrust rules in place to govern health insurance companies as there are for nearly every other business venture in the nation.  That means health insurance companies have very little competition and, consequently, very little reason to lower their rates.  Since there are only five or six major health insurance companies in the country, it does not matter that much to the other companies if one company controls the entire health insurance market for one state.  Another company might control a different state.  What this situation does not do, however, is give the citizens of that state any choice in which health insurance provider they can choose.  The public option would change this.

The public option provides competition to insurance companies but choice to consumers.  Health insurance companies argue that without a profit motive or a reason to make money, which the public option does not have, there is no guarantee the government will cut waste, and private insurers will be forced out of business in the process of trying to compete.  The counter to this argument, however, is that traditional market competition does not exist for health insurance companies.  This is because insurers compete by risk selection, which means that the most successful companies are the ones that do the best at denying coverage to those needing it most, according to New York Times columnist Paul Krugman.  In other words, if you are poor, have a pre-existing condition, and come from a high-risk population, health insurance companies very likely will end your coverage or deny you any insurance in the first place.

The public option does not deny people coverage based on pre-existing conditions or ability to pay.  Moreover, the health care bill passed by the House last weekend outlaws denying coverage based on pre-existing conditions by any insurance company.  As for the public option forcing competition with the insurance companies, most dyed in the wool capitalists actually favor the idea of competition, unless, of course, they are trying to form monopolies like, for example, health insurance companies.  Thus, perhaps, all the opposition to the public option stems from the fact that the health insurers and those politicians receiving generous donations from those same companies really just like the status quo and want monopolies to stay in place if for no other reason than sheer greed.  It really could be that simple, and I freely admit the public option will tamper with that plan.

Alternatives to the public option include health insurance cooperatives or co-ops, "trigger" plans, and "opt-in" and "opt-out" systems.  Explaining these other options often muddies the waters for people.  I will only give brief examples of these three alternatives to avoid any more confusion.  First, co-ops would need federal money to make these private nonprofit health insurance entities viable, meaning large enough and established enough to make them competitive and bring them into the health insurance exchanges with traditional health insurance companies.  However, co-ops would likely only be statewide, which immediately calls into question their power to compete and ability to grow large enough to reduce health care costs in relation to private health insurance companies.  These factors make this alternative look less likely all the time.

Instead of statewide public plans, Senator Olympia Snowe (R-ME) favors a "trigger" that would cause a plan to take effect at some point in the future in certain states that do not have more than a predetermined number of private insurance companies.  Of course, nothing would prevent health insurance companies from breaking themselves into many smaller versions of the parent company when the time came for the "trigger" to take effect, thereby eliminating the need for a public option.  The "opt-in" system allows states to choose if they want to institute a public plan or not, which could leave citizens in states with less generous governors and legislatures from ever receiving a public option.  The "opt-out" system would mandate states to offer a public option for a set period but allow the governor and state legislature to end the option after the time expires, assuming, of course, they felt very secure in their chances for reelection.

This can be a very dense subject, and it really isn't very easy to inject any humor into it.  Of course, since we are discussing life and death issues, humor really should not play a factor.  Nonetheless, I hope this hodgepodge of an explanation makes some sense.  I truly hope it didn't confuse anyone that much more.  What I just listed about the public option likely will not be in the final bill exactly like this after the House and Senate each pass their respective measures.  Assuming the public option is still there, it will have many changes to it, but we will cross that bridge when we come to it.

Political Round-up

This portion of the blog will touch on different areas in politics—on a national, state, and even local level—that interest and/or infuriate me.  However, I will not usually spend an inordinate amount of time dwelling on them.  Below are a few things that come to mind this time around the horn.

·         The Community First Choice (CFC) Option serves as the precursor to the Community Choice Act (CCA), which would require state Medicaid plan coverage of community-based attendant services and supports for certain Medicaid-eligible individuals.  The CFC Option emerged as a way to make progress on home and community-based services and supports under Medicaid and a way to lay the foundation for later enactment of the CCA.  The CFC Option would encourage states to provide home and community based services by providing an increased federal share of Medicaid payments.  However, if a state chooses the CFC option, they would have to adhere to its higher standards (no caps on services, no waiting lists, and no geographic restrictions.)  The CFC Option is estimated to cost $6 billion over 10 years.  The Affordable Health Care for America Act, the health care bill passed by the House, included a statement of support for the CFC Option, which means the House wants it incorporated into the final bill between the House and Senate.  This is a very good thing for people with disabilities, especially those living in institutions.

·         The Community Living Assistance Services and Supports (CLASS) Act was also included in the Affordable Health Care for America Act.  This is a major victory for people with disabilities who want to live independently without all the barriers presented by government bureaucracy.  Most Americans with significant disabilities have one option for coverage that supplies them with critical services, such as housing modifications, assistive technologies, transportation, and personal assistance services, and that option is Medicaid.  The reliance on Medicaid for services essential to independence creates a strong incentive for them to “spend down” assets, reinforcing cycles of poverty and unemployment.  Medicaid pays 50% of the costs of long-term services, and increased expenditures on long-term services will likely add $44 billion annually to the cost of Medicaid over the next decade.  The CLASS Act offers a chance to break the cycle.  It will create a new national insurance program to help adults with significant disabilities to remain independent, employed, and active in their community.  Financed through voluntary payroll deductions  (with opt-out enrollment like Medicare Part B), this legislation will help remove barriers to independence and choice (e.g., housing modification, assistive technologies, personal assistance services, transportation) that can be devastatingly costly by providing a cash benefit to those who are eligible.

·         From Jennifer Jacob Thomas and Amber Smock of Chicago ADAPT:

"As a result of the economic recession and a poor state budget, for several months disability advocates in Illinois have been battling threatened cuts to our vital Home Service Program (HSP).  HSP provides critical personal attendant hours to people with disabilities across the state.  HSP is a program that belongs to our Department of Rehabilitative Services, a division of our state Department of Human Services.  To save about $12 million, DHS and DRS decided the solution would be to impose caps on personal attendant hours.  The proposed caps have been as follows: Meal preparation 30 hours per month, Outside the home 18 hours per month, Laundry 12 hours per month, Housework 17 hours a month, Finances 3 hours per month.  For many people, these limits don’t make sense. 

Last week, on Thursday, October 29, 25 Chicago ADAPTers gathered for a direct action on DHS.  Our demands were to meet with the DHS Secretary, Michelle Saddler, to eliminate the caps, and to resume quarterly meetings with the State government on the planning and implementation of home service programs in the State of Illinois.  At 11 am, led by new member Adam Ballard, we streaked past DHS security guards and hit the elevator buttons to go up to the seventh floor.  The guards immediately took action to prevent Chicago ADAPTers who made it into the elevators from going up to the 7th floor.  A DHS staffer came down to find out what was going on, and as Chicago ADAPT pulled out our signs and began chanting, Rahnee Patrick and Amber Smock let the staffer know what we wanted.  She promised to immediately see if we could get Secretary Saddler.  While we waited for her to get the Secretary, our people did an awesome job of chanting “We Want Saddler!”  About ten to fifteen police officers arrived on the scene and Mike Ervin went to greet them.  The DHS staffer came back with the DRS director’s assistant to report that Secretary Saddler and Assistant Secretary Grace Hou were in our state capitol three hours away as the legislature was meeting, and could not be reached to meet by phone.  Chicago ADAPT caucused and asked to meet with Saddler and Hou as soon as possible in person.  The DHS/DRS staff then asked that Rahnee and Amber go up to their office while they got details of when the meeting could be held.  Our people then made space for people to use the elevators and lobby, but remained on watch.  We got an agreement to have 10 Chicago ADAPTers meet about HSP with Saddler and Hou on Thursday, November 5.  This information was shared with our people, at which point we declared a victory and backed off, much to the relief of DHS/DRS, security, and the cops. 

Today, November 5, our people went to meet with Hou and Saddler.  About six or seven extra folks stayed down in the lobby passing out fliers about our meeting to passersby.  Our agenda was to stop the HSP cuts, testify that the cuts are being implemented NOW even though DRS says they are not, discuss long range HSP planning and also discuss the fact that pro-Howe Developmental Center supporters have forced the state legislature to have a hearing on whether Howe’s closing has a good process and whether it should be re-opened.  Saddler, Howe and DRS director Rob Kilbury were at the meeting. They listened to our concerns and heard first person testimony from Mark Karner, Susan Aarup and Joe Barrett.  DHS said that the cuts are basically on hold and that any implemented cuts are being done by offices who haven’t gotten the word about the hold.  Affected persons should complain to DRS. DRS said that Jennifer Thomas has done a great job of advocating on HSP and letting them know what is going on with the grassroots.  DHS agreed to resume quarterly meetings with ADAPT, the next one to be held in January.  DHS is very interested in what can be done to advocate for the CFC Option so Illinois can take advantage of it.  DHS also encouraged us to be present at the Howe hearing.  In general, it was a very productive meeting and all sides were able to air their views, particularly in regards to who was communicating any info about cuts to HSP.  There remains a great deal of stress in the state due to an unbalanced budget and the state’s inability to pay up to all its contracts, but from this point on we have established that we will partner as well as we can so no decisions are made about us, without us. 

Great job to Chicago ADAPTers, both veterans and newbies!  FREE OUR PEOPLE!"

Ramblings from the Ranch

From the gridiron:

If you've made it this far, I thank you.  Those of you who actually read this section should always expect it to be here.  Three things in life are certain, and they are death, taxes, and the Cowboys.

Well, in the eyes of the media, the Boys pulled an upset by beating those dreaded Philadelphia fowl, and I know I did not use the proper noun there.  I'm not afraid to admit that I was a bit apprehensive going into that game, especially since it was at their place.  Yet, I tell you this is a different team from last year.  These Cowboys will not lie down and die for any team, especially one hailing from Philadelphia.

With only a couple of exceptions, Tony was brilliant in that game, and let the naysayers skulk into the shadows when they say he and Roy Williams are not in sync.  It took Brady and Moss, at least, two or three games to get their rhythm back, and they've been playing together for going on three years now.  Besides, if people thought Roy Williams was going to do what T.O. did the last few years, they were way off target in the first place.  Roy is a possession guy, and he will move the chains for you.  However, he's not going to catch a 60-yard out-and-up.  That's why we have Miles Austin.

I won't belabor the fact that we won and that we are now atop the NFC East.  However, I will point out a few things.  First, as I've always said, if you get into McNabb's face and put pressure on him, he will fold like a cheap suit.  He had thrown one interception before coming into that game.  Yet, what did he do during the game?  He threw two interceptions—one in the first drive of the game.  I'm not saying he's a terrible quarterback, or maybe I am.  I am saying our defense played incredibly well, and Jay Ratliff might have just punched his ticket to the Pro Bowl.  Regardless, the question remains as to whether or not McNabb has ever won the big game.  The answer is a resounding, "No."  Neither has Tony, but who's been around longer?

At this point, I see the NFC East as a race between two teams—the Cowboys and Philadelphia.  Of course, I believe we have the upper hand, at least, in terms of head-to-head matchups at this point.  New York and Washington are merely shadows of their former selves, and that is giving Washington far more credit than I should.  Obviously, Minnesota and New Orleans are still at the top of the mountain is the NFC, though both teams showing glaring weaknesses in the last few weeks.  All I'm saying at this point is being 6-2 is a very good thing and much better than 5-3 or 4-4.

I will not get too cocky here, as I know there is still a half of a season to play.  Nevertheless, the Boys have three very winnable games on the schedule.  It will not be easy to play in Green Bay in November.  It never is, but if we can get through that game with a win, I don't see Washington or Oakland being that much of a challenge.  Of course, I will put a caveat on that statement by saying I'm sure Philadelphia didn't think Oakland a challenge either.  Never look ahead in football.  There's always someone sneaking up behind you, especially if you're the Dallas Cowboys.