Universal weakness

Universal Weakness

by digby

It's obvious that health care reform will not be repealed under President Obama. It is, after all, his signature legislation. But that's not going to stop the Republicans from working on building consensus around their own "reform of the reforms" when they get into power. This article by Brian Beutler at TPM outlines the various angles they are developing as well as some further reforms from Democrats, which might end up being improvements if they could get through the House.)

But I think this one is the most vulnerable, and it's the main provision that made it so difficult for liberals to vote against the reforms:

Republican governors are trying to tap the brakes on the law's addition of 16 million Americans to the Medicaid insurance program for the poor, starting in 2014. They also want to axe a piece of the law that makes it more difficult for states to cut Medicaid enrollees to patch budget shortfalls.

"The health care legislation is really bearing down on the states," said Republican Texas Gov. Rick Perry. "The mandates that are in that legislation will most likely cripple health care delivery, with a price tag that will absolutely bust the budgets."

That's over half the uninsured who were supposed to be covered under the new reforms.
Sadly, I won't be surprised to see the Democrats help them do it, and I have no idea if the White House would be willing to deal this piece away. After all, it's not the part of the reforms that everyone is so proud of --- it's the old clunky government paid health care that we've decided isn't sexy enough for our modern "market based progressivism."

The White House would fight to the death for the exchanges and the mandate and the popular provisions like pre-existing conditions, lifetime caps on benefits. That's the essence of HCR --- the reform of the private health insurance market. It's an interlocking plan that requires all the pieces to work properly and the Democrats won't let that go if they have the power to stop it. But universality? Well, the debate over health care seems to have evaporated the bipartisan consensus on that. It's not out of the realm of possibility to think that some Democrats would agree to cut the Medicaid coverage or that President Obama would sign the bill.

I never understood why universal coverage wasn't the explicit goal of health care reform and the principle on which the whole thing rested. But it wasn't. (Even the reform as finally passed fell quite a bit short, although it wasn't bad.) The goals were fairness and cost savings, which isn't quite the same thing, so the government funded portion of the bill was always the most vulnerable. I've always been skeptical that those provisions would be safe. And now that we are joining the global austerity crusade, I expect there will be tremendous pressure to starve this program or at the very least delay the implementation. Certainly the Republicans will do away with it the minute they get the chance. They can always be counted upon to stick it to poor people.