December 21, 2009 Liz Borkowski, MPH 0Comment

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In a historic achievement, 60 Senators have agreed to a healthcare bill that will dramatically expand health insurance coverage and curb some of the insurance industry’s worst practices. Getting agreement between the Senate and the House, which has passed its own healthcare bill, will still be an arduous process, but the chambers agree on most essential elements, and this is the farthest Congress has come in decades towards fixing our healthcare system’s serious problems. (If you want to compare the House and Senate bills, the Kaiser Family Foundation has a handy comparison tool.)

Here’s a quick summary of what the Senate bill does and why it’s worth passing:

The legislation will require all US citizens and legal residents to have health insurance, or else pay a penalty. (Those for whom the lowest-cost option would exceed 8% of income are exempt.) In turn, the government will provide subsidies to those with incomes between 100-400% of the poverty level, expand Medicaid eligibility to the poorest, and make it easier for everyone to get adequate coverage that doesn’t leave them so vulnerable to bankruptcy.

Insurers will no longer be allowed to do things like deny coverage based on a person’s health history or impose lifetime or annual caps on how much they’ll pay for a person’s benefits. The legislation also limits the extent to which insurers can vary premiums between its lowest- and highest-risk members. The creation of exchanges will help those who lack affordable workplace coverage get access to the kinds of plans that those of us with group coverage take for granted.

A Center on Budget and Policy Priorities analysis explains how both the House and Senate bills will reduce the deficit, slow the growth in healthcare costs, and achieve Medicare savings. Atul Gawande has an interesting New Yorker article comparing the Senate bill’s demonstration projects for reforming the healthcare delivery system to the approach that the government took to improving agricultural yields early in the last century – an approach that was hugely effective and is still helping farmers today.

Some of the big disappointments in the Senate bill are the absence of a public option (or a Medicare buy-in option for those ages 55-64, which was offered as an alternative) and the fact that much of it doesn’t kick in until 2014. That move brought down the ten-year cost of the bill, but at the expense of those who can least afford to keep struggling along without adequate health insurance.

This is certainly not an ideal bill, but it’s the best bill we’re going to get – and if it dies, it’ll probably be a decade or two before we get another shot at correcting the many things wrong with our healthcare system. If this bill fails, the alternative is not a better bill, but the status quo, under which 22,000 – 45,000 people die annually because they lack health insurance. (Those figures are from the Institute of Medicine and Harvard, reported by the Washington Post’s Ezra Klein.)

I’ll leave the last words (and pictures) to Igor Volsky at The Wonk Room, who gives an elegant summary of why this legislation is worth passing:

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