The Senate is a body which basically does nothing without being forced to. These last two years have seen it wait for the House to pass legislation, then far more often than not has consigned it to the dustbin of history cloture.
But with a Republican-controlled House willing to pass ridiculous health care repeal bills that will never become law (while capturing all the headlines), could it be time to turn the tables on them and make the House either ignore or take difficult votes on health care modifications passed by a Democratically controlled Senate?
No one claims the PPACA is perfect. There are plenty of changes that could be proposed, some of which Republicans in the Senate might have a hard time voting against, some they might even be in favor of. Here are four modest proposals the Senate should at least try to enact, forcing the Republican House to do something other than bloviate about repealing the health care law.
Four Modest Proposals:
Perhaps you can think of others.
High Risk Pools. Change the uninsured time-limit qualification:
The High-Risk pools set up by the PPACA are woefully undersubscribed in almost every state.
The Medicare program chief actuary predicted last spring that 375,000 would sign up for the new risk pool insurance in 2010. But by the end of November, only 8,000 had done so.
One component of the problem is the requirement that people be six months without insurance to qualify (another is the cost of premiums, especially for older folks; there have been some reductions in premiums this year). The six-month qualification was designed to insure that the pools were not flooded with applicants, causing costs to exceed the $5 billion allocated by Congress to pay for the program. This is presumably no longer necessary to insure the financial soundness of the program given that many fewer people than projected have signed up.
High Risk Pools. Allow people who run out of COBRA to qualify immediately.:
Currently, someone with a pre-existing condition whose COBRA runs out cannot get insurance from the high-risk pool program, nor can they get insurance from a private insurer because of their condition. There is no sane reason not to let such people transfer into a federal high-risk pool immediately; it is not as if they would be gaming the system.
Eliminate the small-business 1099 reporting requirement:
Everyone hates the 1099-reporting requirement imposed on small businesses and the self-employed. What it does:
Section 9006 of the health care bill -- just a few lines buried in the 2,409-page document -- mandates that beginning in 2012 all companies will have to issue 1099 tax forms not just to contract workers but to any individual or corporation from which they buy more than $600 in goods or services in a tax year.
Attempts to repeal that provision of the PPACA have been going on since it was put in, thwarted by various combinations of pig-headedness and partisan politics. Yes, repealing it will cut federal revenue by a small amount, but Republicans have demonstrated that they don't care about deficits. Spin it as a pro-business tax cut and Republicans should be all over it like hyenas on a dead gazelle.
Bring forward the date the exchanges and the pre-existing condition ban begin:
There's no logical reason why the exchanges and the ban on pre-existing conditions begin by statute on January 1, 2014. It's just an arbitrary date. If the exchanges can be set up at all, they can be set up in another two and a half years (by July 1, 2013) rather than in three years.
The main reason why this was pushed out until 2014 was budget considerations -- specifically providing subsidies for lower-income people to buy insurance, thereby increasing the deficit. As much as it would be a good thing, there is no reason I can think of why the subsidies have to kick in before 2014 even if the ban and the exchanges do; the exchanges can be up and running and the ban on pre-existing condition rejection can be effected without the subsidies going into effect.
Doing this would give millions, if not tens of millions, of people access to reduced-cost health insurance six months earlier than otherwise, with the knowledge that starting in 2014 some part of their premiums may be covered by the Federal government (depending on income level). And it would stop denial of coverage because of pre-existing conditions six months early too.
What about the mandate, you say? Won't people game the system come July 1, 2013? Do you know that the penalty for not having health insurance coverage for all of 2014 is? $95.00 Yup, ninety five dollars. (It goes up to $325 in 2015 and the maximum of $695 or 2.5% of income in 2016 and beyond). In other words, the penalty for 2014 is essentially meaningless. Extending a meaningless mandate six months into 2013 is pointless, so the simplest thing to do is just not to worry about it. But if you really think that's not right, go ahead and extend the $95 'penalty' so that it starts on July 1, 2013 as well.
There is nothing in these proposals that should attract the ire of Republicans. In fact, the high-risk pools were originally a Republican idea, and the additional 1099 reporting requirements are anethema to small government, pro-small business Republicans everywhere. And is anyone this side of insurance company executives opposed to banning pre-existing condition refusals? Of course the Republicans will object, but that's the whole point: let them squeal and make fools of themselves on national television.
The Senate could take a pro-active role in making the PPACA better while providing an alternative to the House Republicans' "repeal and do nothing" headline-catching vacuousness.
What about it, Senate Majority Leader Harry Reid?