As Chris said below, exit polls showed that it wasn’t anger at the new health care law that drove the voting in this election. But with new Republican majorities in the US House, NC House and NC Senate driven by many people who have said they want to “repeal” the new health care law what can people who care about affordable health coverage expect in the days ahead? Overall, I really don’t think much is going to change and the main elements of the new law will continue to move forward. Why? First, remember that both President Obama and Governor Perdue are still in office, so there is no change in administration either here or in Washington. Also in NC, Insurance Commissioner Wayne Goodwin, who has been aggressive in reining in insurance costs and getting ready to implement reform was not up for election and remains at the head of the NC agency, the Department of Insurance, that will have the most to do with implementing reform in NC. In addition:
1. The elements of the health law already in place are proving to be quite popular. They include parents being able to keep their kids on their health plans until age 26, cuts in drug costs for people on Medicare, new high risk insurance pools already enrolling hundreds of hard-to-insure people, banning pre-existing condition exclusions for kids, tax credits for many small businesses who offer coverage, and elimination of lifetime limits on health plan coverage. During the heated election campaigns no one wanted to say just what parts of the health law they would repeal and this is why – people like what is being implemented right now.
2. Repealing any major part of the health law will increase the deficit and must be paid for. Yes, this was something missed during the campaign rhetoric too, but Republicans who control the House will have to actually come up with money if they want to repeal any part of the law – full repeal would cost over $100 billion and just repealing the Medicare provisions that reduce the projected increases over ten years in Medicare costs (no, they don’t “cut” Medicare) costs over $400 billion.
3. Back in Ronald Reagan’s White House, health reform plans were developed that included a major change in how people got coverage that increased their personal responsibility: the idea that a person couldn’t wait until he or she was sick and in the hospital to buy coverage but rather they should be required to purchase health coverage so it would already be there before they got sick. The Reagan idea of the individual mandate to buy coverage was passed in the new health reform law and in a surprising twist became one of the provisions those who want to repeal the law complain most about. The problem with repealing just this provision is that without it the other extremely popular provision in the health law – that insurance companies can’t charge people more because of pre-existing health conditions – must be eliminated as well. Doing one without the other would be devastating for health insurance companies and the health insurance market and mean skyrocketing health costs for everyone as no one would have any incentive to buy health insurance until they got sick. This is simply not going to happen.
4. Down here in North Carolina, the biggest change will likely be the state giving up authority to the federal government to set up its own health insurance exchange where individuals, small businesses, and members of Congress will buy coverage after 2014. NC has started planning to set up a NC-based exchange that would include a wide variety of plans, better regulation, and ease of access to help with buying coverage. However, setting up a state-based exchange will require the NC General Assembly to pass legislation and the prospects for that are unlikely. This is a shame since NC would give up quite a bit of authority to the federal government about how we do health reform in NC. If NC hasn’t made substantial strides in setting up its exchange by 2013, the federal government steps in and sets one up for NC residents and members of Congress that meets the basic requirements of federal law for affordability and choice of health plans. For individual consumers this isn’t necessarily a bad thing, but NC could probably do a more consumer friendly and better job.
5. Many other parts of the health reform law are already being implemented by various entities in North Carolina. Hundreds of millions of dollars in grants have already been awarded for new prevention programs and to test new models of delivering health care. The Department of Insurance has gotten a large federal grant and is starting to set up a new consumer assistance and ombudsprogram modeled on their very popular and successful similar effort for older adults. NC’s Department of Health and Human Services is already moving to prepare to expand Medicaid coverage in 2014 which will be fully paid for by the federal government and save millions of dollars in uncompensated care costs for hospitals and providers all across North Carolina.
In sum, while Republicans nationally and in NC will try to slow down the pace of reform, the horse is already out of the barn.