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A Health Care Deal out of Arab Bazars

| December 20, 2009

Flying high (White House photo)

Could it be? Democrats appear to have the 60 votes they need to surmount a Republican filibuster on health care. They’ve reduced health care reform to an approximation. But that’s how it goes. Whatever the thing is that’s making its way through the Senate, it’ll need intensive care for many years before it resemble something more civilized. But I’ll take it wither way. For all the missteps, for all of Obama’s prevarications and defanged tactics, the end result will (should the bill pass) vindicate whatever he did, however he did it. What was bound to be a colossal battle turned out to unravel the worst and little of the best about America. Something that could be said of the Civil War. Still, Obama will be able to say that he’s achieved what no other president has, which is no small thing.

It took some revolting compromises, including one on abortion that won’t or shouldn’t stand up in court (an opt-out provision for states to cover abortion costs, and a requirement that those that do make individuals paying for abortion costs write checks separate from checks written for other forms of care, a form of scarlet-lettering of abortion-seekers). That’s to please Ben Nelson, the sand-hilled senator from Nebraska. The state is also getting extra Medicaid money, which should send other states’ senators wondering if they shouldn’t make last stands of their own (Louisiana’s Mary Landrieu also got her state an extra $300 million). Mitch McConnell, the Senate’s reactionary-in-chief, called the bill “a monstrosity full of special sweetheart deals for a few states.” He’s right, but every bill out of the Senate is a monstrosity of sweetheart deals. For once, the deals will benefit lower income people. That’s what Republicans find monstrous. Their till, their entitlements, were raided.

If Democrats hold on to their majority (and Republicans’ implosions are making it easy for them), they’ll have a few more years to fix it up. But let’s not ignore the ready value in the bill as it is. Besides its new mandates that will prevent insurers from ending coverage of the sick or imposing lifetime caps and discriminating against pre-existing conditions, there’s this, from the Congressional Budget Office analysis, for the uninsured and for children, as well as for states’ budgets:

Starting in 2014, most nonelderly people with income below 133 percent of the FPL
would be made eligible for Medicaid. The federal government would pay all of the costs
of covering newly eligible enrollees through 2016; in subsequent years, the federal share
of spending would vary somewhat from year to year but would average about 90 percent
by 2019. (Under current rules, the federal government usually pays about 57 percent, on
average, of the costs of Medicaid benefits.) In addition, states would be required to
maintain current coverage levels for all Medicaid beneficiaries until the exchanges were
fully operational; coverage levels for children under Medicaid and CHIP would have to
be maintained through 2019. Beginning in 2014, states would receive higher federal
reimbursement for CHIP beneficiaries, increasing from an average of 70 percent to
93 percent. The legislation would also provide states with additional CHIP funding in
2014 and 2015.

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