Despite confusion and controversy, the new healthcare law, which aims to insure additional 32 million, is seen as a landmark victory for advocates of reform.
Americans see 'great promise' in health bill
BROOKLYN, NEW YORK // At a sterile reception area in the Brooklyn Free Clinic, a medical centre offering free care, a diverse collection of New York's uninsured waited patiently for their turn. Ashley, a 59-year-old Jamaican man, shifted his gaze from the doorway leading to the consultation rooms to a small television set.
A news anchor was describing the Democrats' sweeping healthcare reform bill that President Barack Obama had signed into law only hours before. "The little I understand is that this has been something in the making for years and that there's a set of people who is just hell bent and just don't want it to come," Ashley said with a thick Caribbean accent. "I can't understand the reason. I see it as something good, especially for the poorer class."
Since moving to the US over a year ago to join family members, Ashley has been unable to find work and has not had access to health insurance. He asked that his last name not be used and that no photos be taken of him. "I'm not in the system yet," he said. Ashley comes to the free clinic "every now and again" to keep an eye on his blood pressure and for other preventive care. And even though Mr Obama's new healthcare law - which aims to insure another 32 million Americans over the next decade and cut over US$100 billion (Dh367bn) from the federal deficit - will do nothing to help undocumented residents such as Ashley, he is all for it.
"I believe in it. I believe in him. I believe in what the government is doing," Ashley said. "I cannot understand how the Republicans cannot see nothing good in the bill." For decades healthcare reform has been one of the chief ideological battles between Democrats and Republicans. Over the last year it has been the source of a great deal of Washington's political acrimony, with some congressional Republicans vowing the issue would be Mr Obama's Waterloo.
While the new 2,000-plus page law is popular on the left and among the ranks of the uninsured, many Americans are opposed to it. Still more are confused by its many provisions, some of which are years away from taking affect. "We're really expecting a lot of calls, people wanting to know how this affects them," said Sara Collins, the vice president for the Affordable Health Insurance Program at The Commonwealth Fund, a non-profit and non-partisan organisation committed to improving the nation's healthcare system.
She said the Congressional Budget Office estimates that the bill will cover 32 million people who are not insured now by 2019. "This is a really big change, obviously, from where the US is right now," Ms Collins said. With an estimated 46 million uninsured in 2008, Ms Collins said that could rise to 54 million by 2019 if there was no reform. Most of the bill's major provisions will be implemented in phases, many in 2014.
These include the expansion of Medicaid, America's government run heath programme for low-income individuals and families and the creation of state healthcare exchanges through which individuals and small businesses can band together to replicate larger firms and bring down prices. Most significantly, the bill requires that by 2014 nearly all Americans buy a health insurance policy. It is this last requirement that Republicans find objectionable. Many argue that despite the need for reform, healthcare is not a right enumerated in the US constitution and that forcing nearly all Americans to purchase policies from private companies violates individual freedom.
Insurers will no longer be able to drop people from coverage when they get sick, a controversial money-saving practice that happened regularly in the past. In addition, uninsured adults with pre-existing conditions, who previously would have had trouble finding affordable plans, will have access to government-created insurance pools. Small businesses will also get some help, by qualifying for large tax breaks to offset the rising cost of employees' insurance.
Democratic proponents of the bill say these provisions are aimed to help those in the greatest need, people such as Natoma Canfield, a cleaning woman from Ohio recently made famous by Mr Obama. A cancer survivor, Ms Canfield wrote to the White House in December, asking the president not to abandon healthcare reform. She said her insurance premiums were slated to increase 40 per cent in 2010, up to more than $700 a month. "I need your health reform bill to help me!!! I simply can no longer afford to pay for my health care costs!! Thanks to this incredible premium increase demanded by my insurance company, January will be my last month of insurance," Ms Canfield wrote.
To cover skyrocketing health costs and hedge against the costs of illness, health insurance premiums have risen steadily over the years, particularly for individuals with pre-existing conditions. Without insurance, Ms Canfield is now back in the hospital. She was diagnosed with leukemia several weeks ago. Within six months, the new healthcare bill should grant her access to more affordable health insurance despite her pre-existing condition.
Ms Collins said people in situations like Ms Canfield's would see increased protections under the law. "There are 15 million [people] in the individual market. They stand to benefit enormously from this change," she said. However, she also noted that until the creation of large-scale exchanges in 2014 the premiums for many independently insured individuals would most likely continue to rise. Despite the confusion and controversy, the healthcare law has been seen as a landmark victory for advocates of reform.
Daniel Horn, a fourth-year medical student at State University of New York Downstate, was running the Brooklyn Free Clinic Tuesday night. He was excited about the new law's potential to help the uninsured and underinsured. "I think that the promise of the bill is great and the implementation is yet to be seen. What it promises is absolutely wonderful. I was a strong proponent of the bill, an advocate for it. And while it's not perfect, it's a start and we'll go from here," Mr Horn said.
Ms Collins of the Commonwealth Fund noted that in addition to helping patients, the bill would probably be beneficial to doctors and hospitals. The expansion of insurance will ensure payments and provide greater administrative transparency, she said. "There will be a lot more clarity than there is now. That helps on the provider side, [there's] a lot more clarity when people are insured." Although the reforms are being touted by the American left as "historic", the new law falls well short of universal coverage, and the single-payer, government-run system some reformers had hoped for.
There are also religious and financial exemptions to the mandate to own insurance. And, most notably, millions of undocumented immigrants labouring across America will see no benefits from the new law. Ms Collins estimated they would make up about one-third of the many millions who will still lack coverage after the law's chief provisions take effect. At the Brooklyn Free Clinic, Ashley did not seem bothered by the absence of reform for a large section of America's immigrants.
"If you have a healthy people, you have a healthy society," he said. "If you have a healthy society, you have a healthy country. If you have a healthy country, you have a healthy world." * The National