It was one of the pillars of President Barack Obama's charge for change as he ran for president. And today, he stands ready to sign a bill that will dramatically change the country's health care system.
Late Sunday evening the House of Representatives passed by a margin of 219-212, with no Republicans voting for the measure and 34 Democrats voting against it. The bill was first passed by the Senate on Christmas Eve and now goes to the President for his signature which he's expected to do Tuesday.
But the fight isn't over on this bill. Rarely in the legislative process do both chambers pass the exact bill, but rather pass its own version and then go to conference to formulate a new compromise bill and then approve the compromise package in each chamber.
But without a conference, House Democrats have passed what they're calling a reconciliation bill, a bill that can "reconcile" things they don't like out of the Senate bill. The measure, which also passed Sunday night by a 220-211 margin, now heads to the Senate where they will have to approve it. It remains unknown at this time whether the Senate has the needed votes to pass the measure.
Reconciliation bills are normally used only for fiscal matters, and allow the Senate to approve the bill without the 60 filibuster proof margin, but by only a 51 vote majority. Many of the concessions sought after by Democrats are in this reconciliation bill. The timeline of when or how this gets passed remains unknown at this time.
Ag groups mixed
Both sides of the aisle agree that the health care system needed to be fixed, but it was a question of how far the government should go. This resonated with ag groups as well.
For instance, the American Farm Bureau Federation President Bob Stallman said in a letter to House members before Sunday's vote that the legislation’s “negatives of new taxes, mandates, growth in government programs and overall cost far outweigh its benefits.” Stallman said Farm Bureau strongly favors health care reform, but it must be “workable, sustainable and balanced against the overall cost of doing business.”
AFBF advocated for market-based reform that would lower costs and increase choices for private health insurance.
“Most farmers and ranchers are self-employed and buy health insurance for themselves and their workers through individual and small group markets,” Stallman said. “Passing a coverage mandate accompanied by a threat of penalty for noncompliance will only make the situation worse for people unable to afford coverage.”
The National Farmers Union on the other hand praised the vote. A statement from NFU said the "Patient Protection and Affordable Care Act will bring down the cost of coverage; bring more physicians to rural hospitals; and prevent insurers’ discriminatory practices with regards to preexisting conditions."
Dennis Berens, president of the National Rural Health Association, said, "The health care bill not only will cover 95% of the uninsured, but it will go far in addressing major workforce shortages in rural America. Rural America needs health care reform now."
According to a letter sent to representatives by National Rural Health Association, NFU and Center for Rural Affairs, health care access for rural people will be strengthened through the establishment of health insurance exchanges for the self-employed and small businesses. And premium assistance will be provided through tax credits for small businesses and for low and moderate income individuals purchasing insurance through the exchange. The letter also contains a list of provisions in current legislation of great importance to farmers, ranchers, rural small businesses and rural health care providers, the groups wrote.
Impact on you
As part of state-based responses to federal health reform legislation, individual members of at least 36 state legislatures are using the legislative process to seek to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance. In general the measures seek to make or keep health insurance optional, and allow people to purchase any type of coverage they may choose, according to Richard Cauchi, program director at the National Conference of State Legislatures.Massachusetts, a state with a state-run health care plan, is draining its capital resources because of the decision in 2006 to go to a government-run health care plan. Read more in this NY Times article posted last week.
In the days and weeks ahead, more information will unfold on the impact this bill will have on you. I'll be working to sort out the messy details of this bill and what it means for you as a farmer and/or small business owner.
If you're ambitious, you can view this 121-page summary written by the George Washington University School of Public Health and Health Services. It answers many questions on changes to health insurance, Medicare, and the enactment dates to the provisions.
Or stay tuned, and I'll see what I can learn from one of the biggest legislative overhauls in modern times.