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AEA Healthcare Update Archives
Debate on Health Care Coming Down to the Wire
By Rachel LaForest
AEA Health Care Initiative We're down to the wire and it now seems nearly certain that the Senate Finance Committee will not support a public option to enter the marketplace to compel competition with private health insurers. It is unlikely that any progressive public option reforms will be written into the Senate Finance Committee's bill. Immediately after their final vote however, there is still the task of attempting to merge the Finance Committee's bill with that of the more progressive bill of the Senate Health, Labor and Pension Committee, which still includes a public option. Given Senator Max Baucus' (D-MT) insistence that "no bill with a public option will pass on the floor of the Senate", it could leave the House bill as the last bastion for any type of progressive public option, but with such an aggressive lobby by the insurance industry and other private special interest groups what gets further stripped away could leave little to be desired. This is less of a pessimistic view than it is a realistic one. We know that reform is necessary or the health coverage we currently have will become more expensive and/or offer less in terms of the quality of coverage. What we get left with at the end of this war however, may be far less than expected. This remains a highly politicized issue with Republicans accusing Democrats of not seeing the forest for the trees and being consumed with the possibility of "making history." On the flip side, Democrats criticize Republicans for having offered little to nothing in terms of creating reform options. We've watched President Obama's original ideas to slow the ever-expanding costs of healthcare be watered down immensely. Within the Senate bill, only two are left: a minimal tax on the "Cadillac" private health insurance policies and a non-partisan commission that would be charged with cutting the Medicare budget. While the "Cadillac" tax is not supported by organized labor, these two ideas being the only two vestiges remaining, are demonstrative of how much pressure has been put on the administration to make concessions. Insurers fight back Added to the waffling of many lawmakers is a huge increase in pressure from the insurance industry. They have worked for months behind the scenes to help shape healthcare reform. They have been attracted by the promise of millions of more people getting coverage (millions of new consumers buying policies). Their latest blow has been the release of a study commissioned by PricewaterhouseCoopers. The industry trade group, America's Health Insurance Plans, sent its member companies a new accounting firm study that projects the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions in the bill would be in effect. The study projected that in 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher. A spokesman for Senate Finance Committee Chairman Max Baucus questioned the credibility of the numbers. Baucus spokesman Mulhauser said the study is "seriously flawed" because it doesn't take into account provisions in the legislation that would lower the cost of coverage, such as tax credits to help people buy private insurance, protections for current policies and administrative savings from a revamped marketplace. "The misleading and harmful claims made by the profit-driven insurance companies are politicking for corporate gain at its worst," Senator John Rockefeller (D-WV) said in a statement. "Their recent statements only further highlight that our focus here in Congress must be on the inclusion of a public health insurance option in the marketplace to protect families and put more money back in their wallets by creating greater competition and driving down costs." Equity Continues the Fight Despite the difficulty in monitoring the daily changes to the bills in both houses, Equity has continued its outreach to elected officials and other unions and its support of the AFL-CIO's health care campaign. We have not wavered on our demand for a public option and hope that House Speaker Nancy Pelosi and the House representatives do not either. Member involvement and demand for continued up-dates and information has been key in this fight. Your letters, inquiries and comments have kept us on our toes. This is exactly the way Equity's legislative work should function. At press time, the Senate Finance Committee was scheduled to vote on its ten-year, $829 billion bill. The battlefront now becomes the Congressional floor and how heavily President Obama will weigh-in on ensuring there remains a solid public option remains to be seen. To cave in would seem to present a profound betrayal of the public good and so we must all do our part to keep their feet to the fire.
Equity will continue to post up-dates and activities to our website, www.actorsequity.org.
Heath Care Update - September 14, 2009 by Jack Goldstein, Healthcare Consultant The health insurance debate was greatly energized by President Obama's decisive speech to a joint session of Congress on Sept 9, 2010. The President clearly debunked some of the worst misconceptions and intentional distortions that have plagued the public discourse on the issue. Among the most egregious false charges he refuted were that health care to senior citizens would be rationed, that Medicare would be gutted, or that his insurance proposal would cover undocumented workers. In a subtle policy shift, the President declared that a Public insurance option was necessary, not just to offer a low cost alternative to average consumers, but to regulate the private insurers through honest competition. However, he guaranteed that the Public option would be unsubsidized by tax payer dollars and therefore will have to operate according to the same economics as private insurers. He argued that the Public option's lower premiums would flow from its more economic operations as a major non-profit and that those savings would be passed along to the consumers. Far from putting private insurance out of business, the President's advisers estimate that only 5% of the available new insurance market would opt for the Public option because private insurers would rush to provide competitive plans, particularly to the young and the healthy. The notion of an unsubsidized Public option was first floated by New York Senator Charles Schumer during early debates in the Senate and it remains to be seen if the idea is attractive enough to move the Senate Finance Committee to include the option in its long awaiting legislation due out the week of September 14, 2009. It also remains to be seen if an unsubsidized public option, even with tax credits to consumers to soften the cost of maintaining insurance, would produce low enough premiums so as not to create a hardship on low income Americans, including many Actors. Equity has long stated that a worst case scenario of health insurance reform would be an Individual Mandate requiring every one to carry insurance - a major component of the President's proposal - but the absence of a guarantee of affordable insurance plans choices for consumers. Simply creating a huge new market of individuals for the private insurance industry is not, by any progressive standards, a definition of real reform. A calculation of how inexpensive the Public insurance option is likely to be must form a central test of the President's proposal. In what many agree was the most effective and affecting speech of his Presidency, Mr. Obama lingered over the moral implications of Congress' responsibility to enact health insurance reform. Referring to a letter written by Senator Edward Kennedy shortly before his death, the President reminded legislators of both parties that history would judge the character of the Nation, its leadership and it deliberative bodies by their success or failure on health insurance reform.
Equity will be examining the proposal as it develops in the Senate and in debate during the weeks to come.
AUGUST HEALTHCARE UPDATE by Jack Goldstein, Healthcare Consultant A deal appears to have been reached with fiscally conservative Democrats on the House Energy and Commerce Committee which may allow a Committee vote to take place before the House recesses on Aug 8. That would set up floor debate and a vote by the entire House of Representatives sometime in September. The Democratic leadership of the Senate Finance Committee is still struggling to win over Republican support for anything approaching meaningful healthcare reform - a goal many believe should be shelved at this point. Senate Finance must act soon so that the reconciliation of its measure with the bill previously released by the Senate Health Education, Labor and Pension Committee can begin. The House Energy and Commerce action contains a compromise which has already alienated many reform progressives. It retains the President’s call for a Public health option, but removes provision which would mandate medical billing at Medicare rates in favor of private negotiations with healthcare providers. In other words, the Public option would be required to operate like any other insurance company. A more economic schedule of payments for services by the new government sponsored insurance program was seen as a way to insure low and moderate wage earners and put a necessary break on private insurance rates. Without it, the legislation’s efforts to reign in costs would be seriously weakened. The enormous investment in private healthcare insurance and delivery, an investment which is registering as growth in the employment and real estate sectors, has always been an underlying governor of resistance to cooling down escalating health insurance premiums and cost of healthcare services. Profit expectations have fueled many of the stands taken by interest groups and, as expected, coalesced into a political bloc on Capital Hill. While this group is often called economically conservative, it is in practice tied to a belief in runaway healthcare costs which will actually cripple the economy. The resistance to positive change is neither more vociferous nor unprincipled than anticipated.
President Obama has signaled his willingness to extend his deadline for health insurance reform into the fall. Equity plans a series of outreach activities to the membership involving targeted email, letters and, perhaps, lobbying visits over the course of the next few months. The strategy will include trying to enhance the participation of Area Liaison Committees, Regional Directors and coordination with other entertainment Unions. It will executed cooperatively with the AFLCIO healthcare field and messaging campaigns.
July Health Care Update By Jack Goldstein, Equity Consultant Equity took the lead in organizing entertainment labor participation in one of the largest health care reform rallies on record. Co-sponsored by the AFL-CIO and Health Care for America Now, the gathering in Capitol Hill's Upper Senate Park on June 25, 2009 drew thousands of supporters of health care reform from the Eastern seaboard and as far away as Ohio and West Virginia. Among others, featured speakers Actor Edie Falco, Senators Charles Schumer of New York and Sherrod Brown of Ohio and CWA President Larry Cohen called for sweeping changes to the Nation's health care system. The rally was meant primarily to support President's Obama's Public health option which is designed to compete with private insurance companies and to ensure the survival of existing employer-based insurance won through many negotiating cycles over the past decades. Equity was represented in the persons of Health Care Committee Chair Arne Gundersen, Second Vice President Kim Jordan and her daughter Marin, and DC members Barbara Callander and Sandy Murphy, supported by Staff Joe Chiplock and consultants Maria Somma and Jack Goldstein. Other unions represented included, AFTRA, SAG, SDC, Local 802 AFM and the WGAEast. Responding to requests from the NY State AFL-CIO and the New York City Central Labor Council, Equity and its professional colleagues collectively visited the entire New York State Congressional delegation, some expressing support for the President's proposal and others for HR 676, the John Conyer's Single Payer legislation in the House of Representatives. The successful lobbying day was made possible by the cooperation of the Washington DC/MD Area Liaison Chairs Jess Speaker III and Carl Randolph. As Executive Director John Connolly and Arne Gundersen wrote to the DC/ Maryland membership, "We think this summer represents the best chance to make sure that President Obama's healthcare reform contains all the elements that working people need, not the insurance industry! But to do that we need to stand up and show up to support our ideas. Your support will also give our Council a better sense of the kind of power Equity can exercise by mobilizing nationwide in every Equity city around healthcare, funding for the arts, and professional standards and jobs for Equity Actors everywhere. This issue is the place to start." While the rally and Congressional visits were taking place, the Senate Finance Committee was holding hearings on some of the more contentious aspects of health care reform- the Public option and the possibility of taxing existing health care benefits. The House had recently issued its comprehensive reform bill which is being referred to as the Tri-Committee bill because it is the product of cooperation by the House Ways and Means Committee, the Committee on Energy and Commerce and the Committee on Labor and Education As reported in The Wonk Room, "the House plan establishes a 'new national health Exchange' to enroll Americans in affordable coverage, gives Americans the choice to enroll in a new public health insurance options, prohibits private insurers from excluding Americans with pre-existing conditions from coverage and offers sliding scale "affordability" credits to help middle class families afford health insurance." This is essentially the same bill introduced by the Senate Health, Education, Labor and Pension Committee several weeks ago, but it is stronger in many ways than what appears to be evolving in Senate Finance Committee. It will be the job of the Congressional Democratic leadership, working closely with the White House, to reconcile all these versions and emerge with a consensus bill which the rank and file Democrats can support. It seems less and less likely, as time passes, that Republicans will align themselves with any meaningful health care reform. Reactions from that side of the aisle have so far been almost universally negative.
Equity will be following up with all the Congressional contacts made the day of the rally and is committed, with the help of Area Liaisons, to keeping the pressure on as legislation develops. As you may have read, the President is reaching out to Governors across the country to intercede with their political allies on the Hill. Because of the enormous lobbying pressure being aimed at Congress, regional involvement and grassroots support are being seen as essential to the success of health reform.
June Health Care Update By Jack Goldstein, Equity Consultant Health care reform still seems on track although the schedule is pretty aggressive. The Congressional Democratic leadership in both Houses remain committed to having legislation written and reported out of committees in June and brought to the floors for a vote in July. The Senate will go first- the Senate Health Committee under Sen. Ted Kennedy and Senate Finance under Sen. Max Baucus are not necessarily on the same page on key issues such as the Public plan. The House will follow with a bill that is expected to strongly reflect the President’s original proposal. The dynamic of the reconciliation process between the two Houses will then turn on trying to strengthen the weaker Senate version. The AFLCIO has participated in Committee roundtables during the past month on health care delivery, coverage and financing. They have focused on many aspects of insurance reform such regulations limiting consideration of age and preexisting conditions when setting insurance premiums and the details of early Medicare buy-in. But their three central issues of concern have been:
1. The Public insurance option, They report satisfaction with the direction on all three issues in the Senate Health Committee and the expected House bill, but say all three are in trouble in the Senate Finance Committee. Sen. Baucus continues to be a strong supporter of taxing benefits and there has been talk of a provision which would trigger a Public plan some time in future only if the private insurance industry failed to enact necessary reforms. Many economists from both sides of the aisle support taxation of benefits. Those on the left and in the White House budget office think that it would largely pay for the Public plan. Conservative economists feel it is a regressive tax on those without employer insurance and should be eliminated. At this point, the AFLCIO is trying to exert equal pressure in support of a strong Public plan and the taxation question and doing what they can to avoid it becoming a contest between the two issues. Taxation of health benefits is politically volatile and the AFLCIO is trying to convince Committee Democrats that it would simply hand the Republicans a ready made issue with which to defeat the whole reform effort. Still, they are very concerned that they are making too little progress with Senate Finance and are focusing a great deal of attention there. A major rally is being planned for the Senate Park on Capital Hill on June 25th which is being organized by Health Care for America Now (HCAN) with the support of AFLCIO and Change to Win. Following the rally, HCAN is setting up a series of state by state “town hall “ meetings in various nearby locations and inviting key members of Congress from those states to listen to their constituent concerns. Other lobbying measures are also in the planning stages for the day. We’re trying to determine the best use of our resources. Equity has contacted AFTRA, SAG, Local One, Local 802 and SSDC to see if we can organize a bus to attend the rally. We are also working with the Washington DC/ Baltimore Liaison Committee to involve local Equity members. Letters are also being sent to all members of the five Congressional committees with jurisdiction. The Health Committee is fully involved in the planning. Francis Jue can’t make it this trip because of work, but Arne and Sharon Wheatley are able to participate in one–on-ones with Congressional Reps on the Hill. That option is under consideration.
June is going to be a busy month and we will try to keep everyone up to date.
Health Care Legislation May Be Signed by September By Jack Goldstein, Equity Consultant The President and Democratic Congressional leadership seem to be holding to their aggressive time table for passage of major health care reform this year, projecting that the bulk of the work on legislation will be completed by the August recess and that a final bill will go to the White House for signature sometime in September. As is becoming a hallmark of his political style, President Obama has apparently reigned in his Executive staff assigned to health care reform, and expects the relevant Congressional Committees to devise a workable bill within a suitable framework set by his office. Some observers note that policy-watchers have fewer details to read from the White House now, on the eve of real action, than they did nine months ago during the campaign and that Nancy-Ann DeParle, Director of the White House Office of Health Care Reform seems to be a conscientious observer of the edifice-in-the-making rather than its chief architect. There can be little doubt that the President is operating behind the scenes and defining the overall objectives of reform, but time will tell if his distance is meant to empower or protect him.
House Bill
Senate Bill At press time, a well-orchestrated roll out of the legislation in the Senate seemed to be shaping up as follows. Hearings will revolve around three major issues with roundtable discussions planned for April 21, on medical delivery systems, for May 5 on the Public Health Insurance Option and for May 14 on finances. We can expect a mark up of a bill in June and the joint bill itself in July. This schedule is in keeping with expectations that a bill would arrive on the President's desk for signature sometime in September.
Equity Continues Outreach Organized Labor is also keeping the heat up on health care issues. Single Payer forces continue to rack up important endorsements for HR676, John Conyers' Single Payer legislation, which now number more than 500 labor unions and State AFL-CIOs and Vermont Senator Bernie Sanders' recently introduced Single Payer legislation in the Senate is also likely to rack up significant support. This success is notable in the face of the realities that the President does not support a Single Payer solution at this time and it, therefore, seems to have little chance of success despite labor's close White House ties. Nor, as yet, does there appear to be any effective plan to use Single Payer advocacy on behalf of the Public Health Insurance Option.
The AFL-CIO has mounted another major on-line survey campaign to duplicate its success during the Presidential campaign of gathering 25,000 real life stories of health insurance disasters. This year's survey is designed specifically to gather information on insurance company abuses. If you wish to participate, please link to www.healthcaresurvey.aflcio.org. MoveOn.com and Howard Dean have also joined forces to secure the signatures of 250,000 Americans in support of the Public Health Insurance Option, which Dean will deliver to Congress. That address is www.pol.moveon.org/standwithdean/
April Health Care Reform Update By Jack Goldstein, Equity Consultant Gov. Howard Dean is joining MoveOn.com in a major effort to secure 250,000 signatures in support of the most controversial aspect of President Obama’s health care reform plan - a new low-cost government sponsored health insurance option to compete with private insurers. Clinking on the following link will add your name to the list which Gov. Dean hopes to deliver to Congress in person. http://pol.moveon.org/standwithdrdean/o.pl?id=15863-3260752-9Ny6pmx&t=1 The initiative is vital because, as of this writing, the first test of President Obama’s health care reform strategy is playing out on Capitol Hill as both Houses of Congress are voting on the Annual Budget Resolution. The President’s budget calls the establishment of a $634 billion reserve fund to pay for the cost of health care reform over the next 10 years. Half of the new health care fund will come from limiting itemized deductions for the wealthiest 1.2% of taxpayers and another quarter will come from eliminating excessive payments to private plans under Medicare. The last quarter has yet to be identified. It could involve taxing the health care benefits of a small percentage of highest wage earners and organized labor is lining up in opposition to that solution. The Budget Resolution is a prerequisite to health care reform. Serious reductions would jeopardize the White House’s and Congress’ ability to enact the sweeping revisions to the Nation’s insurance patchwork that experts generally concede are necessary. The political loss would undermine the new Administration at a time when its influence over the Legislative process is essential. The AFL-CIO has made the Budget Resolution an outreach priority and has asked its affiliates to engage the Congressional leadership. President Zimmerman and Executive Director Connolly have therefore written to Senators Kennedy of MA and Baucus of MT and Representatives Rangel of NY, Waxman of CA and Miller of CA expressing the Union’s unequivocal support for the President’s proposal as currently structured. They chair the five Senate and House Committees with shared jurisdiction over budgetary and health care matters. Equity has also contacted New York’s Freshman Senator, Kirsten Gillibrand as a new member of the Senate Budget Committee. As President Zimmerman and Executive Connolly wrote, "Real health care reform must inevitably be broad and expensive. Those charged with steering a new course must be confident that proper fiscal provision will be made or the cost to the Country will be registered in their capacity to innovate and make meaningful progress. That cost, we can all agree, is too great to risk." Once the Budget Resolution is passed the debate on the nature of health care reform can begin in earnest. It promises to be rancorous. While the Democratic Congressional leadership seems to have come to a consensus on the essentials of reform legislation, some of the rank and file Democrats and much of the Opposition object to basic elements. As noted above, the most contentious proposal remains the establishment of a new Government run health insurance program, like Medicare, which would offer a basic, low cost insurance plan open to all. Critics see it as a thinly veiled effort to put private insurance out of business charging that the non-profit Public option would have an unfair competitive edge over commercial insurers. Proponents see it as the only way to establish cost controls and to make insurance affordable enough for universal converge to become a reality. It highlights the central question of reform-is health coverage a marketable commodity or a benefit of citizenship? Even the White House staff are split on the Public plan with Mary-Ann DeParle, Chief of the Office of Health Care Reform and HHS Secretary-designate Sibelius for it, and Peter Orszag, Director of the Office of Budget and Management against it. The challenge to proponents will be to keep the Public plan from becoming so great a political liability that it threatens the whole reform process- hence the importance of the MoveOn.org campaign.
The political rhetoric which killed President Clinton’s health care reform plan in 1994 is already resurfacing on talk radio and in television ads. "Harry and Louise" scare tactic ads, threatening government control over daily medical decisions are expected to become part of the debate again. It remains to be seen if the Administration, organized labor and other allied interest can effectively counter that strategy this time. Certainly the still-active network of Obama for President campaign organizations will have a role to play. As for Equity, the Union will continue to use its resources effectively, reaching out to legislators when appropriate and coordinating when possible with its fellow labor unions.
Late March 2009 Government Sponsored Health Insurance Option Comes Under Attack By Jack Goldstein, Equity Consultant The best of all possible worlds for the insurance industry and pharmaceutical companies would be a national health reform bill that required every American to buy health insurance, that would allow insurance companies to do business across state lines thus avoiding highly regulated states, and that left it to the private market place to compete with one another for all the new customers, preferably as individuals unable to negotiate as part of large groups. The health care industry is apparently willing to spend millions of dollars to enact reform legislation based on these "free-market" principles, and that vision is certainly much more of a possibility today than any Obama supporter could have imagined during the Presidential campaign. While they might have to accept a requirement to cover everyone regardless of expense related factors such as age, genetic predisposition to diseases or pre-existing conditions, private insurers could be the biggest beneficiaries of the campaign to reform the nation's dysfunctional public health system and to provide universal coverage.
President May Reconsider The Public option is seen by many reform advocates as the only way to reverse the triple threat of rising costs, shrinking coverage and diminishing quality of health care and health coverage in America today. While attacks on the Public plan from the private sector were to be expected, the President's flexibility on so defining an issue was enough to create a serious wave of doubt among public policy analysts. It was, at the very least, a quiet call to arms for organized labor which is planning a spring filled with public demonstrations and attacks on insurance industry abuses.
Commonwealth Fund Report The Commonwealth Fund's Commission on a High Performance Health System, which is responsible for the study, includes representatives of the private health care industry. The report's policies were modeled into cost estimates by the Lewin Group, a nationally recognized health policy analyst with its own private industry ties. This is all to say, the study is a conservative document which eschews radical solutions and clearly says that under the new system it proposes, private insurance can still make money. Yet, the study calls for an independent Public insurance option as essential to gain control of an otherwise out of control sector of the economy.
The President and Congress should take heed.
Labor is gearing up to defend the Public option. Health Care for America Now (HCAN), which is taking a progressively more central role in advocacy and organizing labor on the issue, is planning a spring campaign that includes home District meetings with Congressional leadership in April. HCAN is also planning a major demonstration on the Mall and a lobby day on Capitol Hill late in June when Senator Baucus is expected to introduce the Administration's major health care reform Bill. It is vital to reform that the Bill contain a Public plan option from the beginning and that it be strongly defended by the President and his allies in Congress.
March 2009 Obama Reaffirms Support for Healthcare Reform by Jack Goldstein President Obama reaffirmed his strong support for comprehensive health care reform in three important policy statements last week. At his White House summit on fiscal responsibility, the President linked controlling health care costs to the success of his economic recovery program. His address on Tuesday to a joint session of Congress reiterated his campaign pledge to sign a reform bill into law this year that will achieve his three part agenda toward universal health insurance: cost control, expanded coverage and better quality of care. Lastly, the President unveiled a sweeping new budget proposal that includes a reserve fund of $630 billion over the next 10 years dedicated to financing reforms of the health care system. These unequivocal policy directives correct the sense of drift which followed the withdrawal of Sen. Tom Daschle from the joint appointment as Secretary of the Department of Health and Human Services and Director of the White House Office of Health Care Reform. (Gov. Kathleen Sibelius of Kansas has been nominated to serve) and sets in motion an aggressive timeframe for Congressional action. It is now expected that a Senate bill be marked up in June drafted by Sen. Max Baucus, followed by a House version based on a "outline" submitted by the White House and, if all goes well, a final bill sent to President for signature before the end of the year. It is an aggressive schedule. But to some extent the President's confidence is based on the mood of the Country. In a new CNN poll, 72% of those asked said that Government must get more involved in health care reform. That is a high percentage tied to widespread anxiety over growing unemployment and doubt in the private sector’s ability to solve the Nation's problems. The President is now committed to a course of speedy and comprehensive reform which will test his political skills and risk considerable political capital. Perhaps for that reason, and to prevent premature sniping, the President shared relatively few specifics. Rather, his office issued a summary of points that established a framework for reform. It began is with a summary of legislative actions already taken separately and in connection with the economic stimulus and recovery act.
In moving forward on the actual reform legislation, the President established the following framework for Congress:
The President skirted some tough issues. Most notable was the absence of any specific reference to a Public insurance alternative, at once the most divisive and essential aspect of a meaningful reform strategy. The budget alone takes on many vested interests and, while the President looks to costs savings, reductions in abuses, tougher bargaining for the costs of services and taxing the rich to pay for health care reform, even supporters questions whether those alone will do the job. There will be a high level meeting of health care interests at the White House later this week which the AFL-CIO will attend and we expect to hear more from them.
Labor is gearing up. The AFL-CIO's national grass roots mobilization schedule is going to its Executive Council for approval this week. AFL-CIO is also following up on its successful on-line survey of last year which gathered thousands of stories about the health care crises. This year the focus will be on insurance company abuses and will go live in April. (We will post the survey address in Equity News & on the Website) Health Care for America Now (HCAN) will launch a major campaign against insurance industry abuses in March. HCAN is also planning home district meetings during the spring recess. These actions will be accompanied by work site briefings, shareholder actions and culminate with a mass demonstration in Washington DC in June. We will try to involve ourselves to the fullest extend possible.
February 2009 Update Equity Continues Reaching Out to City, State, National Leaders on Plans for Health Care Reform By Jack Goldstein "Health care is a human right and providing it is in large part what government is essentially for" was Councillor Francis Jue's succinct assessment of the health care reform process, at a community roundtable discussion sponsored by Christine Quinn, Speaker of the New York City Council. The meeting on Jan 12, 2009 at City Hall brought together a broad spectrum of interest groups from the five boroughs to provide the Obama-Biden transition team with input on how to right the nation's health care system. The discussion was moderated by Carol Reiss of the New York City Department of Education and considerable time was devoted to the need to preserve and expand wellness programs in schools. Improved preventative care for the young, both to reduce the incidence of conditions such as diabetes and heart disease and to lower costs is a central component of the Obama plan. Projected through the prism of personal experiences and professional expertise, participants in the forum touched on essential realities of health care and cultural attitudes in America today:
Eastern Regional Vice President Arne Gundersen and Councillor Sharon Wheatley also attended the forum. Mr. Gundersen spoke of the need for greater public awareness of patients' rights and cautioned against being victimized by the system. In his experience, when dealing with an imperfect system, persistence and knowledge of how things work may be the most effective tools. Councilor Wheatley described how, as a working Actor married to a performer and with two young children, the need for affordable family coverage can dictate significant life choices, in her case the need for her husband to augment his work in the profession with an academic position and the health coverage that comes with it. Equity's participation in the forum came about through an invitation by Speaker Quinn to First Vice President Paige Price who also sits on the City's Theatre Sub-District Council. Equity's Executive Director John Connolly has made the Union's participation on the health reform process a priority. "Every time we participate in an event like this we gain valuable experience, and add to our stature as serious players in this discussion." Entering the National Debate The Western and Central Regions will assume a greater importance in the health care reform as the national debate begins in earnest after the inauguration. California's two Senators and particularly Ron Widen of Oregon will be influential in the Senate and, as the House Ways and Means Health Subcommittee Chairman, Representative Pete Stark of California's 13th Congressional District in the East Bay will play major role in the House. Representative Stark has already joined with 12 House Democrats to reintroduce legislation, twice vetoed by President Bush to expand the State Children's Health Insurance Program (SCHIP) Mr. Stark stated, "With a new President, we can and should quickly enact this legislation to help millions of children maintain their health coverage, a step made all the more important by the failing economy." Equity is reaching out to State Labor Federations and to its fellow entertainment Unions to maximize its limited resources to greatest effect. A full list of key Congressional members who will be the major proponents and opponents of health care reform will be posted on Equity's website (www.actorsequity.org) by state and district with their contact information should members wish to express their views. Equity's position will also be posted along with talking points. Who's in Charge? The White House has had to shift gears on health care reform with the withdrawal of former Senate Majority Leader Tom Daschle of South Dakota. Daschle had been named to the twin posts of Secretary of the Department of Health and Human Services and Director of the White House Office of Health Care Reform. As such he would have been the Administration's chief health care architect and spokesman. Daschle was one of the longest-serving Senate Democratic leaders in history and the only one to serve twice as both Majority and Minority Leader. His knowledge of the Senate and his cordial relations with Democrats and Republicans will be hard to replace. Dr, Jeanne Lambrew, appointed the same time as the Daschle nomination will remain Deputy Director of the White House Office of Heath Care Reform. Dr. Lambrew is a nationally respected leader in Medicare, Medicaid and children's health care. From 1997 to 2001, she worked on health policy at the White House as the program associate director for health at the Office of Management and Budget and as the senior health analyst at the National Economic Council Dr. Lambrew's philosophical approach to health care reform can best be summarized by the Abstract of an article she co-authored with John D. Podesta and Teresa L Shaw entitled, Change In Challenging Times: A Plan for Extending and Improving Health Coverage.
President Obama, therefore, has assembled a professionally and politically fit team to implement his vision for health care reform and provide the nation with affordable universal health coverage for the first time in its history. But, if advocates for sweeping government intervention and supporters of a free market solution can agree on anything, it is the size of the problem and the depth of the ideologies that divide opinion. Differing Approaches Ideally, private insurers would like to see a national individual mandate requiring everyone to buy health insurance tied to the ability of insurance companies to do business across state lines and avoid headquartering in states which have strong consumer protection regulations. Single payer advocates would like to see private health insurance legislated out of existence and replaced by a uniform national health insurance policy paid for out of tax revenues. President Obama's plan, not surprisingly, falls somewhere in the middle. It contains long term efforts to control costs such as disease prevention and early treatment and more efficient use of technology to track medical histories and disseminate research and treatment results. But, its central provision is a new, national low cost insurance program subsidized by a progressive tax on manufactured goods and services. Government would go into the insurance business in competition with private insurers with, either unfair economic advantages as the insurers claim, or the moral and economic wherewithal of good government, according to the President and the electorate which put him in office. The Public program will be at the center of the argument, with free market economists and private insurers saying it will unfairly put them out of business and those who see profit in this particular instance as an unnecessary evil, saying, "good." The Obama initiative will try to strike a balance, by creating an insurance plan that average citizens can afford and that will attract a large enough risk pool of healthy and sick, young and old to be financially stable. Putting private insurance out of business is less a goal than a possible outcome after many years. More to the point would be the ability of a less expensive, but comparable Public insurance policy to set the bar for private insurance on premiums costs, benefit packages, prescription drugs, clarity of regulations and the priority of medical judgment over financial considerations when determining proper treatment. Health Care Remains Growth Area Complicating the task for President Obama and even the most reform-minded Congress members is the fact that health care appears to be one of the few growth areas in the economy. While near record unemployment puts pressure on Government to fill the gap in insurance left by disappearing jobs that used to provide coverage, the reality is also that legislators will be very careful about delivering yet another blow to the general economy by undermining those few sectors that appear to be relatively robust. The stakes are high. A recent econometric study commissioned by the California Nurses Association states that the current health care industry:
According to the study, a Medicare-for-all single payer-type national system would create 2,613,495 million new permanent good-paying jobs (slightly exceeding the number of jobs lost in 2008), boost the economy with $317 billion in increased business and public revenues, add $100 billion in employee compensation, infuse public budgets with $44 billion in new tax revenues. With these kinds of figures in play and the worst recession since the great Depression, the President and Legislators will be treading carefully when, real reform requires boldness. What Can Equity Do? The Daschle withdrawal and the spreading economic crisis have engendered a new sense of urgency to move ahead with significant comprehensive reform as soon as possible. What can Equity, with its relatively small numbers, do to move the process along in the right direction? John Connolly and Councillors such as Arne Gundersen, Francis Jue and Sharon Wheatley are effective and intelligent speakers who can articulate Equity's positions to a political audience. Equity's position is ethically sound, principled and easily understood. A single payer approach is the ideal way to accomplish universal, affordable health care, but getting there may be an incremental process. The membership should be given all the information it needs to understand and discuss the issues and this conversation should be taking place in theatres across the country. Alliances with other entertainment and labor groups, consistent action within the larger labor community and outreach to management will all make for a higher profile and sensible debate.
Unanimity, common sense and visibility are the three most important conditions for a successful outcome.
November 2008 Update
Equity Steps Up Efforts to Achieve Health Care Reform By Jack Goldstein Actors' Equity Association has begun to participate in a series of meetings with Congressional leadership to discuss health care reform. To date, the Union has joined with other labor groups in seeing Representative Edolphus Towns, of New York's 10th Congressional District, a senior member of the House Sub-Committee on Health, and Representative Gregory Meeks, of the 6th District who holds senior positions on key House finance and banking committees. Other meetings are being scheduled for the Eastern region and are in the planning phase for the Western and Central regions. While these meetings have been preliminary, everyone is keenly aware pf the urgency of meaningful health care reform and Equity's message to the legislators has been two-fold. First, as Eastern Vice President Arne Gundersen stated recently, "The Equity health care plan and those of other unions have been progressively under siege. Too many of our members and too many other Americans cannot afford even the most basic health coverage. The time for decisive action is now and we are looking to our Congressional Representatives to take a leadership role." The second point was articulated by Councillor Francis Jue. "Health care is a human right, and not a commodity to be bought and sold and bartered for across a bargaining table. It ought to be a part of the role of government, of our national identity." We are likely to see significant health care reform in 2009, certainly despite, and perhaps because of a worsening economy in which we can expect hundreds of thousands of Americans to loose their jobs and hence the health coverage they have been used to taking for granted.
Encouraging Signs Most importantly, President-elect Obama thinks that universal, affordable health coverage is important and doable, and he will put the weight of Government behind it. That cannot be said of his predecessor or his recent opponent. In addition, while the economy is clearly the highest and most immediate agenda item for the new Administration, health care reform has not been side-lined so far, and all the signals are good that it will not be. The first item to be moved will undoubtedly be the expansion of the State Children's Health Insurance Program (SCHIP), which President Bush vetoed several times, that will both grow the number of children covered under the Federal program through increased funding and expanded eligibility to include the children of moderate income as well as low income families. But soon after that will come more far-reaching steps.
Administration's Plan Even the most skeptical about the chances of a Single Payer proposal expect, at the very least, President-elect Obama to unveil a huge new Federal program, based on the menu of health plans currently available to members of Congress and their families. The program would be available to every American and priced to be particularly attractive to the uninsured and the underinsured. Instead of replacing the private insurance industry totally, the plan could out-compete it with the significant advantages of operating as a non-profit tax subsidized entity. That may not be aggressive enough for those who, like Equity, are on the record as supporting a complete restructuring of American healthcare. There is already a Single Payer Bill in Committee in the House of Representatives called the United States National Health Insurance Act (H.R.676). It was drafted and introduced by Representative John Conyers of Michigan and currently has 93 Congressional Cosponsors, including Representatives Towns and Meeks. It has been endorsed by 473 union organizations in 49 states including 117 Central Labor Councils and Area Labor Federations and 39 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC,MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA,AK, MI, MT, NE, NY, NV and MA). Were this Bill to be enacted, private insurance companies would be eliminated from the health insurance market place; employer-based insurance as we know it, would become obsolete, the Federal Government would tax everyone and pay everyone's medical bills. Private doctors, hospitals and drug companies would remain private; public facilities such as Veterans Hospitals would remain public and basically, the entire nation would be covered under a vastly expanded Medicare-type plan. There is a strong and well-organized national constituency, which is going to try to convince Congress and the President to follow this course.
Labor is Divided While whole sectors of organized labor constantly weigh wages against health care benefits in the regular negotiations, there is no guarantee that giving up those benefits will result in higher salaries and ultimately a system of universal health care means the working are taxed to pay for the unemployed and, in some scenarios, unregistered workers as well. To many, that is a major drawback to universal coverage of any kind, Other groups are simply concerned about a major Government intervention, seeing it mistakenly as "socialized medicine," or mistrusting the Government to be able to manage so vast a system without a costly and cumbersome bureaucracy inevitably taking control of it. Single Payer advocates point to the success of the Medicare program over many decades. They also point to the cost savings which would be effected by the simplicity and efficiency of one billing and record keeping system that would follow people from cradle to grave, from job to job, and state to state. And, as Francis Jue notes, "To those who say they don't want government making medical decisions for them, I say that the private health insurance industry already does that for them, and we currently pay far more per capita for health care than any other industrialized country in the world."
Chronic Care Labor has a right to congratulate itself for keeping its differences of opinion to a minimum and in the background for the past year. But principled disagreements will be, and should be, aired now. The last time that happened during the first Clinton Administration labor fractured into hostile camps that helped doom the Clinton plan. It could happen again. The implementation of a Single Payer system, without a period of transition could potentially involve the loss of thousands of jobs in the health insurance sector, and to the extent that sector plays into the economic success of the large health care industry, it would be eroding one of the few bright spots in the economy at the moment. While most of the lost jobs would be white collar, there could still be a sizeable reduction in consumer spending and that would have an impact on manufacturing and retail jobs. All of that will have to be taken into consideration. It is a complicated dynamic made more so, by the broader economic crisis and the need to take action soon. If there are answers to all of these concerns, perhaps the key to finding them lies in keeping a steady eye on the moral core of the issue. As Francis Jue, stated, "Even in our current economic crisis, I believe that Equity's members, indeed the vast majority of workers, are willing to pay their fair share if it would mean true universal health care."
Equity will continue to play a prominent role in the discussions. Speaking on behalf of Executive Director John Connolly, Arne Gundersen and Francis Jue remarked that, "We're ' proud of Equity's efforts to continue the fight for meaningful health care reform in this country."
September 2008 Update
AEA Health Care Update: McCain and Obama Health Plans Side by Side In previous months, we have examined McCain's and Obama's health care proposals. This month, we compare the two side-by-side. Health care reform will be a priority for the next President and Congress. Equity's official position regarding health care is to support a single-payer system and steps to achieve that goal. What each candidates proposes now, the direction in which he promises to take the discussion, will have an impact on the viability of single-payer. Of greatest importance is that every Equity member vote in November. There is a substantial difference on health care between the two candidates on this issue. Exercise your right to affect the outcome of the next election.
July/August 2008 Update Obama Sees Expanded Role for Government in Helping Individual Americans Pay for The Cost of Their Health Insurance. Can America join the list of nations with affordable and effective insurance coverage for all its citizens? Senator Barack Obama has announced the centerpiece of his strategy to achieve universal coverage will be to offer the Federal Employees Health Benefits Program, the same plan that currently insures U.S. Senators, Representatives their families, to any American who wants to purchase it. Under the Obama plan, health care professionals, hospitals and other medical facilities would remain largely private as they now are, but open enrollment in the Congressional insurance plan would hang a National health insurance safety net in place of the gap in coverage that has left 50 million Americans without health insurance. In addition, the Obama plan would employ many of the elements of the health insurance reform model largely pioneered by various States:
The Obama plan however departs from most state reform plans in its omission of an Individual Mandate. This is a legal requirement that everyone must carry some form of insurance or pay a fine. Sen. Obama's position is that effective cost saving measures will make insurance premiums affordable enough that most people will voluntarily opt for coverage over the risk of going without insurance. In the absence of lower prices, individual mandates are likely to be ignored or unfairly punish low and moderate income Americans. The Senator recommends improved prevention to contain costs- a healthier populace reduces demands on the health care system- and more technology advanced information exchange and record keeping. The application of internet storage and communication of health records and treatment protocols has an avid following and is popular with policy makers. While the use of new media is attractive, the real cost of transferring the nation to a single billing and health data management system is unclear as are or the cost savings once such a system were in operation. The staging of so vast a database might prevent a full and accurate accounting of the benefits for many years to come. The Obama plan does, however, offer more immediate financial relief. In addition to subsidizing those who cannot afford the going rate for insurance premiums, Obama proposes to create a Government assistance program to help employer-based plans offset the high costs of treating catastrophic illnesses such as cancer and heart disease. The cost to the tax payer of the Obama reform package would be considerable, but many experts believe that only an infusion of Public money will be able to slow, then reverse the negative trends of spiraling costs and growing population of the uninsured. The source of those extra revenues is still under consideration. To date, the Obama campaign has rejected the idea of taxing employee benefits as one method of raising new funds.
Senator Obama has made it clear that he does not endorse a Single Payer Insurance reform solution. His philosophical approach, however, does envision the Federal Government as a major player in setting the proper conditions for success and that Public policy makers, insurance operators and the general public will have to work together to achieve affordable, universal coverage.
June 2008 Update Senator McCain Backs Free Market Solution to Health Care Reform Targets Employer Based Coverage By Jack Goldstein On campaign stops in Florida and Pennsylvania in April, Senator John McCain fleshed out some of his proposals for National health care reform. The presumptive Republican presidential candidate proposed a sweeping challenge to employer based insurance coverage that would affect the 71 percent of Americans who currently get their insurance in the workplace. Central to his proposal are the following.
The avowed intention of the plan is to move more Americans out of employer-based health care plans into the private insurance market as individuals. Supporters of free market reform maintain that with more people in the marketplace shopping for coverage, and fewer regulations governing the industry, insurance companies will become more competitive and hence the cost of insurance will come down. By taxing health care benefits as wages, the McCain plan would also eliminate the corporate tax deduction businesses currently take for insurance expenses and hence remove the major incentive companies have for offering such benefits. The impact could be wide spread throughout the American economy, forcing millions of employees to seek coverage in the private market. The plan would potentially result in the proliferation of new insurance companies and increase the number of policies. That, some analysts say, would bring the price of insurance down through competition while others say it would only further benefit an industry whose need for profits many already see as a major inflationary factor in the cost of premiums Other concerns with the McCain plan focus on insurance regulations and the possibility of increased medical discrimination as more individuals face off against insurance companies and those companies are allowed to do business across state lines. Most employer based plans cannot discriminate against individuals with pre-existing conditions while in many states insurance companies may refuse to cover such individuals seeking coverage. Insurers could be encouraged to relocate to states with weak insurance regulations, and many of those who most need insurance will be less likely to find it. The McCain plan reflects the basic principles of a market driven approach to the health care crisis. While it is unclear how much of his proposal would be able to pass Congressional or voter muster, it does signal the Senator's strong willingness to work through an expanding private insurance industry to solve the Nation's health care ills.
This column will report briefly on the health care proposal of the presumptive Democratic candidate in the next issue.
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May 2008 Update Support for a single payer system of national health care is gaining momentum throughout the Labor movement. Equity first endorsed the single payer concept - or government provided health insurance - in the early 1990's. Council resolved at that time to "… participate in the formation of a national coalition of labor organizations, health care suppliers and public interests groups…, the goal of which is the adoption and implementation of a single-payer, universal, comprehensive national health care plan." With the defeat of President Clinton's health care initiative and a period of economic growth in which health care costs remained steady, the call for a single payer plan lost momentum, an interest which is now coming to the forefront again with health care costs rising out of control and over 47 million Americans unable to afford even basic coverage. Health care advocates and Labor leaders are focusing their attention on House Resolution (HR) 676, Medicare for All, a bill introduced by John Conyers Jr. (D-MI) in 2003. HR 676 would provide universal health coverage by making every American citizen eligible for the Medicare system that is currently only available to people over 65. None of the major Presidential contenders has endorsed HR676 as yet, but the Bill's supporters are encouraged by the fact that it has been inked by 400 union organizations including 103 Central Labor Councils or area Labor Federations and 33 state AFL-CIOs. Equity's position in favor of a single payer system is consistent with the aims of HR676 and the Union is examining the Bill. At the same time, the Association is working with sister unions, advocacy groups and Government entities to improve the health care safety net at State and Local levels and supports incremental steps leading to National health care for all.
In the coming months, as the nation draws closer to the Presidential vote, this column will layout the various proposals for single payer and other reform proposals, take a look at each candidates' positions on health care and to report on the membership can help influence the nationwide efforts to reform health care.
April 2008 Update In March, the Health Care Reform power point presentation was given to the Western Regional Board. The presentation was developed to make the health care debate understandable to the membership at large, demystifying basic terms and concepts predominant in the health care reform discussion. At press time, the Central Regional Board presentation is scheduled for April 7th with a future date for the Eastern Regional Board still to be confirmed. Over the coming months, staff members, trained in the power point, will travel to liaison cities to give the presentation. Following the lead of Massachusetts, Maine and Vermont, New Jersey legislators unveiled a proposal in mid-March that will require all residents to have health care coverage within three years. We are researching how this will impact our members who reside in New Jersey.
California School Employees have endorsed HR 676, a single payer healthcare legislation introduced by Congressman John Conyers (D-MI). HR 676, which has 88 co-sponsors in the U.S. House of Representatives in addition to Conyers, has been endorsed by 387 union organizations in 48 states, including 95 Central Labor Councils and Area Labor Federations and 33 state AFL-CIOs.
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