Health Care Now
“We apologize for the inconvenience. The Marketplace is currently undergoing regularly scheduled maintenance and will be back up Monday 10/7/3013.” You read it right, 3013. That was the message on the homepage of the New York state health insurance exchange website this past weekend.
Yes, the Affordable Care Act (ACA), popularly known as Obamacare, is going through difficult birth pains, as the marketplace websites went live only to crash. The government is not giving out numbers, but informed observers speculate that very few people have succeeded in signing up for any of the plans so far.
The ACA rollout occurred as Republicans shut down the government in their attempt to defund Obamacare. But their strategy backfired. Had there been no shutdown, all of the attention would have been on the disastrous rollout. The fundamental issue, at the core of the health-care dispute, is typically ignored and goes unreported: The for-profit health-insurance industry in the United States is profoundly inefficient and costly, and a sane and sustainable alternative exists—single-payer, otherwise known as expanded and improved Medicare for all. Just change the age of eligibility from 65 to zero.
“When Medicare was rolled out in 1966, it was rolled out in six months using index cards,” Dr. Steffie Woolhandler told me Monday. “So if you have a simple system, you do not have to have all this expense and all this complexity and work.” Woolhandler is professor of public health at CUNY-Hunter College and a primary-care physician. She is a visiting professor at Harvard Medical School and the co-founder of Physicians for a National Health Program, or PNHP. PNHP is an organization with 17,000 physicians as members, advocating for a single-payer health-care system in the U.S.
What is single-payer? Critics denounce it as “socialized medicine,” while ignoring that single-payer is already immensely popular in the U.S., as Medicare. A 2011 Harris poll found that Medicare enjoyed 88 percent support from American adults, followed closely by Social Security. Woolhandler explained that with a Medicare-for-all system, “you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion [per year].” Dr. Woolhandler went on, rather than “thousands of different plans, tons of different co-payments, deductibles and restrictions—one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want … not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.”
Monthly premiums in most cases are expected to decrease with Obamacare’s health-exchange systems, which will enhance the transparency and ease of comparison for people shopping for a health-insurance policy. If and when the technical problems are eliminated from the online health insurance exchanges, and people can easily shop, there will likely be a huge number of people buying policies for the first time. The ACA offers important advances, which even single-payer advocates acknowledge: subsidies for low-income applicants will make insurance affordable for the first time. Medicaid expansion also will bring many poor people into the umbrella of coverage. Young people can stay on their parents’ insurance until the age of 26. People with so-called pre-existing conditions can no longer be denied insurance.
While the ACA was deemed constitutional by the Supreme Court, the opinion gave states the option to opt out of the Medicaid expansion, which 26 states with Republican governors have done. A New York Times analysis of census data showed that up to 8 million poor people, mostly African-Americans and single mothers, and mostly in the Deep South, will be stranded without insurance, too poor to qualify for ACA subsidies, but stuck in a state that rejected Medicaid expansion.
So, while partisan bickering (between members of Congress who have among the best health and benefits packages in the U.S.) has shut down the government, the populace of the United States is still straitjacketed into a system of expensive, for-profit health insurance. We pay twice as much per capita as other industrialized countries, and have poorer health and lower life expectancy. The economic logic of single-payer is inescapable. Whether Obamacare is a pathway to get there is uncertain. As Dr. Woolhandler summed up, “It’s only a road to single-payer if we fight for single-payer.”
Without Single-Payer, Patchwork U.S. Healthcare Leaves Millions Uninsured
From Democracy Now –
Despite helping expanding affordable insurance, “Obamacare” maintains the patchwork U.S. healthcare system that will still mean high costs, weak plans and, in many cases, no insurance for millions of Americans. We host a debate on whether the Affordable Care Act goes far enough to address the nation’s health crisis with two guests: Dr. Steffie Woolhandler, a primary care physician and co-founder of Physicians for a National Health Program; and John McDonough, a professor at the Harvard School of Public Health and former senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. Between 2003 and 2008, McDonough served as executive director of Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law, known as “Romneycare,” regarded by many as the model for the current federal healthcare law.
From the New York Times –
A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.
Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.
Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.
People shopping for insurance on the health exchanges are already discovering this bitter twist.
“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.
At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”
The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.
“The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.”
The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.
Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not.
In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base.
“Any additional cost in Medicaid is going to be too much,” said State Senator Chris McDaniel, a Republican, who opposes expansion.
The law was written to require all Americans to have health coverage. For lower and middle-income earners, there are subsidies on the new health exchanges to help them afford insurance. An expanded Medicaid program was intended to cover the poorest. In all, about 30 million uninsured Americans were to have become eligible for financial help.
But the Supreme Court’s ruling on the health care law last year, while upholding it, allowed states to choose whether to expand Medicaid. Those that opted not to leave about eight million uninsured people who live in poverty ($19,530 for a family of three) without any assistance at all.
Poor people excluded from the Medicaid expansion will not be subject to fines for lacking coverage. In all, about 14 million eligible Americans are uninsured and living in poverty, the Times analysis found.
The federal government provided the tally of how many states were not expanding Medicaid for the first time on Tuesday. It included states like New Hampshire, Ohio, Pennsylvania and Tennessee that might still decide to expand Medicaid before coverage takes effect in January. If those states go forward, the number would change, but the trends that emerged in the analysis would be similar.
Mississippi has the largest percentage of poor and uninsured people in the country — 13 percent. Willie Charles Carter, an unemployed 53-year-old whose most recent job was as a maintenance worker at a public school, has had problems with his leg since surgery last year.
His income is below Mississippi’s ceiling for Medicaid — which is about $3,000 a year — but he has no dependent children, so he does not qualify. And his income is too low to make him eligible for subsidies on the federal health exchange.
“You got to be almost dead before you can get Medicaid in Mississippi,” he said.
He does not know what he will do when the clinic where he goes for medical care, the Good Samaritan Health Center in Greenville, closes next month because of lack of funding.
“I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”
The states that did not expand Medicaid have less generous safety nets: For adults with children, the median income limit for Medicaid is just under half of the federal poverty level — or about $5,600 a year for an individual — while in states that are expanding, it is above the poverty line, or about $12,200, according to the Kaiser Family Foundation. There is little or no coverage of childless adults in the states not expanding, Kaiser said.
The New York Times analysis excluded immigrants in the country illegally and those foreign-born residents who would not be eligible for benefits under Medicaid expansion. It included people who are uninsured even though they qualify for Medicaid in its current form.
Blacks are disproportionately affected, largely because more of them are poor and living in Southern states. In all, 6 out of 10 blacks live in the states not expanding Medicaid. In Mississippi, 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population.
Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks.
That is compounded by the country’s rapidly changing demographics, Dr. Geiger said, in which minorities will eventually become a majority, a pattern that has produced a profound cultural unease, particularly when it has collided with economic insecurity.
Dr. Shirley said: “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs. It’s a tactic that appeals to people who would rather suffer themselves than see a black person benefit.”
Opponents of the expansion bristled at the suggestion that race had anything to do with their position. State Senator Giles Ward of Mississippi, a Republican, called the idea that race was a factor “preposterous,” and said that with the demographics of the South — large shares of poor people and, in particular, poor blacks — “you can argue pretty much any way you want.”
The decision not to expand Medicaid will also hit the working poor. Claretha Briscoe earns just under $11,000 a year making fried chicken and other fast food at a convenience store in Hollandale, Miss., too much to qualify for Medicaid but not enough to get subsidies on the new health exchange. She had a heart attack in 2002 that a local hospital treated as part of its charity care program.
“I skip months on my blood pressure pills,” said Ms. Briscoe, 48, who visited the Good Samaritan Health Center last week because she was having chest pains. “I buy them when I can afford them.”
About half of poor and uninsured Hispanics live in states that are expanding Medicaid. But Texas, which has a large Hispanic population, rejected the expansion. Gladys Arbila, a housekeeper in Houston who earns $17,000 a year and supports two children, is under the poverty line and therefore not eligible for new subsidies. But she makes too much to qualify for Medicaid under the state’s rules. She recently spent 36 hours waiting in the emergency room for a searing pain in her back.
“We came to this country, and we are legal and we work really hard,” said Ms. Arbila, 45, who immigrated to the United States 12 years ago, and whose son is a soldier in Afghanistan. “Why we don’t have the same opportunities as the others?”
From the New York Times –
Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.
From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.
When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.
Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.
Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.
“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”
Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.
Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas.
“The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” said Joseph Mondy, a spokesman for Cigna.
The current concerns echo some of the criticism that sank the Clinton administration’s plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients’ options, their access to care and their choice of doctors.
From Kaiser Health News –
The nation’s total health spending will bump up next year as the health law expands insurance coverage to more Americans, and then will grow by an average of 6.2 percent a year over the next decade, according to projections released Wednesday by government actuaries.
That estimate is lower than typical annual increases before the recession hit. Still, the actuaries forecast that in a decade, the health care segment of the nation’s economy will be larger than it is today, amounting to a fifth of the gross domestic product in 2022.
We are thrilled to announce that Frances Fox Piven, professor of political science and sociology at City University of New York, will give the keynote address at our National Strategy Conference in Nashville on October 5th and 6th. She will speak about lessons from social movements that transformed American life.
Frances is the author of many books, such as Poor People’s Movements: Why They Succeed, How They Fail and Challenging Authority: How Ordinary People Change America.
Here she is talking about inequality and the importance of social movements. And here’s her seminal article on welfare rights, “The Weight of the Poor: A Strategy to End Poverty.”
If you haven’t already, go here to register for the conference today!
Also, we’re happy to release the first draft of the conference agenda. You can download it here (.pdf).
Workshops will be led by activists from Physicians for a National Health Program, National Nurses United, Public Citizen, Single Payer Now, Health Care for All Colorado, Healthcare-NOW! New York City, The Labor Campaign for Single Payer, and All Unions for Single Payer.
Don’t forget: You or your organization can sponsor an ad in our conference booklet. All ads include one free registration to the conference. Ads are a great way to congratulate one of 2013′s honorees. We will be honoring Tim Carpenter, of Progressive Democrats of America, with the Marilyn Clement Award for the Pursuit of Healthcare Justice. The Divestment Campaign for Healthcare will receive the Healthcare-NOW! Organizational Achievement Award. More information here.
Thanks for your support and we hope to see you in Nashville!
From All Unions for Single Payer –
The just concluded AFL-CIO convention reaffirmed its commitment to a single payer health care system while demanding that the Affordable Care Act (ACA) be fixed to protect Taft-Hartley (multiemployer) plans, to end the excise tax, to make employers cover workers who average 20 hours a week, to require construction companies with 5 or more employees to provide health care, to penalize companies who dump their workers onto Medicaid, plus more.
Some of the debate on the resolution can be seen here:
Full text of the resolution can be found here.
By Andrew Stein for VTDigger.org –
If Gov. Peter Shumlin pursues a payroll tax to fund a publicly financed health care system, he will meet heavy resistance from one of the state’s most influential business groups.
Betsy Bishop, president of the Vermont Chamber of Commerce, says her organization and its members would not look favorably on a payroll tax.
“When you take away the decision-making process, but leave the payment still in place, it disconnects the employer from the payment,” she said. “What we’re interested in is continuing a system where employers, if they are paying for health care, have some level of control over what they are paying for.”
Last week, Shumlin told Times Argus Editor Steve Pappas that a payroll tax would be one of the vehicles for funding a single-payer, universal health care system in Vermont. Shumlin has been touting single payer for years, but he has provided little detail to date about how the state would pay for the system.
“Clearly, the payroll tax is going to have to play a major role,” he told Pappas.
Shumlin’s Office of Health Care Reform is working on a financing plan to raise an estimated $1.61 billion for the system, and the governor says he will hand the plan to the Legislature in January 2015. The state would not be eligible for a waiver from the Affordable Care Act to implement a single payer plan until 2017.
“Opponents are going to say this will be the biggest tax increase in Vermont history — fair enough,” Shumlin told Pappas. “But it’s going to be the biggest health care premium reduction in American history. We’re just going to swap a health care premium for a publicly financed health care premium.”
All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers.
With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you’ll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America’s healthcare system in our lifetimes. Here are a couple of things to keep in mind:
First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.
Second, there’s an obvious way to correct this flaw: The country should progress on to a single-payer system.
The idea that the ACA is a logical precursor to single-payer, in which the government would be the source of all medical reimbursement, has been gaining traction as key thresholds for healthcare reform approach. The biggest milestone is the Oct. 1 launch of open enrollment for the health insurance exchanges that will offer individual insurance starting Jan. 1.
Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA “a step in the right direction” but adding that the U.S. would have to “work our way past” private insurance-based healthcare. “We’re far from having something that’s going to work forever,” he said.
“There isn’t a popular groundswell yet” for a single-payer plan “because most people haven’t seen the ACA at work in detail yet,” says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October “and accelerate through the winter.”
Among the law’s shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don’t have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)
That’s not to say that the ACA won’t make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.
In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they’re actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.
The ACA’s critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn’t go far enough — that is, further toward single-payer.
In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the “public option,” a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry’s insistence.
But the U.S. does offer a healthcare program that resembles single-payer. It’s Medicare, the broadly popular health plan that covers all Americans over 65. Medicare’s administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That’s why one oft-proposed version of single-payer is “Medicare for all” — simply expand its coverage beyond the 65-plus.
Canada’s single-payer system is another model. It’s popular and efficient and costs about one-third of America’s system to administer. Don’t believe the myths purveyed about Canada’s healthcare by the U.S. insurance industry’s minions.
As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it “rations” care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.
There’s little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.
Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn’t include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.
Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors’ offices, they calculated.
What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they’re totally ineffective at cost control.
Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn’t hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn’t buy adequate oversight.
The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.
“Private insurance is a parasite in the system,” says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. “It adds nothing of value commensurate with its cost.”
Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more “accountable care organizations” — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.
What’s really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.
The forces of opposition won’t lie down; the insurance industry won’t give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.
“It’s going to be a slow and painful process,” Relman says. “But sooner or later we’ll have to turn to single-payer. It’s the only logical solution.”
From Unions For Single Payer –
The New York State United Teachers (NYSUT) has reaffirmed support for single payer health care. The reaffirmation, which was submitted by Retiree Council 12, calls specifically for support for HR 676, Congressman John Conyers’ Expanded and Improved Medicare for All legislation.
NYSUT is made up of more than 600,000 who work in, or are retired from, New York’s schools, colleges, and healthcare facilities. NYSUT is a union of classroom teachers, college and university faculty and professional staff, school bus drivers, custodians, secretaries, cafeteria workers, teacher assistants and aides, nurses and healthcare technicians.
NYSUT is a federation of more than 1,200 local unions. It is affiliated with the American Federation of Teachers (AFT), the National Education Association (NEA), and the AFL-CIO.
The NYSUT reaffirmation is available in full here at the link in #607.
By Margaret Flowers for FlushTheTPP.org –
The Obama administration has been negotiating an agreement called the Trans-Pacific Partnership (TPP) for the past three years that is now heading into the final stages and could be signed into law as early as October. If it is not stopped, this new agreement has the potential to prohibit single payer health insurance, even at the state level, or any new public insurance, could cement the privatization of Medicare, could prevent many of the mechanisms that are commonly used to control health care costs and would raise the prices of medications and pharmaceutical devices.
The TPP is being negotiated as a trade agreement, but in fact, it is much more than that. Of the 29 chapters, only five are traditional trade chapters. The others contain many policies that corporations have tried to advance through Congress and through World Trade Organization (WTO) talks without success. These include patent and property protections, financial deregulation, greater legal standing for investors and corporations, the end of ’Buy America’ and weakening of what are called state-owned enterprises (SOEs). This is why the TPP is being called “NAFTA on steroids.”
The bottom line for the TPP is to advance the neoliberal economic agenda with which we are becoming more familiar; this means de-funding public programs, privatizing public resources by making them available to corporations and treating every entity, be it education or health care, as a commercial enterprise. For those of us who advocate for universal health care systems and public health programs, the TPP would be a disaster.
What we know about the specific provisions in the TPP come from chapters that have been leaked and from industry reports. There has been a virtual media blackout on the TPP. Unlike past trade agreements which were available for public viewing on the US Trade Representative (USTR) website, the text of the TPP is classified. Members of Congress are only allowed to see portions of the text upon request, and then must do so on a ‘read and retain’ basis without aids of any sort for note-taking. They are not allowed to speak publicly about what they have read. However, the more than 600 corporate advisors who are working with the Office of the USTR have access to the text on their computers in live time as it is negotiated.
The reason for the secrecy was revealed after the former USTR, Ron Kirk, left his position to work for a Washington lobbying firm. In essence Kirk said that if the people knew what was in the TPP, they wouldn’t be able to get it signed. This is due in large part to the public opposition to the WTO and free trade agreements.
The TPP, and its sister the Trans-Atlantic Trade and Investment Partnership (aka TAFTA), are backdoors to advance the WTO agenda. Since the Doha Round of WTO talks which began after the ‘Battle of Seattle,’ the WTO has essentially stalled. And since the passage of NAFTA, 14 free trade agreements have been stopped by public protest. The new approach being used for the TPP is to gather a group of small nations including Vietnam, Brunei, Malaysia, Singapore, Chile and Peru and, with the assistance of allied nations including Australia and New Zealand, bully them into accepting harmful provisions. A unique feature of the TPP is that it contains a ‘docking provision’ which allows other nations to join the TPP after it has been negotiated as long as they agree to its terms.
Together, the TPP and TAFTA will redefine the terms of the global economy in ways that give corporations greater power than sovereign nations. Corporations will be able to sue nations in a trade tribunal that operates outside of national judicial systems if environmental, labor and consumer protection laws interfere with expected profits. The trade tribunal will be staffed by corporate lawyers on leave from their jobs to serve as judges. For many poorer nations, this will lead to weakening of these laws rather than paying tens of millions of dollars in compensation to transnational corporations.
The effect of the TPP on health care in the US and around the world could potentially undermine decades of work by single payer and public health advocates. We know from text leaked in June, 2011 that the TPP will grant twenty year patents for pharmaceuticals and medical devices that can be renewed if a new indication is found or the mechanism of delivery is altered. This is a process called ‘Evergreening’ and it is designed to prevent generics and protect profits. The TPP will also give greater legal standing to health corporations to challenge reimbursements from health systems and to include the cost of marketing into what is considered a ‘fair market value.’
The TPP will undermine public health efforts by raising health care costs for public health systems and also by preventing public health education efforts, such as ant-tobacco campaigns, if they are viewed as conflicting with corporate profits. This aspect of the TPP even has Mayor Bloomberg concerned.
It is also possible that the TPP could prevent the establishment or expansion of public insurances. On one hand, public insurances could be viewed as state-owned enterprises and could be prohibited from having any market advantages that are not also offered to private insurances such as subsidies, access to capital or tax preferences. On the other hand, a single payer health insurance in particular could be prohibited altogether because it would create a monopoly that would exclude private insurances. This is explained in detail in an article published by Nick Skala in 2009.
And finally, the TPP, if it is similar to the WTO provisions, could prevent Medicare from returning to a fully public system, regulation of specialty hospitals, limitations on for-profit disease management products and requirements that health insurers spend a particular amount of premiums on health services (regulation of the medical loss ratio). It would open the door to greater privatization of health care which is already resulting in great inequalities in access to health care services and health outcomes.
The time to stop the TPP is now. President Obama recently made a formal request to Congress to grant him Fast Track, also called Trade Promotion Authority, and a vote is expected in late September or early October in both the House and Senate. Fast Track, which was previously used by President Clinton to pass the WTO and NAFTA, gives the President the authority to negotiate and sign trade agreements before the agreement goes to Congress who would then only have the ability to vote yes or no on it. It would prevent hearings in Congress on the text of the agreement and amendments. Under the Commerce Clause of the U.S. Constitution, it is Congress that has the responsibility to oversee commerce and trade, not the president.
The first step to stop the Trans-Pacific Partnership and to achieve transparency and a democratic process in Congress is to stop Fast Track. Constituents are meeting with their members of Congress now while they are on break in their home districts to ask for a commitment to vote “no” on Fast Track. Some are planning events for September 17, Constitution Day, to thank members who commit to a no vote or to ‘spank’ members who won’t commit by exposing their corporate connections. On September 21 and 22, there will be a “Stop the TPP Action Camp” in Washington, DC with ongoing actions starting September 23 and continuing through the vote. Volunteers are needed to participate in visibility actions on September 23 and 24 and then to join the “Fair Trade Brigade” daily in Congress to remind members that trade should put people and the planet before profits.
Personally, as an activist for single payer health insurance, I feel that I must devote my time and attention to stopping the TPP. It is something that can be stopped, as the past 14 trade agreements have been. It is a cause that unites all of us who advocate for economic and social justice. And, when we work together and win, it will be a blow against the further consolidation of global corporate power. Stopping the TPP is essential to our ultimate goal of a universal health care system based on single payer health insurance.
ObamaCare has become big business for an elite network of Washington lobbyists and consultants who helped shape the law from the inside.
More than 30 former administration officials, lawmakers and congressional staffers who worked on the healthcare law have set up shop on K Street since 2010.
Major lobbying firms such as Fierce, Isakowitz & Blalock, The Glover Park Group, Alston & Bird, BGR Group and Akin Gump can all boast an Affordable Care Act insider on their lobbying roster — putting them in a prime position to land coveted clients.
“When [Vice President] Biden leaned over [during the signing of the healthcare law] and said to [President] Obama, ‘This is a big f’n deal,’ ” said Ivan Adler, a headhunter at the McCormick Group, “he was right.”
Veterans of the healthcare push are now lobbying for corporate giants such as Delta Air Lines, UPS, BP America and Coca-Cola, and for healthcare companies including GlaxoSmithKline, UnitedHealth Group and the Blue Cross Blue Shield Association.
Ultimately, the clients are after one thing: expert help in dealing with the most sweeping overhaul of the country’s healthcare system in decades.
“Healthcare lobbying on K Street is as strong as it ever was, and it’s due to the fact that the Affordable Care Act seems to be ever-changing,” Adler said. “What’s at stake is huge. … Whenever there’s a lot of money at stake, there’s a lot of lobbying going on.”
The voracious need for lobbying help in dealing with ObamaCare has created a price premium for lobbyists who had first-hand experience in crafting or debating the law.
Experts say that those able to fetch the highest salaries have come from the Department of Health and Human Services (HHS) or committees with oversight power over healthcare.
Demand for ObamaCare insiders is even higher now that major pieces of the law, including the healthcare exchanges and individual insurance mandate, are being set up through a slew of complicated federal regulations.
“Congress is easy to watch,” said Tim LaPira, a politics professor at James Madison University who researches the government affairs industry, “but agencies are harder to watch because their actions are often opaque. This leads to a greater demand on K Street” for people who understand the fine print, he said.
“K Street’s agenda follows the government’s agenda. It’s not typically the other way around,” he said.
Watchdogs say the rise of the ObamaCare lobbyist is another example of the “revolving door” that turns public service into private enrichment.
“After passage of major legislation, those who have networks on Capitol Hill take exceedingly lucrative jobs with the same industries subject to the legislation,” said Craig Holman, a lobbyist for Public Citizen. “It raises questions about the [bill's] integrity.”
For K Street, healthcare lobbying has been a bright spot in what has otherwise been a down business cycle.
While lobbying revenue at major firms has been flat or declining in recent years, the healthcare law has generated steady work — a trend that is likely to continue for years to come.
That’s because ObamaCare runs on a long timeline — well into the next administration. Unless the law is severely crippled, the reform’s rules and requirements will be rolling out through at least 2020.
That’s good news for lobbyists who want to sign up clients for the long haul.
The windfall from the healthcare overhaul is being reaped at firms large and small. Some veterans of the legislative push have landed at boutique firms that are increasingly specializing in lobbying niches.
The firm Avenue Solutions, for instance, recently hired Yvette Fontenot, a former staffer for both the Senate Finance Committee, which wrote ObamaCare’s tax-related provisions, and HHS’s Office of Health Reform, which is assisting the implementation.
Since her hire in April, the four-woman firm has picked up Health Care Service Corp. as a client, and Fontenot is now lobbying for the Blue Cross Blue Shield Association and the National Electrical Manufacturers Association as well.
The Democratic firm banks about $3 million in revenue per year, records show, but is on pace for growth in 2013, earning $1.8 million through the first half of the year.
It’s not just ex-staffers who are becoming trusted ObamaCare guides — former members of Congress are lobbying on the law as well.
Former Rep. Earl Pomeroy (D-N.D.) joined Alston & Bird in 2011 after dealing with healthcare and tax issues as a member of the House Ways and Means Committee.
Now Pomeroy and his one-time chief of staff, Bob Siggins, are lobbying on ObamaCare for clients such as clients such as Vision Service Plan, the National Coordinating Committee for Multiemployer Plans and Medicare — a health insurance provider.
Consulting is another avenue former staffers and officials can take to work for outside interests while they look to comply with and shape the impending regulations.
“This is not a do-it-yourself project; it’s complicated,” said Adler. “They need help from insiders to help navigate this thing correctly.”
Former senior counsel to HHS Secretary Kathleen Sebelius Dora Hughes became a senior policy adviser at the law firm Sidley Austin last year.
Hughes is not a registered lobbyist, and told The Hill she mainly provides “strategic policy advice” while abiding by the ethics pledge not to lobby the administration. She has no congressional contacts in her sights, either.
Even the president needs some lobbying know-how when it comes to advancing ObamaCare.
The White House brought on Clinton administration veteran and former lobbyist Chris Jennings last month to help navigate the implementation of the law.
During a call with several directors of the state healthcare exchanges on Wednesday, Jennings was seated in a plum position — right next to Obama.