The Democrats' year-long effort to achieve health-care reform and point the nation toward the security of universal care -- a goal put in gear by the bill passed by the Senate in December and approved at last by the House on Sunday against heavy odds in a remarkable tension-filled day -- marks a long-sought triumph of epic proportions. Various presidents have pursued this goal since Teddy Roosevelt first advocated it nearly a century ago, only to be defeated by selfish vested interests each time. With President Obama's signature, this visionary plan, already achieved in every other industrialized nation in the world, will finally begin to become a reality in our own United States.
Granted, the bill is not as strong or cost-efficient as it would be with a public option or a parallel single-payer system to operate as a competitive alternative to a for-profit insurance system. Both were vehemently rejected by Republicans. Yet signing the bill as it is into law is the first great step on a plan that could be continuously improved, much as Medicare was over the years after its inception (against solid Republican opposition) in 1935.
The new plan won't be fully fleshed out until all its parts are put in place, and some of the main pieces won't be become effective until 2014. Before that work can even begin, Senate Democrats must yet work to fulfill a promise to their House counterparts to pass a package of quick amendments that will strengthen the initial bill through a budget reconciliation package.
They will have to do that, again, over the continuing strident opposition of Republicans, who in all the committee and full membership meetings in both chambers have delivered just one single vote -- just one member's vote, one time -- for health care reform in the entire year-long process.
Once the bill is enacted, however, more than a dozen changes would take effect this year, including:
* More help for senior citizens to pay for drug prescriptions under Medicare.
* Allowing dependent children to remain on their parents' group health care insurance, for a fee, until the age of 26, and exempting children under 19 from exclusions for pre-existing conditions.
* Americans previously rejected by insurance companies as uninsurable could qualify for coverage under a new, affordable federal high-risk pool.
* Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for tax credit of up to 35 percent of their premium costs, and the credit would rise to 50 percent by 2014..
* Insurance companies would be barred immediately from placing lifetime caps on coverage.
Medicare recipients' drug benefits would increase markedly in the second and third years, and by 2014 would cover most of the gap in prescription drug coverage, called the "donut hole." By 2020 it would be closed altogether.
By 2014, the larger pieces of reform would be in place. In that year, the worst abuses of the insurance would be eliminated: Insurers' use of pre-existing conditions, annual and lifetime limits on coverage, exclusions, and recissions to cancel existing policies when people become ill would be barred, and insurers could not discriminate against policy applicants on the basis of health conditions, gender and other factors.
Americans with incomes less than 133 percent of the federal poverty level would be eligible for Medicaid, and federal aid for Medicaid would be expanded to cover newly enrolled members. Additional payments to the states would ease that financial burden.
Families with incomes from 133 percent to 400 percent of the federal poverty level (from $29,326 to $88,200 for a family of four) would be eligible for federal subsidies, adjusted on a sliding income scale, to purchase insurance, and their out-of-pocket costs would be limited. If they were without employer-based insurance, they could buy coverage through insurance exchanges organized by states on a competitive basis.
Companies with more than 50 employees that failed to offer insurance would be assessed a proportional fee to help offset the costs of federal subsidies to help American workers without employer-based insurance purchase affordable insurance.
These and other reforms would make coverage available --through establishment of a mandate to purchase insurance and financial aid to make that possible -- to some 32 million uninsured Americans, most of whom would welcome the opportunity.
Taken together, the reforms will begin to establish secure, near-universal care at a fair price and protected from insurance company abuses. That is a is a giant step toward the social progress, justice and moral accountability that ultimately will flow from this achievement.
The bill may yet be improved, but first it will have to be protected from the Republican and Tea-Party naysayers who still are bent on demolishing the effort by falsehoods about its form and purpose, by lawsuits from Republican-controlled state capitols, and by unfounded vitriol boosted by vast sums of medical industry money for lobbying and advertising.
Until health-care reform and universal care are rooted in deep cement, the nascent effort will remain under assault. But it holds great promise, and merits strong support.