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Since President Obama signed the new federal healthcare bill into law last Sunday, the legislation has been both celebrated and aggressively opposed throughout the country.
The new bill is expected to benefit a large amount of uninsured Americans, guaranteeing healthcare in spite of pre-existing conditions within six months. In addition, by 2014, federal subsidies will likely be provided for household incomes of less than $88,000, and adults will be allowed to keep their children as a beneficiary on their health plan through age 26.
However, these guarantees include a legal requirement for all Americans to carry health insurance by 2014, with tax penalties imposed by the Internal Revenue Service (IRS) for those who do not. The benefits will likely mean tax hikes for individuals and/or businesses as well.
Obama and Democrats throughout Congress celebrated the new bill.
"We are not a nation that scales back its aspirations," Obama said. "We are not a nation that falls prey to doubt or mistrust. We don't fall prey to fear. We are not a nation that does what's easy. That is not who we are. That's not how we got here."
Republicans, on the other hand, were not pleased. No Republican in either the House or Senate voted in favor of the healthcare bill. Immediately following the signing, attorney generals from 13 states filed suit against the bill on the grounds that it violated the Constitution by mandating provisions for each state without reimbursing them for costs.
Congressional Representative Greg Walden (R - Ore.), like many of the Republicans in Congress, supports the idea of healthcare reform, but believes the new bill is too expensive and does nothing to curtail the increasing costs of healthcare.
"This bill does not reign in junk lawsuits nor reduce premium costs," Walden stated. "Real healthcare reform would make premiums more affordable, allow small businesses to group up and make coverage more accessible, all without government takeover or new taxes. This bill levies $569 billion in new taxes and spends $1.2 trillion."
In addition, Walden is skeptical of the claims from the non-partisan Congressional Budget Office that the bill will reduce federal budget deficits by $138 billion in the next 10 years.
"I bet you we are more likely to find alien life in the next 10 years than have this not add another dime to the deficit," Walden said.
Along with federal expenses, because the bill opens Medicaid, a state-run program, to more low-income households (about 16 million nationwide), Oregon could see its cost for Medicaid increase by an estimated $90 million to $800 million.
"It's a concern that this a major tax increase in one of the greatest recessions in history," said Walden spokesman Andrew Whelan. "The question is how do you raise that money?"
At this point that question is tough to answer. All that local state representative George Gilman (R - Dist. 55) can say for sure is that it increases the state's financial responsibility.
"The feds will kick in $5 billion over the next 10 years to Oregon to help implement the program, but nobody knows if that will be enough money," he said.
While he is critical of the bill overall, Congressman Walden believes there are some positive aspects as well. For instance, the bill cut out waste, fraud, and abuse in Medicare, and Walden is pleased that the bill made it illegal for insurance companies to turn away sick people.
United States Senator Ron Wyden (D - Ore.) supports the bill, but hopes improvements to the legislation will be made. For him, the greatest victory in the new bill has to do with insurance market reform.
"Making it illegal to discriminate based on pre-existing conditions and gender is really important," said Wyden spokesperson Jennifer Hoelzer. "Insurance companies should compete on the basis of cost and service, not risk."
In December 2006, Wyden introduced the Healthy Americans Act, one of several healthcare reform proposals. The bill was the only one proposed to receive bi-partisan support in Congress. Some elements of the Healthy Americans Act are reflected in the newly signed healthcare legislation, the primary one being the creation of a health insurance exchange.
Under the exchange, health insurance companies would be grouped together to allow individuals or businesses to shop for the best insurance plan. For those who joined that exchange, Hoelzer said they would join a risk pool of thousands or more, unlike employer health care, where the pool would be as deep as the number of employees, or individual, where the risk pool is merely that person.
Hoelzer explained that when insured people get sick, the rate increase is absorbed across the risk pool. For that reason, the larger the pool, the less rates increase for each person.
Under Wyden's plan, all individuals and businesses would be eligible for this exchange, Hoelzer stated. The new federal bill does not make businesses eligible for the exchange, so people whose health insurance is provided through employers would not be impacted by the bill. If businesses were made eligible, Hoelzer said employees would become part of the larger pool on the exchange and possibly see lower premiums.
As it stands now, the exchange would be available for about 27 million Americans. Nonetheless, Wyden is encouraged with any inclusion of a health insurance exchange, believing, for that reason, that the bill is a step in the right direction.
The other significant piece of the Healthy Americans Act to find its way onto the new healthcare bill was a state waiver provision.
The waiver is for states who "think they have a better way to provide healthcare insurance," Hoelzer said. This provision, according to Wyden, makes any of the state attorney general lawsuits moot because any state has a way to opt out.
Like Wyden, United States Senator Jeff Merkley (D - Ore.) was encouraged by the healthcare bill overall, but hopes to improve the new legislation going forward. His primary concern with the bill was the exclusion of a public option for health insurance.
"Senator Merkley was disappointed that a public option was not included in the final bill," said Merkley spokesperson Julie Edwards. "He believes that a public option would have strengthened the bill by providing more choices for consumers, lowering costs and keeping insurance companies honest."
Oregon Business Association Senior Policy Analyst Andi Miller believes Oregon will likely have an easier time than other states implementing the new reform laws.
"Oregon has been working on healthcare reform in the recent legislative session," she said. As early as 2005, Miller said the legislature was forming committees committed to improving healthcare in the state, and, during the 2009 Legislative session, passed House Bill 2009. Under this bill, the state formed the Oregon Health Policy Board whose job will be to develop a plan for access to affordable healthcare for all Oregonians by 2015, as well as implement a variety of specific healthcare reforms that will reduce costs and improve the quality of care.
"We are leaps and bounds ahead of others states," Miller said.
As far as the impact to businesses in Crook County and other rural communities throughout the state, Miller sees the bill as a change for the better. She pointed out that small businesses throughout the country will likely benefit from a small business tax credit.
"Businesses with fewer than 25 full-time employees that contribute at least 50 percent of the total premium will be eligible for tax credits of up to 35 percent of the employer contribution," Miller said. "That's the opposite of increasing the tax burden. I think that small businesses will benefit. I cannot see them being harmed."
Oregon Bureau of Labor and Industry head commissioner Brad Avakian similarly stated the bill will likely help small businesses.
"Making progress on healthcare reform is going to benefit Oregon employers in terms of health costs to their employees," he said. "Small business people in particular want to see their employees get health insurance, but they shouldn't have to choose between providing their employees health insurance and keeping their doors open. The new law will benefit Oregon employers and workers alike by getting more Oregonians healthcare insurance."
Locally, Prineville Economic Development manager Jason Carr said he has limited knowledge of the bill at this point and suspects that is the case for most people in the area.
"I don't think anybody really knows what the impact will be," he said.
The one certain change that Carr is aware of that could affect businesses is that any company with 50 or more employees is required to provide coverage. However, that may not make a difference in Crook County.
"I believe most of the large mills and Les Schwab already provide health insurance coverage," Carr said.
For Congressman Walden, rural areas like Crook County are not adequately represented in the bill. During the time leading up to the passage of the bill, Congressman Walden attempted to include provisions for rural healthcare.
One amendment would have required MedPAC, a non-partisan commission that advises Congress on the Medicare program, to have proportionate representation from people with rural healthcare credentials.
"Currently, 26 percent of the Medicare population lives in rural areas," Walden pointed out. "However, just two of the 17 MedPAC commissioners (11 percent) have rural healthcare credentials"
Walden wanted similar representation of rural healthcare experts on the federal-healthcare-bill-created Independent Medicare Advisory Board.
In the end, Walden said both amendments were blocked from inclusion on the bill.
"Rural America continues to be challenged by shortages of healthcare providers and barriers to healthcare access," Walden said.
