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Health Care Reform: Did Obama Deliver?

theloop21.com, Alyssa Giachino Posted: Jan 20, 2010

Health care reform has been one of the banner issues of Obamas administration, and the evolution of the debate offers measures of how much policy was shaped by solving problems and how much was shaped by corporate influence.

The premise of reforming our messed up health care system is populist to begin with, so much so that candidates in both the Republican and Democrat camps saw it as a key issue that could garner them important votes in the 2008 presidential campaigns.

With bipartisan support for some kind of reform, plus with the powerful combination of a Democrat holding the presidency and a majority of Democrats in both chambers of Congress, getting new legislation through should have been a no brainer.

Of course, we all know that it has been an agonizing process replete with the trademark beltway antics of partisan posturing, inflating wedge issues, opportunistic media grabs, corporate lobbying, blatant bribery in other words, the ugly sausage-making that is the norm.

This week, a difficult task got harder when the Democrats flubbed the Massachusetts election, losing one of their 60-seat majority in the Senate. The loss, partially attributed to soured voter opinion of health care reform, symbolizes how Democrats failed to control the message.

We dont quite know the end result yet, but heres our take on whether health care reform bears clear fingerprints of the nations first Black president or whether it looks more like politics as usual.

Today we look at how the legislation, so far, will impact the people who need it most. Read Health Care Reform Part II for a look at corporate influence in the process from drug makers and the insurance lobby.

Insurance for everyone

The nearly 50 million Americans not covered by health insurance in the planets wealthiest nation were a clear indicator that change was needed. 

But the Obama administration has been careful to avoid focusing too much on this group and instead dedicating more public commentary to the insured middle class. It was clearly a political calculation, middle class Americans were growing uneasy that their decent health coverage would be jeopardized by reform, and are often wary of expanding welfare programs that benefit the poor and cost taxpayers.

Obamas skittishness about the uninsured was a missed opportunity, particularly in this economy where job losses have cost many families their insurance. That means its easy to find examples of people without the political baggage of government assistance who have been locked out of health care insurance.

Sixty percent of the uninsured are people with jobs, and employer-provided coverage has been dropping for about a decade, according to the Center for Budget and Policy Priorities. People of color count highly among the uninsured. In the current system, nearly 20 percent of African Americans lack health insurance, and 33 percent of Latinos, compared to 15 percent of the population overall.

But Obama was careful to keep his distance from these groups.

In July, a roaming free clinic set up in Virginia and attracted thousands of patients over a few days. People from across Appalachia poured in for basic medical treatment, camping overnight for the chance to have their teeth examined.

In August, the same clinic was set up in Los Angeles, a place that ostensibly provides easier access to medical treatment because it is urban and in the more generous state of California. Again, thousands of people lined up for hours to get basic medical services. Media accounts told of those who were recently laid off, or had hours cut and lost their benefits.

That same month, Democrats were caught off guard and bludgeoned at Town Hall meetings by tea baggers and astroturf activists screaming about Obamacare and socialism.

Obama and the Democrats failed to take advantage of clear illustrations, like the free clinics, of the need for a major overhaul of the system. They failed to address the fact that middle-class wages have been stagnating for a decade, in part because employers have poured more and more of their payroll expenses into health care premiums.

The major issue of cost controls has only been partially dealt with in the current versions of reform. Thats the issue that impacts middle-class families and employers the most, but Congress couldnt manage to force through serious caps on premiums, although the insurance exchange system should help force competition among insurers, which hopefully will bring down cost.

The reform will certainly reduce the number of uninsured. The Congressional Budget Offices estimates the House bill will reduce the number of uninsured by 37 million in the next 10 years. The Senate bill reaches fewer, but still is a big improvement over the status quo.

Obama has latched on to the elimination of pre-existing condition denials as a universally appealing reform. Unfortunately, it looks like insurance companies will still have that tool at their disposal in full until 2014, and possibly through loopholes thereafter.

Read other stories from the theloop21.com's series Obama: Man of the People?

Alyssa Giachino is an economics writer for TheLoop21.com. She has worked as a reporter in New York, New Jersey, Mexico City and California covering stories on labor, the environment, immigration and politics.

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