Health Reform: How It Happened, What It Means

Landmark is The Washington Post’s summary and interpretation of the Affordable Care Act in book form. It has three parts: (1) a history of health reform politics, (2) an explanation of the law’s main provisions and how they’ll affect Americans, businesses, and the health care sector, and (3) a plain language section-by-section summary of the law written by the Congressional Research Service (CRS).

The first section on the political history, by Ceci Connolly, was the most fun to read since it included political details I didn’t know. For instance, at Edward Kennedy’s funeral Obama and Cardinal Sean O’Malley exchanged a few important words.

Obama rose to his feet as Cardinal Sean O’Malley reached for his hand. O’Malley, the archbishop of Boston, welcomed the president and offered condolences. Then the highest-ranking Roman Catholic in ultra-Catholic Boston, in a private moment during this public gathering, delivered an unusually pointed message.

“The bishops are anxious to support health care,” O’Malley said. “It’s very important.”

“But,” the prelate added, still gripping Obama’s hand, “we are very concerned that there not be public funding for abortion.”

At the time, it might have seemed little more than a discordant note at a memorial service. But O’Malley’s words foreshadowed the arduous struggle about to unfold once everyone was back in Washington–and the contentious issue that would almost derail Obama’s quest to make health-care history.

If one merely wishes to be entertained by such vignettes, one need not read Landmark. Jon Cohn’s cover story in the June edition of The New Republic, How They Did It, will satisfy (subscription required). Cohn gives meaning to all the political maneuver’s, including the late February health reform summit at Blair House.

But the summit itself was less important than the time it bought. “It just froze the game,” says John Podesta, president of the Center for American Progress. “Everybody just decided, ‘OK, let’s see what happens a month from now [at the summit].’ It stopped people from jumping ship.” (It also gave reformers a chance to publicize news about huge premium hikes by California’s WellPoint insurance.) Pelosi used the time to work on her members, while House staff—coordinating with their White House and Senate counterparts—quietly figured out how to write a bill that would fix the Senate package within the intricate rules of reconciliation. Reid worked his caucus, urging them to give Pelosi time and making sure 51 members would be ready to approve the reconciliation bill when the time came.

And, for free, there’s Sam Stein’s HuffPo summary of how health reform was passed (about which I commented in an earlier post).

But, back to Landmark. The second section that covers how the law works and what it will do included some details I didn’t know, though probably should have. For instance,

  • Individuals under 30 can satisfy the individual mandate with a low-cost, high-deductible (~$6,000) plan, whose premiums have been estimated to be about $138/month. Those who qualify for the hardship exemption to the mandate are also eligible to purchase this plan even if they’re over 30.
  • Regulators can bar insurers from exchanges if they increase health insurance premiums at an unjustifiably high rate in the next few years.
  • Medicare Part D premiums will be subject to the same means test as exists for Part B beginning next year. Meanwhile the Part B income threshold for higher premiums will no longer be indexed. Gradually, a greater proportion of beneficiaries will be subject to higher premiums.

I didn’t read the CRS plain-language summary with which Landmark concludes, but it will make a handy reference. All told, Landmark is worthy of the small amount of shelf space it will occupy.

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