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A recent New York Times highlighted Maine’s attempts at comprehensive healthcare reform. Their experiences serve as a cautionary tale for Congress.   The state established a public health insurance plan, expanded Medicare and Medicaid eligibility, and banned insurers from refusing to cover people with pre-existing conditions, but those actions have done  little to insure more of its residents.  Contrary to the promises of public option supporters, health care costs have only continued to rise in the state.

Reasons for the high health care costs range from the state-specific to the general. Unlike the bill that recently passed the House of Representatives, Maine’s healthcare reform legislation didn’t include a mandate to buy health insurance plans. It’s a vicious cycle: forcing health insurance companies to offer policies to unhealthy people with pre-existing conditions raises the rates for younger people; young adults will be even less likely to buy health insurance if their premiums go up, which results in the insurer’s risk being spread among less people. In the end, the older, unhealthier population remains in the pool and must contend with less affordable health insurance. Therefore, there is a larger uninsured population.

Granted, Maine is a market dominated by just one private health insurance company (which, with its effective monopoly, can increase premiums to their liking); and its population is older, sicker, and poorer than the U.S. in general. Senator Olympia Snowe points to her state as a cautionary tale of what may happen if drastic changes are made too fast. Snowe is a Republican that supports healthcare reform but is against the public option. Budgeting problems have caused Maine to cap enrollment of its own public option health insurance plan at under 9,000. The federal government, unlike most states, is allowed to run a deficit. However, it isn’t exactly rolling in the money right now either.

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The reform bill passed in the House has the potential to change what all health insurance plans cover. An amendment proposed by Bart Stupak, which passed in the House of Representatives, prevents federal funding from being used to buy any health insurance plan that offers coverage of elective abortions. In exchange for the votes of pro-life Democrats essential to pass the legislation, the healthcare reform bill was modified. The previous language only prevented government money from being used directly to pay for an abortion.

Obviously, the public option will not include abortion coverage. However, the ban extends to private health insurers participating in the government’s insurance exchange. Low- and medium-income individuals and families will receive subsidies in order to buy a health insurance plan. A compromise proposed by Speaker Nancy Pelosi, which would serve to distinguish private dollars from federal money and allow insurers to cover abortion services with solely the latter, was rejected. Many people with employer-provided or individual health insurance have abortion coverage provided in their policies. In order to enter the potentially lucrative exchange market, insurers might eliminate that coverage entirely.

Those who pay for their entire health insurance policy out-of-pocket will still be allowed to buy plans that provide abortion coverage, although the availability and affordability of these plans will most likely decrease. Pro-choice advocates, such as Planned Parenthood, are crying foul.

Interestingly, the amendment received 240 votes–higher than the actual bill’s margin of victory. Assuming that many pro-choice Democrats voted against it, this result means that a significant portion of Republicans voted for the amendment. Whether they wanted to salvage something they wanted out of a bill that was almost certain to pass or sabotage the bill by creating a schism between Democrats, they decided to amend a bill while rejecting the bill itself.

(Image: mahalie under CC 2.0)

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Healthcare reform was finally passed in the the House of Representatives after a long night. The final vote on the healthcare reform bill was very close: 220 for to 215 against. It seems that President Obama’s last minute push for the legislation worked. Despite Obama’s pep talk, nearly 40 Democrats voted against the the bill. As predicted, the vast majority of Republican representatives voted against it. However, one Republican voted for the bill. Supporters are happy that the public option was retained in the bill, and that health insurance plans will no longer be allowed to deny coverage to people with pre-existing conditions.

Now the bill must go to the Senate, where it will be debated and modified further. Some liberal representatives in the House weren’t completely satisfied with the healthcare reform proposals passed, but feel that they have a better chance of getting what they want if they pass the bill and allow their Senate counterparts to work with it. Their other option is letting it fail, possibly endangering the chances of universal health care altogether.

A 242-192 vote allowed the health care reform legislation to reach the House floor to begin with. Several representatives promised to allow the bill to reach the floor for debate, although they opposed the actual proposals to change the health insurance system.

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