Croakey’s Washington correspondent, Dr Lesley Russell, reports on the state of play with health reform in the US (this post was updated on 25 March):

“Yesterday President Obama signed into law the landmark health care reform bill that passed the House of Representatives on Sunday night. The ceremony included members of Congress, doctors and nurses and Americans representative of those who will benefit from the bill.

Although health care reform is not yet complete – the Senate must still act to pass the reconciliation package with the amendments to the original Senate bill – this alone is a significant accomplishment for Obama and congressional Democrats.

“We proved that this government – a government of the people and by the people – still works for the people,” said Obama on Sunday night after the legislation and the  accompanying package of fixes were approved by the House. “This is what change looks like.”

The Senate is already at work on the House-passed revisions.  Due to the use of the budget reconciliation process, debate will be limited to 20 hours and likely will end early Thursday (Washington time), leading to a series of votes on amendments that will have no time limit. The goal is said to be passage of the bill by Saturday, allowing senators to leave for the scheduled Easter break.

But Republicans are threatening to derail the process, with, they claim, “hundreds” of amendments aimed at both substance and process.  If they are able to get the Senate parliamentarian to rule an aspect of the bill unfit for reconciliation, it would send the legislation back to the House.  However to date the parliamentarian has rejected all the GOP challenges.

While the full reform package will not kick in before 2014, there are a number of benefits that will begin as soon as the reconciliation bill is signed. Within three months of the law taking effect, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for subsidized coverage through a new high-risk insurance program.  In six months, new insurance policies will have to permit adult children to stay on their parents’ policies until they turn 26.  And small businesses with fewer than 25 employees and average annual wages of up to $50,000 will receive tax credits to offset the cost of buying insurance for their workers.

New rules for insurance companies will also take effect – all new plans will have to cover the full cost of preventive care, including annual physicals and children’s immunisations. Insurers won’t be able to require prior approval for patients who need to see gynecologists or go to the emergency room. There will also be bans on insurance companies dropping people from coverage when they get sick, from denying coverage to children with pre-existing conditions, and from placing lifetime caps on coverage.

For seniors, the bill will immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly. When the Senate passes the reconciliation bill, the gap known as the “doughnut hole” in Medicare prescription drug coverage will gradually be closed.

Meanwhile the right wing continues to freak out. Last Sunday, former Bush speechwriter David Frum declared that the passage of health care reform meant that conservatives and Republicans had “suffered their most crushing legislative defeat since the 1960s.”  But Frum’s reflective thesis is being rejected by many Republicans.  Senator John McCain declared in a media interview that “There will be no cooperation for the rest of the year.  They [the Democrats] have poisoned the well in what they’ve done and how they’ve done it.”  On his Fox News show, Glenn Beck compared reform to 9/11, Pearl Harbour, Chamberlain meeting Hitler and the Hindenburg disaster.  House Minority Leader John Boehner claimed that reform was “armageddon”.

Republicans and conservatives are now promising to invalidate reform, launching efforts to repeal it legislatively and to challenge it in the courts.  This issue is a long way from being over!  But, a Gallop poll just in shows that 49 percent of Americans now think that health care reform is a good thing, compared to 40 percent who think that it is bad.”

• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies  Center for Health Policy, University of Sydney/ Australian National  University and a Research Associate at the US Studies Centre, University of Sydney.  She is currently a Visiting Fellow at the Center for American Progress in Washington DC.

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