From Truman to Nixon to Clinton, presidents have tried and failed to provide affordable and accessible health care for all Americans. So the legislation President Barack Obama will sign into law today is indeed historic. It is imperfect, and it marks the beginning — not the end — of the transformation of a dysfunctional health care system. But the legislation is a remarkable achievement for the determined young president and for every family who fears their next medical crisis.
The health care reform package is the most significant domestic program since Medicare and Medicaid were created in 1965. More than 32 million uninsured Americans are ultimately expected to receive coverage, including more than 2.7 million Floridians. Uninsured individuals and small businesses will be able to shop for private plans at new insurance exchanges. Experimental reforms are aimed at slowing the rise of costs within Medicare. And while the cost over the next decade is estimated at $938 billion, the nonpartisan Congressional Budget Office pro-jects the reforms will cut the deficit by $143 billion. The sweeping changes will touch virtually every American and take years to play out, and the partisan political debate over their impact will continue at full volume.
Yet there will be immediate benefits. This year, small businesses will get tax credits to offer health insurance to employees. This year, children with pre-existing conditions cannot be denied coverage, and adults with pre-existing conditions can be insured through a high-risk pool. This year, insurers will be banned from placing lifetime limits on coverage and cannot cancel coverage for policyholders who become ill. This year, Medicare recipients who hit the prescription drug doughnut hole will get a $250 rebate. And this year, parents on many plans can keep their children on their health policies until the children are 26 years old. These are the sorts of significant benefits that should ease the anxiety in many households and build public support before the broader changes take effect.
The reforms have their flaws, even with the revisions in a reconciliation package approved by the House on Sunday night and awaiting approval by the Senate this week. There is some slight-of-hand accounting related to taking in new revenue for several years before new benefits take effect. New taxes on families with annual incomes above $250,000 should have been reserved for broader federal deficit reduction. And creating state-run insurance exchanges still seems less efficient than creating a national exchange where the uninsured and small businesses could shop for coverage.
But these health care reforms are a significant step forward, and they can be improved in the coming years. The status quo is unsustainable in terms of cost, and many Americans who have coverage now find it unaffordable or inaccessible. And while it would have been preferable for such significant legislation to have bipartisan support, Obama made efforts to reach out to Republicans and was rejected at every turn. Republicans in Washington will continue to pick away at the reforms, and Republicans in Florida such as Gov. Charlie Crist and Attorney General Bill McCollum will continue to pursue their self-interests instead of the best interests of Floridians. As Americans become more familiar with the benefits of reform, they will reject the GOP's fear-mongering.
Obama staked his presidency on passing health care reform and persevered with the help of courageous Democrats in Congress, including every Florida Democrat. They dared to look beyond short-term political calculations to embrace long-term change to health care policy that should benefit every American. Now all they have to do is make it work.