Legislative Update

Election Analysis:  What Do the Results Mean for the
Bleeding Disorders Community?

By Glenn Mones, NHF Vice President for Public Policy

Now that some of the hoopla over what has certainly been an historic presidential campaign and election has started to settle down, we have an opportunity to take a look at what the results may mean for people with bleeding disorders and other chronic conditions.

Although there’s never any guarantee that a campaign promise will be fulfilled in its original form, the campaign rhetoric is the best starting place for determining what changes the new administration might make to healthcare.  During his campaign, Barack Obama outlined a plan designed to let people who had satisfactory employer-provided health insurance stay with their existing coverage, while offering new options to people who did not have adequate coverage.  These new options, offered through a National Health Insurance Exchange, would include a public health insurance plan similar to Medicare, as well as a range of private plans.  Important features of Obama’s plan, with particular significance for people with bleeding disorders and other high-cost conditions, include the following:

• All children would be required to have health insurance.  Many would be covered through an expansion of the Children’s Health Insurance Program (CHIP).
• Medicaid would also be expanded to cover more families with lower incomes, as well as individuals with special needs.
• All Americans would have access to the new public health insurance plan and other “guaranteed issue” plans.  This would offer more options for coverage, especially for those who live in states that don’t currently have guaranteed issue policies and where high-risk pools are underfunded.
• Premiums for new plans would be reasonable and could not be based on health status.  Subsidies would be offered to those who cannot afford the premiums and there would be no exclusions for pre-existing conditions.

Most of this sounds pretty good, but the question people are asking now is “will it really happen, and if so, when?”  Many Americans are still smarting from the failed efforts of the Clinton administration to make substantial changes to healthcare.  On the plus side, the Obama plan is in many ways less radical than the Clinton plan, particularly in the way it seeks to preserve the status quo for the many Americans who feel they are already well-served.  Also, healthcare reform was high on the Democratic campaign platform and the transition team has indicated that it remains a very high priority.  In addition, the alignment between the incoming president and the majority in both houses of congress can help clear the way for a variety of changes, including some of the reform measures that elected officials have already been seeking.  For example, the new political climate may make it easier to advance the bill to raise lifetime insurance caps, which the National Hemophilia Foundation (NHF) and others in the bleeding disorders community have been promoting.  Further, President Obama has indicated his intention to use executive orders where possible to institute changes, circumventing the need for some legislation.  It may be possible for him to make some significant changes to programs like Medicaid and CHIP using such orders.

Even so, don’t expect to open the newspaper tomorrow and read about too many imminent changes, or to open your mailbox the next day and get a mailing describing your new insurance options.  Insiders are saying that 2010 is probably the earliest we are likely to see the first signs of healthcare reform, with most of it coming much later.  This is due in part to the normal time it takes to design and implement major new programs, but also to the likely effect the economic crisis will have on this and anything else that comes with a price tag.  The new administration may find it necessary to put anything that doesn’t immediately affect the economy on a back burner.  Also, it may scale back some of the costlier items until such time as the economy rebounds and/or sufficient savings can be realized from other areas.  We should also be wary of the cost-savings measures that can adversely affect access to healthcare.  At the state level, we have already seen payers attempt cost-cutting measures like tiered formularies or preferred drug lists.  These lists restrict access to the full range of available treatments.  This disrupts the ability of the physician, in consultation with the patient, to make the best medical decision for that patient.  It is certainly possible that, as the new President and Congress look for ways to pay for healthcare reform, they will also be considering ways to save costs that may not be acceptable for people with bleeding disorders.

If anyone imagines that this is the time to sit back and let the newly elected pro-healthcare administration and Congress do their work, they’d better think again.  This is the time for Americans who care about healthcare reform to remind all elected officials how important access to quality healthcare is for all of us.  This is also the time for Americans with bleeding disorders and other chronic conditions to remind elected officials of who we are.  We need to make sure our specific concerns and needs are fully considered as new programs are developed.  Finally, we must use all the tools at our disposal, through NHF and other national organizations, our Chapters and local organizations, Washington Days and State Advocacy Days and our treatment centers.  We must use all means at our disposal to make our voices heard and make meaningful healthcare reform a reality.

Previous article take from the January/February 2009 issue of HemAware, a publication of the National Hemophilia Foundation.