Merkley: Senate On the Doorstep of Fulfilling Promise on Health Care for All

– The United States Senate took another step towards passing comprehensive health care reform this morning, clearing a number of procedural hurdles to allow the bill to have a final vote later this week.  Oregon’s Senator Jeff Merkley joined the effort to move forward on the Patient Protection and Affordable Care Act.

“The bill before us is far from a perfect bill, but it is a good piece of legislation that will finally provide affordable, accessible health care for all Americans,” said Merkley.  “Importantly, it will allow small businesses and the uninsured to band together to buy more affordable coverage while putting in a health care bill of rights that ends insurance companies’ worst practices.  For generations, we have tried to fulfill the promise that no American should go without needed care; we are now on the doorstep of making that happen.”

Among the major provisions of the Patient Protection and Affordable Care Act:

  • Exchanges:   The bill will establish state-based exchanges – or marketplaces – where Americans who are self-employed, uninsured or work for businesses of fewer than 100 workers can purchase insurance.  Due to their lack of market clout, these groups have historically paid higher insurance rates than large businesses, if they could get coverage at all.  This will help them create a larger purchasing pool and bring costs down.
  • Health Care Bill of Rights:  The bill will prohibit the most egregious practices of the insurance industry through the creation of a Health Care Bill of Rights.  These rights will prevent insurers from denying coverage to those with a pre-existing condition, dropping those who become seriously ill or injured, implementing lifetime limits on coverage, or discriminating on premiums on the basis of gender, occupation or health history.  The bill will also allow Americans to stay on their parents’ plans until their 26th birthday, have affordable coverage if they lose or change jobs, and access preventive care without extra costs.
  • Financial Assistance so Everyone Can Afford Insurance:  The bill will provide a sliding scale of tax credits to Americans to help them purchase coverage.  The assistance phases out at 400% of the poverty level or approximately $88,200 for a family of four.
  • Tax Credits for Small Businesses:  The bill provides tax credits to small employers to help them provide coverage.  The credits will be available on a sliding scale to small businesses with fewer than 25 employees and average annual wages of less than $50,000. 
  • Expanded Access to Medicaid:  The bill helps states expand access to Medicaid to individuals and families up to 133 percent of the poverty level (or $29,327 for a family of four) by having the federal government pick up the full cost of the expansion for the first three years.

The legislation also includes a number of provisions pushed by Merkley, including:

  • Opening Exchanges to Small Businesses:  The bill expands the number of businesses which are immediately eligible for the exchange.  Merkley had successfully offered an amendment during the Health, Education, Labor and Pensions Committee deliberations to raise the ceiling for eligibility to businesses with up to 50 employees.  Merkley continued to advocate to bring more businesses into the exchanges, and the Senate leadership further raised this ceiling to 100 employees in the merged bill that came to the floor, with states having the option of lifting the ceiling once exchanges are up and running.
  • Breastfeeding:  The bill retains language authored by Merkley and adopted by the HELP Committee to require that employers provide reasonable space and privacy for employees to take unpaid breaks to pump or breastfeed.  Numerous studies have shown that breastfeeding offers health benefits to both infants and mothers, saving health care costs by reducing the rates of asthma, obesity, diabetes and certain cancers.
  • Encourage Innovation and Lower Costs:  The bill contains a package of amendments authored by Merkley and other Senate Democratic freshman that would broaden and accelerate efforts to encourage innovation and lower costs for consumers.  Among those amendments are measures to require the public and private sectors to move forward together on the shared goals of cost containment, improved quality, and delivery system reform; require the U.S. Secretary of Health and Human Services (HHS) to aggressively pursue streamlined regulations and anti-fraud initiatives; and require the Secretary of HHS to consult with relevant stakeholders to develop a methodology for measuring health plan value, which would include the cost, quality of care, efficiency, actuarial value of plans.
  • Level the Playing Field for Construction Companies:  Senator Merkley’s amendment to this bill creates fair competition for construction firms.  Specifically, it establishes that firms of five or more employees that don’t provide health care will participate in a shared responsibility provision, leveling the playing field in the competitive world of construction bidding.  Organizations representing about two-thirds of the industry have endorsed it, including Sheet Metal and Air Conditioning Contractors’ National Association, Mechanical Contractors Association of America, National Electrical Contractors Association, Finishing Contractors Association, International Council of Employers of Bricklayers and Allied Craftworkers and The Association of Union Contractors.
  • Marine Cargo Handlers:  The bill contains an amendment authored by Merkley that categorizes marine cargo handlers – or longshoremen – as members of a high risk profession.  The underlying bill shields high-risk professions from the full impact of a new tax on high-value health insurance plans as their premiums are likely to be higher for the same services provided to employees in other professions.  Longshoremen had previously not been included even though their fatality and injury rates are extremely high.  For example, according to 2008 Bureau of Labor Statistics figures, marine cargo workers faced injury rates of 8 in 100, versus 4.7 in 100 for construction workers and 2.9 for those in mining, both of which are in the high-risk definition.
  • Community Health Clinics:  The bill contains a major expansion of funding for community health clinics over the next five years to provide more accessible health care.  Senator Merkley supported this expansion as a co-sponsor of the Access for All Americans Act.