There was nary a vacant seat in the large meeting room at the Flatbush-Tompkins Congregational Church as area residents descended en masse on the house of worship to take part in a town hall on health care sponsored by Representative Yvette Clarke.
The forum was intended as a give-and-take, with Clarke providing information on the bill introduced in the House of Representatives over the summer, H.R. 3200, America’s Affordable Health Choices Act of 2009, and the residents providing input on what they need and want.
While there have been reports of controversy over such inclusions as the public option in other parts of the country, in Flatbush that was distinctly uncontroversial.
Indeed, when Clarke told the group that she had made it clear to the Democratic leadership that she would not vote for a bill that did not contain a “robust public option,” the crowd responded with enthusiastic applause.
They also responded enthusiastically when Clarke expressed her support for providing health care to undocumented immigrants, something the current bill does not do. Noting that President Barack Obama had indicated that he would pursue immigration reform in 2010, Clarke said, “I will be making the case not to leave the undocumented out of the health care system.”
Beyond human rights, she said, this is a practical necessity. Given the ease with which communicable diseases can be spread, especially in a city like New York where people live and work so close together, “If one is vulnerable, we’re all vulnerable,” Clarke stressed.
The bill proposed by the House — which, Clarke emphasized, is “a work in progress” — overall provides a framework to cover nearly all Americans, according to Clarke, by building on existing employer-contracted health care plans and existing government plans (Medicare and Medicaid), and extending what is currently offered.
This would occur, specifically, through a health insurance exchange where those who do not receive employer-contracted health care, or pay more than a certain percentage of their income for such health care, can choose among an array of plans, including those offered by private insurers as well as a public plan, which, she explained, “is not a mandate. It would create a level playing field, create options and lower insurance costs through competition.”
The public option, while it would be started with an infusion of federal money, would be required to be self-sustaining, Clarke said.
The bill would not eliminate existing plans, she added. “Obama promised, if you like your health care you can keep it, and he’s made good on that promise,” Clarke said.
Besides broadening access, Clarke said, the House bill also seeks to “make health care more affordable for families, lower the cost for taxpayers and beneficiaries, and improve health care services.”
A key aspect of the bill is that it would “guarantee that benefit packages are available to all Americans,” with “the mandate shared by individuals, employers and the federal government,” Clarke went on.
“H.R. 3200 builds on what works in today’s health care system and fixes the parts that are broken,” she told the group.
To a large degree, the bill’s provisions would be phased in between 2013 and 2018, should H.R. 3200 become law.
Not every business would be required to offer health care to their employees. Those with payrolls under $500,000 would be exempt. For those with larger payrolls, tax credits could be available to help defray the cost of offering health insurance. Companies with payrolls over $500,000 that did not choose to offer insurance, could opt out, and pay a penalty.
Similarly, while the goal is for all Americans to have health insurance, and the plan provides affordability credits to help those with lower incomes pay the cost, individuals could opt out and pay a penalty as well.
While Americans could choose between various levels of plans, all plans must contain certain basic benefits, including inpatient and outpatient hospital services, physician services and equipment and supplies connected to physician services, Clarke said. They also must include maternity services, prescription drugs, preventive health care, rehabilitation services, a host of benefits for children, and mental health and substance abuse services. The bill would not allow coverage to be denied because of pre-existing conditions, Clarke also said.
Cost containment is a goal of the plan, said Clarke. This, she explained, in part reflects the plan’s focus on prevention. “The bill really shifts the paradigm of how we go about taking care of ourselves,” Clarke emphasized. While, she noted, the Congressional Budget Office can’t estimate the savings in that arena, “Many nurses and doctors say that if only patients took care of themselves, how much it would reduce the costs of emergency rooms and urgi-care centers.”
Other cost savings would be delivered through allowing Medicare to negotiate on prescription drug prices and expanding the use of health information technology, Clarke said, noting also that penalties paid by those who did not participate would help fund the system, as would a tax surcharge levied only on the “top 1.2 percent of income earners,” individuals making over $280,000 a year, and couples making more than $350,000 annually.
While the bill would deliver many needed benefits to Americans, Clarke acknowledged that there has been “a lot of rancor” over it. “We’ve had to deal with, ‘I don’t want to deal with other people’s issues because I’m covered.,” she noted drily.
Flatbush-Tompkins Congregational Church is located at East 19th Street and Dorchester Road.
