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Health Care Reform: Where Are We Now?

April 6, 2009
by Daniel Guarnera
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I wrote the article below for the April 2009 issue of "Recovery Today"--the article can be found online here.

Health Care Reform and Addiction: Where Does It Fit?

By Daniel Guarnera
Director of Government Relations, NAADAC & NAATP

Barack Obama ran for president offering “change,” and he promised that comprehensive reform of the nation’s health care system would be a top priority. In his first address to Congress, President Obama said, “[T]he cost of health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: Health care reform cannot wait, it must not wait, and it will not wait another year.” Health care reform is already well underway. For advocates concerned about addiction prevention, treatment and recovery support, reform offers a unique opportunity to expand the services that reduce drug use and help people recover. Yet it is also poses some significant challenges to overcome.

There is broad political consensus that our current health care system needs an overhaul. The spends 16 percent of its total economy--$2.2 trillion annually—on health care. Health insurance premiums are increasing far faster than wages (they jumped 78% between 2002 and 2007), putting a strain on both families and businesses. At the same time, the federal government and the states are spending more and more on health care, and this trend is expected to get far worse as baby boomers begin to access Medicare. Adding insult to injury, despite such high levels of spending over 45 million Americans have no health insurance at all.

There has been no shortage of proposals put forth in recent years to ameliorate the problems with our health care system. These include de-coupling health insurance from employment (Sens. Wyden and Bennett), transitioning to a “single-payer” system (Rep. Conyers) and eliminating state-level regulation of insurance plans to encourage free-market competition (Sen. McCain).

The growing consensus, however, is that 2009’s health care reform will build upon the current system. Although the policy details are far from certain, this year’s proposal may look something like this: If you like your insurance, you can keep it. More employers will be required to provide health insurance for their workers (with tax credits to encourage them). If employers choose not to do so, they will be forced to pay into a fund that provides subsidies for individuals purchasing their own insurance. The federal government will operate an “insurance exchange” that essentially provides an organized, regulated market from which individuals or businesses can purchase private insurance (or, perhaps, choose a new government-run insurance plan). Plans within this exchange will have to meet certain minimal standards, such as non-discrimination against pre-existing conditions. Tax credits will enable people who are currently uninsured to purchase a plan. There will also be a limited expansion of public health care programs, a process that began earlier this year when Congress enabled four million more uninsured children to enroll in the Children’s Health Insurance Program.

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Daniel Guarnera

Daniel Guarnera is the Director of Government Relations for NAADAC, The Association for...