Over the next few days, I’ll be taking a closer look at the provisions on the House health care bill – H.R. 3962, the Affordable Health Care for America Act. As was the case when the original tri-committee bill was released, the House committees have a ton of fact sheets on the bill that are required reading for folks looking to learn more.

Overall, the House bill is a bill that takes on the insurance industry. Here’s how:

A Public Health Insurance Option

First and foremost, the House bill creates a public health insurance option, available in the new health care marketplace called the “Exchange,” that would compete directly with private insurance. The public option won’t have to worry about profits or stockholders, and because it is run by HHS, it will have huge bargaining clout to get good rates from providers. Overall, while the public option in the House bill won’t save taxpayers as much money as a public option based on Medicare rates, it will still save money according to the CBO.

Because of all that savings, and because the public option will have a mandate to provide health care to people, not maximize profit, it will be a strong competitor to private insurance, keeping prices down and attracting customers. Private insurance will be forced to compete or face losing their most profitable customer base – the individuals and small group customers who are in the Exchange from the start.

Insurance Industry Regulations

The House bill puts new regulations on the insurance industry to curb their bad practices.

The practice of rescission – terminating someone’s insurance plan because they get sick – would be outlawed immediately. Similarly, as soon as this bill is signed, lifetime caps on insurance coverage would be outlawed.

After the Exchange is set up in 2013, all insurers, not just the ones in the Exchange, will be barred from denying care for pre-existing conditions, charging more if your are a woman or sick, or employing annual benefits caps. They will have to cap out-of-pocket expenses at a standard level, keep administrative costs down to below 15%, and publicly disclose and justify their rate increases.

Medicare beneficiaries and the unemployed will benefit as well, with overpayment to private companies through Medicare eliminated and COBRA coverage extended until the Exchange is set up.

Finally, the House bill will eliminate the anti-trust exemption on health insurance companies, making it possible to finally prosecute them for their monopolistic practices.

Immediate Relief

The House bill also provides immediate relief for people at the mercy of the insurance industry by setting up an interim high risk pool open to people who have been uninsured for at least a few months or who have been denied insurance because of pre-existing conditions.

Though clearly not a long term solution, the high-risk pool, combined with the COBRA extensions mentioned above, would get people out from the trap the insurance industry has put them in until full reforms kick in.

Taking on Drug Companies

The House bill also gives us significant savings from drug companies, which according to the Washington Post would amount to between $125 and $150 billion in cuts to their profits.

It does this by eliminating the donut hole which forces seniors to pay unaffordable prices for prescription drugs, starting immediately and completely closing the hole by 2019. It also requires the Secretary of HHS to negotiate for better drug prices for Medicare and Medicaid, and makes it easier for Medicare Part D to offer free generic prescription drugs to enrollees.

Of course, some issues, like biologics (new drugs exempted from generic competition), are still unresolved.

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There’s a lot to talk about in the House bill – employer responsibility, fair financing, a whole host of other reforms that take effect immediately. Over the next few days I’ll talk about those. However, the overall thrust of the bill is clear – it takes on the insurance industry for consumers, strengthening care for folks without insurance, on the individual market, in small and large businesses, and on Medicare and Medicaid.

About the Author: Jason Rosenbaum is a writer and musician currently residing in Washington D.C. He is interested in the intersection of politics and culture, media consolidation issues, and making sense out of our foreign policy disasters. He currently works for Health Care for America Now and he is also the webmaster for The Seminal.

This article originally appeared in Health Care for America Now on October 29, 2009. Reprinted with permission from the author.

The North Carolina union organizer who was the inspiration for the movie “Norma Rae” died on Friday of brain cancer after a battle with her insurance company, which delayed her treatment. She was 68.

Crystal Lee Sutton, formerly Crystal Lee Jordan, was fired from her job folding towels at the J.P. Stevens textile plant in her hometown of Roanoke Rapids, N.C. for trying to organize a union in the early 1970s. Her last action at the plant — writing the word “UNION” on a piece of cardboard and standing on her work table, leading her co-workers to turn off their machines in solidarity — was memorialized in the 1979 film by actress Sally Field. The police physically removed Sutton from the plant for her action.

But her efforts ultimately succeeded, as the Amalgamated Clothing Workers won the right to represent the plant’s employees on Aug. 28, 1974. Sutton later became a paid organizer for the union, which through a series of mergers became part of UNITE HERE before splitting off this year to form Workers United, which is affiliated with the Service Employees International Union.

Several years ago, Sutton was diagnosed with meningioma, a type of cancer of the nervous system. While such cancers are typically slow-growing, Sutton’s was not — and she went two months without potentially life-saving medication because her insurance wouldn’t cover it initially. Sutton told the Burlington (N.C.) Times-News last year that the insurer’s behavior was an example of abuse of the working poor:

“How in the world can it take so long to find out [whether they would cover the medicine or not] when it could be a matter of life or death,” she said. “It is almost like, in a way, committing murder.” 

Though Sutton eventually received the medication, the cancer had already taken hold. She passed away on Friday, Sept. 11 in a Burlington, N.C. hospice.

“Crystal Lee Sutton was a remarkable woman whose brave struggles have left a lasting impact on this country and without doubt, on me personally,” Field said in a statement released Friday. “Portraying Crystal Lee in ‘Norma Rae,’ however loosely based, not only elevated me as an actress, but as a human being.”

Field won an Oscar, a Golden Globe and the Best Actress award at the Cannes Film Festival for her portrayal of the character based on Sutton. The film in turn was based on the 1975 book “Crystal Lee: A Woman of Inheritance” by New York Times reporter Henry P. “Hank” Leiferman.

Sutton was only 17 when she began working at the J.P. Stevens plant in northeastern North Carolina, where conditions were poor and the pay was low. A Massachusetts-based company that for many years was listed on the Fortune 500, J.P. Stevens is now part of the WestPoint Home conglomerate.

In 1973, Sutton, by then a mother of three, was earning only $2.65 an hour. That same year, Eli Zivkovich, a former coal miner from West Virginia, came to Roanoke Rapids to organize the plant and began working with Sutton, who was fired after she copied a flyer posted by management warning that blacks would run the union. It was that incident which led Sutton to stand up with her “UNION” sign.

“It is not necessary I be remembered as anything, but I would like to be remembered as a woman who deeply cared for the working poor and the poor people of the U.S. and the world,” she said in a newspaper interview last year. “That my family and children and children like mine will have a fair share and equality.”

For more on Sutton’s life and work, visit the website of the Alamance Community College’s Crystal Sutton Collection.

(Photo of Sutton speaking in Minnesota in 1988 from the Crystal Sutton Collection.)

About the Author: Sue Sturgis is Editorial Director and Co-Editor, Facing South. She joined the Institute in November 2005. A former staff writer for the Raleigh News & Observer and Independent Weekly (Durham, N.C.), she is co-author of the Institute reports “One Year after Katrina” (August 2006) and “The Mardi Gras Index” (February/March 2006). Sue holds a Masters in Journalism from New York University.

This article originally appeared in Facing South on September 14, 2009. Reprinted with permission from the author.

(The following post is part of our Taking Back Labor Day blog series. Many people view Labor Day as just another day off from work, the end of summer, or a fine day for a barbecue. We think that it’s a holiday with a rich history, and an excellent occasion to examine what workers, and workers rights activism, means to this country. Our Taking Back Labor Day posts in September will do that, from a variety of perspectives, and we hope you’ll tune in and join the discussion!)

*****

President Obama’s well-received health reform speech not only boosted public support for reform, but helped fire up much of the progressive base—despite his failing to draw a firm line in the sand on the public option.  

Yet as Mike Lux, co-director and CEO of Progressive Strategies, pointed out Thursday on the Web radio show I co-host, “The D’Antoni and Levine Show,” Obama accomplished a key goal of inspiring progressives, including influential labor leaders, to push harder for reform—while starting to recapture the “narrative” about healthcare back from the right-wing.

Lux observed: “In order to get big pieces of legislation passed, you have to have people who are pumped, ready to go, fired up, willing to knock on doors. He was having trouble generating that. People were confused and down in the mouth. But the speech did what he needed to do and did it in a big way.

More sparks for a reform drive are expected to start this weekend, when the AFL-CIO begins its convention, and Obama appears before them next week, following up on his fiery Labor Day rally appearance and Wednesday’s congressional speech.

Before the president’s address to Congress, Lux added, “we never really had control of the narrative. Obama, for all his eloquence, had trouble laying out a story of what was wrong and why he wanted it changed. In order to tell a compelling story, you have to tell who the villains are, and he’s not very good at that. We never really had a story being told that people could latch on to, understand and get excited about.”

“We now have that,” Lux said on Thursday about the President’s messaging. “Last night, he went after insurance companies in a big way, and went after people lying about the plan, and called them out in a big way. And now have a narrative we can take to people.”

(Of course, long before the speech, many activists in the union movement have been working hard for healthcare reform — an issue that’s now become a legislative priority ahead of the Employee Free Choice Act — but the speech can reignite their fervor while broadening the range of people involved in grass-roots activism.)

Meanwhile, insurance industry executives continue to play their part as villains: a new report by the California Nurses Association shows that up to 40 percent of claims are denied in California insurance companies, making those profit-driven bureaucrats part of the real “death panels.” On Amy Goodman’s Democracy Now! show this week, she highlighted the nursing association report and featured an interview with a mother, Hilda Sarkisyan, whose daughter died after she was initially denied a liver transplant by CIGNA, which has a 33-percent claim rejection rate so far this year. After a massive public campaign, the insurance company finally relented, but it was too late:

HILDA SARKISYAN: Well, we miss her. We don’t have our beautiful daughter with us anymore. And CIGNA is doing this every day, every day. And that’s why I’m out there to help other families to stop them. It’s not only CIGNA; it’s all the insurance industry, that they are placing profit before patient, and it’s not right…You know, they should not enforce the care of the people to their deep pockets. It’s all about their pocket, all about the CEO, how much he makes. I miss my daughter. I had a beautiful, perfect daughter. I don’t have her anymore. I don’t.

AMY GOODMAN: Hilda, describe what happened to your daughter.

HILDA SARKISYAN: Well, we had insurance. We were covered. We thought we had insurance. So it’s like having insurance and not having insurance is the same thing. People who have insurance and don’t have it, they get the same care. But having insurance and knowing that you do have it, and you are recommended to a certain hospital, because the insurance company only pays if you go to that hospital, you go to that hospital, which in our case was UCLA. We were transferred there. By the way, that’s our fourth hospital within, I would say, three years, because they were jumping us around. And finally, you go there. My son gave her the perfect bone marrow transplant, perfect match. And my daughter needed a liver transplant. And so many requests, so many requests, and they were—the doctors were denied. We were denied, until the California Nurses Association stepped in, helped us out.

We had to get out and go to their headquarters in Glendale, make a scene with our family, the Armenian Youth Federation, our church. Why do we have to do that? I’m a mother who should have been next to my daughter. Only if I knew she was going to die that same day, you think I would have that energy to go out there and do that? I could have been holding my daughter’s hand and praying with her. This is not right.

With his speech to Congress last night, President Obama re-energized the forces for reform and has set a clear path for victory. We’re going to do our part and hold Congress accountable – the time has come for Congress to put people above profits and enact real health care reform. We’re also going to pull out all the stops to take on the insurance industry. The President’s right – ‘The time for games has passed – now is the season for action.’

President Obama made clear his support of a public option, which is just that – an option that will help improve quality, lower costs and keep the insurance companies in check.

Labor Day marches and rallies capped off more than a month of an incredible union member mobilization to move the health care reform debate beyond the screaming diatribes and disruptive tactics by opponents that marred the start of the congressional recess.

During the weekend, some 150,000 union members turned out for rallies, parades and picnics that not only celebrated the workers’ holiday, but showed broad support for comprehensive health care reform.

Those events followed the more than 400 August town hall meetings, health care forums and other events where more than 24,000 union members spoke up for health care and wrote letters, made phone calls and went door to door to educate their neighbors.

(The following post is part of our Taking Back Labor Day blog series. Many people view Labor Day as just another day off from work, the end of summer, or a fine day for a barbecue. We think that it’s a holiday with a rich history, and an excellent occasion to examine what workers, and workers rights activism, means to this country. Our Taking Back Labor Day posts in September will do that, from a variety of perspectives, and we hope you’ll tune in and join the discussion!)

*****

This time, grill some burgers, raise a glass of beer and drink a toast to Laborless Day, in honor of the 10% to 20% of the American workforce who cannot find work, or anything meaningful that pays a living wage.

The current state of labor affairs in the United States is this: We’ve just barely survived eight years in which corporations amassed even more political power and societal control than they had before.

The military-industrial complex has continued to provide us with war, the banking industry gave us substandard mortgage derivatives but won’t loan money to people with good credit, and the insurance industry forced us to buy home insurance, car insurance, flood insurance and life insurance, but refused to sell us health insurance. Labor unions are on the run in many states, and the minimum wage will buy you a dry spot under the U.S. 90A bridge.

The Captains of Industry have had their way, more or less, for decades, and never more than now. You’d think they’d be flying high, but instead, on the eve of this Laborless Day, they find themselves in a quandry.

They’ve re-learned the hard way that their stock appreciation, bonuses, vacation mansions and hot cars accrue in proportion to American consumer spending.

Economists such as Michael Mandel may argue otherwise, but American consumer spending accounts for in the neighborhood of 70% of the Gross Domestic Product, which is roughly to say, our economy. (Mandel makes a good argument that the consumer impact is less than that, but doesn’t count consumer wages confiscated as taxes, which are then spent on government programs and, yes, do have an economic impact.)

After taking a financial beating in a variety of ways, directly or indirectly from numerous corporate captains, the American consumer has lost the ability to spend. The big shots still are living high on the fuel that was stuffed into the pipeline before the Last Straw, but soon nothing will be left but fumes.

Thus we find the Captains of Industry, through major voiceboxes such as the Wall Street Journal, playing a dual role. Yes, as Republicans they still have to diss the Democrats’ stimulus spending (while forgetting Bush Jr.’s). But at the same time, because consumer spending is predicated on consumer confidence, they must declare that the glass is half full and in fact the recession, which was never all that bad to begin with, is really pretty much over and we’re all in recovery now.

Sure, guys. Paper me over with charts explaining how, technically, the bell curve has rung while Southeast Asian production rates clearly are leveling off and job losses truly are not gushing out on the ground as fast as they were just a month ago.

Meanwhile, back in the real world, almost every middle-class American who still has a job and is not employed in the medical industry faces the very real prospect of sudden job loss. In Detroit, by one measure, 17.7% of the workforce was out of work by the end of July. In the El Centro, Calif., market, for some reason, the unemployment total hit 30.2%.

Some, especially over at the Journal, will say these figures are overstated, that the Labor Department figures show the average U.S. unemployment rate at the end of August was “only” 9.7%.

I say that’s more than bad enough. But it’s also an example of how figures lie.

The Labor Department also tracks more meaningful numbers, which I believe the media should use to provide a more accurate picture of U.S. employment.

Like this one: “Total unemployed, plus all marginally attached workers, plus total employed part time for economic reasons, as a percent of the civilian labor force.”

“Marginally attached” workers are those who have run out of benefits, been unemployed for a year or more but are available for a job and want one. The part-time workers referred to really want full-time jobs but can’t find any.

In August of 2008, as the current collapse began, this more accurate average U.S. unemployment rate stood at 10.7%. One year later, it stands at 16.8%. I shudder to think what this rate is in Detroit.

This holiday weekend, be as patriotic as you are on holidays honoring our brave military members who died serving their country. Honor the American working man and woman, salt of the Earth and the blood that keeps our country’s heart beating.

But also honor your fellow Americans, almost one in five now, who want to do their part, secure their families and help spend the country back into recovery with honest work, only there isn’t enough to go around.

About the Author: Bob Dunn is a writer, consultant and web developer based in Richmond, Texas. He can be reached via Bob Dunn’s Brazos RiverBlog.

This article originally appeared in Bob Dunn’s Brazos River Blog on September 5, 2009. Re-printed with permission from the author.

As unemployment rises more women are turning to COBRA for health insurance coverage, but discovering it’s either too expensive or not available. Women who shop for individual insurance often face higher rates due to “gender rating,” a recent study found.

(WOMENSENEWS)–When Jane Schiffler loses her job on July 1, the college administrator will face tough choices.

“To help make ends meet for me and my 7-year-old son, I’ve decided to give up our land line and just use a cell phone; to cancel our cable TV and just get the basic channels; to go to the library instead of buying books; and to cook at home instead of eating out,” says Schiffler, a single mother in New York City. “But I haven’t figured out what to do about our health insurance coverage, which remains my biggest–and most frightening–challenge.”

Schiffler qualifies for COBRA, the Consolidated Omnibus Budget Reconciliation Act.

The 1985 law allows laid-off workers and their dependents to remain on their former employer’s group health plans for 18 months as long as they pay the same amount for coverage as their employer did, and 150 percent of that amount if they extend COBRA coverage beyond 18 months.

“The problem is that COBRA is just too expensive for me to afford,” says Schiffler, who is using a pseudonym in this article because she doesn’t want her concerns about health coverage–and the fact that she may have to do without it at some point–to negatively impact her job search or her chances of getting health coverage in the future.

The average monthly unemployment payment in the United States is $1,278.

COBRA for an individual consumes 30 percent of that. Family coverage devours 84 percent.

Little Left Over

That leaves many laid-off workers with little left for rent, mortgage, utilities, groceries, and other necessities, found a January 2009 report from the Washington-based Families USA.

In February, the federal government moved to help such workers by passing the American Recovery and Reinvestment Act of 2009 (ARRA), which provides $25 billion in temporary subsidies so workers who were involuntarily terminated between Sept. 1, 2008 and Dec. 31, 2009 pay 35 percent of the normal cost of COBRA.

“While this is a significant subsidy, for the average woman, it’s still more than the 16 percent of the cost of individual coverage or the 27 percent of the cost of family coverage that she would have paid as her contribution to health insurance while she was still working,” says Karyn Schwartz, a senior policy analyst for the Kaiser Family Foundation, based in Menlo Park, Calif.

Many unemployed women, meanwhile, don’t qualify for COBRA.

Ineligible are laid-off women with individual incomes of more than $125,000; family incomes of more than $250,000; employers who never offered health insurance in the first place, and employers who went out of business (and therefore had no health plan at the time of job termination).

10 States Lack ‘Mini Cobra’ Laws

“Company size is also barrier to coverage,” says Cheryl Fish-Parcham, deputy director of health policy for Families USA. “COBRA only applies to workers in companies with 20 or more full-time employees. Some states are working to help laid-off people from smaller firms. But in 10 states, there are still no ‘mini COBRA’ laws creating coverage for these laid-off workers, who now have to go without coverage, or pay high premiums for individual plans.”

The average private health insurance plan for an individual costs $4,704, while one for a family costs $12,680, according to a March study in the New England Journal of Medicine. And due to a practice known as “gender rating,” most private insurers charge women more than they charge men, according to a 2008 report by the Washington-based National Women’s Law Center.

“I can only afford COBRA for a few months, and I definitely can’t afford to buy private coverage,” says Schiffler. “If my savings run out, I may have to go without coverage, though my son may qualify for a state program for children. I need a safety net, but if I have to choose between eating and buying health insurance, I am going to eat.”

About the Author: Molly M. Ginty is a freelance reporter based in New York City. A graduate of Columbia University’s Graduate School of Journalism, she has written for Ms., Marie Claire, Good Housekeeping, Redbook, Ladies’ Home Journal, pbs.org and On Earth as well as Women’s eNews.

This article originally appeared in Women’s eNews on June 18, 2009. Re-printed with permission by the author.