health care reform

The estimates of the population without health insurance in the U.S. remained unchanged in 2010, as compared to 2009, reflecting the counteracting effects of not only the sluggish economic recovery but also the preliminary benefits of the Affordable Care Act (ACA), says Timothy McBride, PhD, leading health economist and associate dean of public health at the Brown School at Washington University in St. Louis.

The Supreme Court should affirm the constitutionality of the Affordable Care Act, contends Washington University in St. Louis law professor Greg Magarian, JD, because the Act fits comfortably within a proper understanding of the federal-state balance of power. Magarian, a constitutional law expert, says the basic argument against the constitutionality of the health care bill is that some parts of the bill, most notably the requirement that people purchase health insurance, exceeds Congress’ power to regulate interstate commerce.

The ruling by Judge Henry E. Hudson of the Federal District Court in Richmond, Va., finding the individual mandate provision of the new health-care law unconstitutional is an important ruling, but it does not settle the question, says Timothy D. McBride, PhD, health economist and associate dean for public health at the Brown School at Washington University in St. Louis. McBride says that the individual mandate, while just a small piece of the health reform structure, is very important to making all of the parts of health reform work. “It is more or less like pulling on the thread of a garment, and having the whole garment come apart if this disappears,” he says.

Despite its divisiveness, health reform legislation did not play a major role in the midterm elections. “We are still a 50-50 country more or less on health reform,” says Timothy D. McBride, PhD, professor and associate dean for public health at the Brown School at Washington University in St. Louis. “About half the country really dislikes the reform law, and those voters were likely to vote Republican in this election. But in all likelihood they would have done so anyway. Similarly, the other half that still favor the legislation would likely have voted for the Democrats anyway.” 

The health care industry needs managers with a strong foundation in business and public policy. A new dual degree from WUSTL is designed to prepare students to meet the challenges of complex companies across the health care spectrum. Details of the new MBA/MPH graduate program offered by the Brown School and Olin Business School are announced today.

Congress recently passed the much anticipated and greatly debated health reform legislation, but what does this mean for the St. Louis region and the rest of the country? The Brown School at Washington University in St. Louis will host a public panel discussion titled “What to Expect from Health Reform: Implications for the Region and the Nation,” at 6:30 p.m. Wednesday, April 28, in Steinberg Hall Auditorium.

“If the House passes the latest version of legislation this weekend and sends it to the Senate, that will be the key legislative event in the long health care debate, because both chambers have already passed the legislation,” says Timothy McBride, Ph.D., health economist and associate dean of public health at the Brown School at Washington University in St. Louis.  “I believe the House will pass the legislation, but the vote will be very close, probably within one vote or two. The House probably has not had a vote this close since the vote on Medicare prescription drugs.”

Congressional expert Steven S. Smith says Congress has plenty of parliamentary tactics for stalling and pushing through legislation. The fate of the health care reform bill could be determined by a process of reconciliation, filibusters, deeming or something Smith calls a “vote-a-rama”.

Reconciliation is a “fast-track” legislative process that bypasses potential Senate gridlock and permits the passage of budget-related legislation by majority vote. It’s a hot-button issue now as the Senate grapples with health-care legislation. “The passage this term of health-care legislation, and perhaps the future of health care reform more generally now may turn on rulings of the current parliamentarian,” says Cheryl Block, JD, professor of law. 

With health care legislation now up for debate in both the House and the Senate, comprehensive health care reform is closer than ever, says Timothy McBride, Ph.D., health economist and associate dean of public health at the George Warren Brown School of Social Work at Washington University in St. Louis. McBride says that there is still much work to be done with health care reform and contentious issues remain. Among those are the public option, how the legislation will be financed, the generosity of the coverage, Medicare Advantage reforms and whether there will be mandates for employers to offer coverage. (Video available)