4458527284_21d7409410_mPresident Obama’s signing of the national health reform bill yesterday marks an historic achievement in American history on par with the passage of Social Security and Medicare.  The Patient Protection and Affordable Care Act (summary here) establishes a framework to provide health security for all, and takes immediate steps in that direction.  Of course, there are flaws and omissions in the law as there were (and still are) with those earlier milestones, but PPACA gives us a strong foundation on which to build. How strong? Our fact sheet tells you.

This victory could not have happened without the commitment of the President and legislative leaders, the tireless dedication of staff, and the amazing work of advocates for the health and economic security of all Americans.

Ugly and Ducking

While we can and should celebrate this victory, it has certainly been sad and sobering to witness the opposition’s extremist acts.  Members of the Congressional Black and Hispanic caucuses, as well as openly gay Congressman Barney Frank, were verbally assaulted and spat on.

Someone threw a brick through the window of Rules Committee Chairwoman Louise Slaughter’s office, and Republican Congressman Neugebauer shouted an epithet at Rep. Bart Stupak from the House floor (Rep. Neugebauer later apologized, saying he was talking about the bill).

Many of the protests have called up the worst mob-like vitriol we saw on the 2008 Presidential campaign. House Republicans have generally declined to distance themselves from these events and instead offered embarrassingly weak rationales.

Apocalypse Now?  No?  Well how about now?

Those watching the House floor debate wouldn’t be blamed for feeling like they’d heard the GOP’s world-ending predictions somewhere before.

It seems through a warp in the space-time continuum (perhaps brought about by health reform’s passage) Congressional Republicans are using the same speechwriters as Alf Landon, the 1936 Republican candidate for president, and as the Medicare opponents who wrote this for then pitchman-for-hire Ronald Reagan.

In one sense, however, those who claim this health reform law marks the end of America as we know it are right.  In America as we know it, thousands of people die every year because they don’t have health insurance, and thousands more face bankruptcy from health care bills they can’t afford.

As of yesterday, that America is on its way to being history—the kind of history we learn from, and move beyond. As REM sang, “It’s the end of the world as we know it and I feel fine.”

The Senate Process—the end of the beginning

Democrats scored a key victory late Monday when the Senate parliamentarian ruled against an effort by Republicans to strike on technical grounds an amendment to the excise tax on high-cost health plans.  Yesterday the Senate voted to take up the amendments and started the clock on the 20 hours of debate allowed under the rules of reconciliation.

During the debate we are seeing Republicans do everything they can to delay passage, but their chance of derailing the bill is minimal. This is political theater, but it’s not responsible governing.

The bill now on the floor of the Senate makes mainly popular fixes to the now-law  reform by closing the Medicare prescription drug “doughnut hole,” increasing Medicaid funding for states, striking special deals, and reducing the excise tax on high-cost health plans.

Everything right is wrong again

With the law signed, opponents’ goal is no longer to stop these things from becoming law on the Senate floor (an almost certainly vain effort), but to offer amendments that will make good fodder and embarrassing ads for the November election.

Amendments are being offered on all kinds of subjects, many of them unrelated to the bill, for the express purpose of forcing Democrats to take hard votes. Although it’s possible that some changes will be made in the Senate, which would necessitate a conference committee or one more vote in the House, there is little doubt as to the final outcome.

While passage of the amendments to PPACA will mark a welcome end to a lengthy and often acrimonious debate, there is little time to pause to enjoy the achievement.

With the ink barely dry, the action is already moving in new directions. State and federal officials must begin the task of implementing the bill, some provisions that take effect almost immediately, while opponents are already launching legal and political challenges.

Not in My Backyard Seven minutes after President Obama signed health reform into law yesterday, 13 state AGs filed a lawsuit claiming the individual mandate in unconstitutional. More than 30 states have threatened to bring bills and ballot questions to repeal health care reform, or elements of it.

Most legal scholars say such challenges are legally specious and will have little purchase on implementing reform. But rolling back reform isn’t the primary aim of such repeal threats anyway–it’s to drive reform opponents (plus the angry and misinformed) to the polls in November.

But already doubts are growing about this strategy. Some Republican leaders are suggesting that they’d like to repeal some parts of the law, but leave others alone (no one wants to be the guy who re-allows insurers to deny coverage to kids with pre-existing conditions).

And a Gallup poll yesterday suggests public support for health reform has already jumped. As more and more people understand what reform is (and what it’s not) those numbers are likely to improve even more.

And that’s the key to making this thing go—the more real people understand the real help that comes from this bill, the harder it will be for state politicos with dreams of the Governor’s mansion to make the case for taking it away.

So the work goes on. Advocates and others who helped this bill become a law now must step up to the challenge of keeping it strong.

–Michael Miller, director of strategic policy