This is the beginning, not the end

As the 111th Congress begins its second session, we are poised to pass landmark legislation to reform America's healthcare system. This is a prize that has eluded Congresses and presidents going back to the Roosevelt administration — the Teddy Roosevelt administration. It will be an achievement on par with passage of Social Security in 1935 and Medicare in 1965.


As the 111th Congress begins its second session, we are poised to pass landmark legislation to reform America's healthcare system. This is a prize that has eluded Congresses and presidents going back to the Roosevelt administration — the Teddy Roosevelt administration. It will be an achievement on par with passage of Social Security in 1935 and Medicare in 1965.


Understandably, many have been distracted by the often-strident debate surrounding health reform. However, it bears remembering that the debates leading up to passage of Social Security and Medicare were no less turbulent. Advocates of change faced bitter resistance, and were obliged to make pragmatic compromises. But by persevering, they dramatically improved the health and economic security of the American people. And they laid a solid foundation on which subsequent Congresses would build.

Today, we understand why earlier attempts at comprehensive health reform failed. We have seen that the health insurance industry and other entrenched interests are extraordinarily powerful. By passing the Patient Protection and Affordable Care Act, we will finally break their stranglehold. And we will usher in three landmark reforms.

First, we are going to extend access to quality, affordable healthcare coverage to nearly every American. An estimated 30 million Americans who do not have coverage will get it thanks to this bill. By itself, this is an historic achievement every bit on par with passage of Social Security and Medicare.

If you already have insurance and you're happy with it, you will be able to keep it. However, the Congressional Budget Office estimates that, thanks to the bill, premiums will be lower for the vast majority of Americans, including small businesses and the self-employed; the same policy will cost 14 to 20 percent less in the individual market under the Senate bill. Through new health insurance exchanges, people who currently do not have access to affordable coverage will be able to easily shop and choose from a menu of quality health plans — much in the way members of Congress and federal employees are able to do today.

A second great reform in this bill is an array of provisions cracking down on abuses by health insurance companies — abuses that currently leave most Americans just one serious illness away from bankruptcy. Among other things, this bill will extend coverage to people with preexisting conditions, and eventually it will ban outright the practice of denying coverage due to preexisting condition. It will stop insurers from canceling the policies of people who get sick. And it will stop discrimination against women, who now pay premiums up to 48 percent higher than premiums for men.

A third great reform is something I have championed for many years. Our bill includes a broad array of provisions designed to jumpstart America's transformation into a genuine wellness society. For example, it will require reimbursement for recommended preventive services such as mammograms without deductibles or other cost-sharing requirements.  It will expand Community Health Centers, and will help businesses to create workplace wellness programs. It will require large chain restaurants to post basic nutrition information right on the menu, so consumers can make informed, healthy choices.

In short, our bill will begin to transition our current sick-care system into a true healthcare system — one focused on preventing chronic disease and keeping people out of the hospital in the first place.

To be sure, the path to securing 60 votes was paved with painful compromises. That's also the way our predecessors were able to get the votes to pass Social Security and Medicare, both of which had big gaps in coverage when they were first enacted. Our predecessors passed bills that were less than a full loaf, and then they came back for more in later years.

Instead of that "partial loaf" analogy, I like to think of this bill like a starter home. It is not the mansion of our dreams. But it has a solid foundation, giving every American access to quality, affordable coverage. It has an excellent, protective roof, which will shelter Americans from the worst abuses of health insurance companies. And this starter home has plenty of room for additions and improvements. Let's be clear: This bill is the beginning of health reform, not the end.

We can learn one final — and hopeful — lesson from the history of Social Security and Medicare. Those programs originally pitted Democrats against Republicans, left against right. But, today, they are hugely successful programs that enjoy overwhelming bipartisan support.

I predict the same success and eventual bipartisan support for the health reforms now before Congress. We are going to create a reformed insurance and healthcare system that works not just for the healthy and the wealthy, but for all Americans.


Harkin is the chairman of the Senate Health, Education, Labor and Pensions Committee.