In 1993, the Clinton administration tried to pass a universal health care plan. There were a number of flaws with that national health care proposal — not least that it was employer-based and rooted in HMO’s (something I work assiduously to avoid) — but it was, at least, an attempt to wrestle the problem to the ground.
It died a painful death, and passed into the national consciousness as Hillary Care, leaving some unpleasant associations for Hillary, and a general distaste for the discussion altogether.
Nearly 14 years later, we’re facing a health care crisis, and the debate has returned at last.
Polimom’s excited by the innovative health care proposals coming from various states. From Massachussetts to Maryland to California, we’re finally seeing creative, bipartisan, locally-focused attempts to engage with the health care monster. While there are devils and details and complicated flaws in these hatchling ideas, such state-level proposals are precisely the approach I’ve been hoping to see. Furthermore, and just as importantly, their authors are bringing the discussion to the people, as this morning’s guest post at The Moderate Voice demonstrates:
Under the Governor’s proposal, all Californians must have a minimum level of insurance to ensure that those with insurance no longer pay for the uninsured. Individuals will be responsible for securing health coverage for themselves and their children and contributing to paying for their coverage. Government will return over $4 billion to doctors and hospitals by increasing federal reimbursement for Medi-Cal. The state will also expand Medi-Cal to poor adults and Healthy Families to children in families earning less than $60,000 annually. Employers with 10 or more employees who choose not to offer health coverage will contribute four percent of social security payroll toward the cost of employees’ health coverage. Companies with fewer than 10 employees—a full 80 percent of businesses in California—are exempt. The four percent fee will discourage employers from dropping their health care coverage in light of the state’s program.
Fascinating — but according to this morning’s Wall Street Journal, there’s a problem — not just with California’s proposal, but others as well, and that problem is Erisa:
But it turns out state schemes that feature “pay or play” employer taxes or mandates are probably illegal.
At least that’s the clear implication of a significant but underreported ruling last week by the Fourth Circuit Court of Appeals, which said that Maryland’s “Fair Share” health legislation — otherwise known as “the Wal-Mart tax” — violates a federal employee-benefits law known by the acronym Erisa.
[snip]
Judge J. Frederick Motz wrote for that court that “The Act violates Erisa’s fundamental purpose of permitting multi-state employers to maintain nationwide health and welfare plans, providing uniform nationwide benefits and permitting uniform national administration.” Last week’s Fourth Circuit ruling affirmed that decision, and it could spell trouble for the California and Massachusetts schemes.
Erisa, evidently passed in an attempt to keep costs for large employers down by eliminating multi-state administrative complications, was probably (like most things) a good idea at the time — but it appears counterproductive to local solutions.
On the other hand, Erisa would seem to fit perfectly into a national plan — something I’m not at all anxious to see. As I wrote forever ago, we’re simply too large and diverse a country to think a federally-administered health care plan could succeed. (See FEMA, Katrina)
Unlike the Wall Street Journal author, Polimom does not think the existence of Erisa is a terminal problem, though, and it absolutely does not make these state proposals “ballyooed” or fraught with “policy blunders”. Erisa is a law, after all — not a constitutional amendment.
But I expect we’re going to come across a number of similar pieces of legislation as this debate moves forward, which means that we’re approaching a fork in the road: Are we interested in state and local solutions to common problems, or do we want our health care administered by the federal government?
If we start there, the path will be smoother… and I know which direction I prefer to go.