The United States has attempted to pass major health reform legislation eight times in the last century, starting in the mid 1910s up through 1993-94 with the failed Clinton health reform effort. “Only once in that period was any legislation passed — in 1964-65 when Medicare and Medicaid were passed,” says Timothy McBride, Ph.D., associate dean of public health at the George Warren Brown School of Social Work at Washington University in St. Louis. “Yet, for many reasons, I feel that it is much more likely that legislation will pass this year.”
McBride says that there are three main reasons why passage of health reform is more likely this year. First and foremost, the majority party nearly has a filibuster-proof majority in the Senate for the first time since 1965. Second, the severe recession has increased the political pressure to pass health reform because the recession has exacerbated the problems of the uninsured and rising health costs. Third, passage of major legislation requires strong executive leadership and commitment, as well as political support for the president.
At this point, McBride believes that President Obama has the political support necessary to make health reform happen, and he has made it his top domestic priority.
McBride has been active in testifying before Congress and consulting with important policy constituencies on Medicare, insurance and health policy issues. He is a member of the Rural Policy Research Institute Health Panel that provides expert advice on rural health issues to the U.S. Congress and other policymakers.
“As is inevitable in this stage of legislative development, the controversy over health reform has started to pick up rapidly — over how much it will cost, who will be covered and many other details,” McBride says. “In the last two weeks it appears that health reform has hit some bumps in the road, but this is not out of the ordinary.”
McBride has developed a model to simulate the effects of the legislative efforts on health spending and coverage. He says that most of the major proposals being considered in Congress hold out promise to reduce the number of uninsured, though the proposals will require the Congress to find additional revenues to finance covering many of the 50 million who do not currently have health insurance coverage.
“We know how to provide access to affordable health insurance,” McBride says. “The proposals for doing this have been developed and discussed for years. But the challenge has always been finding the political will to get it done.”