President Obama has prioritized health care reform to ensure that millions of Americans have a fair, affordable and efficient health care system. For immigrants, this vision is far from a reality. First, the current health care reform bill treats legal immigrants unfairly. Individuals who have waited years to come to the United States will be required to wait years in order to obtain affordable health care.

Immigrants are generally younger and healthier than the U.S. population at large. However, no one is immune to falling ill or having an accident. The current health care bill would require recently arrived, legal immigrants to wait five years to obtain the only option for affordable health care coverage, Medicaid. While low-income citizens will have access to Medicaid, the most vulnerable among us will continue to wait for affordable health care despite the fact that they pay taxes for the very programs from which they are excluded. There is no sound reason for Congress to discriminate against these individuals and prevent them from receiving basic medical care.

Congress and the White House also took an unprecedented step to prohibit individuals from buying — with their own hard-earned money — an American good that could help their families. The Senate version of the health care bill forbids undocumented immigrants from purchasing private insurance at full cost in the newly created insurance marketplaces. As a result, undocumented immigrants as well as their family members, who are often U.S. citizens or legal immigrants, will likely remain uninsured and will be forced to seek care in the emergency room.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

Insurers are against both bills, as are several Republican lawmakers, without amendments that would limit taxation on insurers and require more legislative oversight. They argue that the bills set up a new bureaucracy with broad powers to tax them and create disadvantages for smaller health plans in the exchange.

“Our concern is that (the bill) sets up very broad authority and powers,” said Charles Bacchi, executive vice president of the California Association of Health Plans. “We believe if they make wrong decisions, it could result in fewer choices for consumers.”

Health insurers are also fiercely opposed to several bills that propose various forms of rate regulation, an issue that gained traction earlier in the year after Anthem Blue Cross proposed a 39 percent rate increase on 800,000 individual California policyholders.
Power over rate increases

The rate-hike proposals include a bill by Sen. Mark Leno, D-San Francisco, that would require insurers to justify rate increases, and one by Assemblyman Dave Jones, D-Sacramento, that would give state regulators the power to approve or deny rate hikes.

Gov. Arnold Schwarzenegger has proposed a separate plan that would require health care insurers to hire actuaries to review their proposed premium increases.

Bacchi, referring to the Jones bill, said rate regulation diverts attention from the need to curb medical costs. “Health care costs are going up enough,” he said, “without having to create overly burdensome and expensive new government bureaucracies to handle this.”

The California Medical Association and the California Hospital Association join the insurers in their opposition, arguing that if the insurers are squeezed, they’re likely to turn around and squeeze doctors and hospitals through lower reimbursement rates.

“This case could be decided either way without overturning any existing Supreme Court precedents,” Coan said.

So far, federal judges have dismissed two of the lawsuits – one filed in Virginia by Liberty University, founded by Jerry Farwell, and the other filed in Michigan by the Thomas More Law Center, a public interest law firm that focuses on defending the religious freedom of Christians, family values and other issues.

But federal judges in Florida and Virginia have denied the federal government’s motions to dismiss the lawsuits by the states.

Van Hollen, a Republican, wanted to challenge the health care law immediately after it was passed but needed Democrat Gov. Jim Doyle’s approval – and the governor in a strongly worded letter made clear that wasn’t going to happen.

“The State of Wisconsin will not enter into litigation intended to deny health care for tens of thousands of residents,” Doyle wrote in March.

The state also has estimated that the law would save Wisconsin 5 million to 0 million from January 2014 through June 2019 as the federal government picks up a larger share of the cost of insuring residents with limited incomes.