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The National Education Association and Health Care Reform in the United States
President Barack Obama was elected in November 2008 in part based on promises he made to reform the sputtering health care system in the United States. And although it has become an article of faith across the political spectrum that reform is needed, bitter political and social discord exists when it comes to determining what needs to change and how best to change it. The National Education Association (NEA)—the largest labor union in the United States, with 3.2 million members—has a big stake in ensuring that comprehensive reform occurs quickly. The Association has worked hard toward this end, even though most of its members have good health benefits. Now, more than a year after President Obama took office, it is clearer than ever that the struggle for reform is crucial for this country’s well-being, even though the path to reform is still unclear. NEA remains committed to promoting reform, a goal it has pursued over decades.
How NEA Members Obtain Health Benefits
By and large, the teachers, faculty members, bus drivers, janitors, secretaries, and other public school employees who comprise NEA’s 3.2 million members have good, comprehensive health care benefits. That they do is an indication of how much they value those benefits, because they must fight for them whenever they negotiate their compensation packages. In fact, they often give up salary increases to ensure that they do not have to pay more out-of-pocket expenses for health services and that their coverage is not reduced. Indeed, a 2007 poll commissioned by NEA and conducted just before national health care reform became domestic political priority number one for the White House and Congress showed that health care reform was just as important to NEA members and leaders as were education issues.

Throughout the United States, perhaps 30,000 different health insurance plans cover NEA members, although no accurate count of plans exists. Along with the large number of plans comes wide variation in the way they are structured and financed. Frequently, a school district will have several health plans from which employees can choose. The differences between them could be the insurance carrier, the particular health services covered, the type of provider networks and requirements, or the cost-sharing arrangements. Prescription drug, dental, and vision benefits could be included with medical benefits, or they could be offered separately through different plans. In many cases, however, health benefits are not arranged directly between a school district and an insurance company. Instead, school employees could access health benefits through a regional or state-wide trust, a health care purchasing pool, a state government agency, or a retirement system. In a small minority of cases in which NEA members who are still working do not have health benefits, it is usually because they cannot afford to pay required premium contributions or they do not work enough hours with a single employer to qualify for participation in that employer’s health plan. The former is more common for lower-paid, non-teaching professions in public schools, while the latter is more common among adjunct higher education faculty.

For retired NEA members, obtaining health benefits can be equally complicated. In most instances, people 65 years old or older have access to the government-sponsored Medicare program, into which most workers pay taxes during their working lives. However, given the way Medicare has developed, not all state and local government employees—including those working in public education—are eligible for Medicare. With limited exceptions, retired workers under the age of 65 are not eligible for the government program. Some NEA members who retire before they are eligible for Medicare continue to have access to their former employer’s health plan, although how much and under what circumstances such retirees must pay varies as greatly as it does for active employees.

For NEA members, as with others with employer-sponsored health benefits in the United States, a key factor that distinguishes one plan from another is how much the employee and covered dependents must pay to receive services, and under what circumstances they must pay. Plans can require a copayment of a certain amount at the time services are provided, a coinsurance payment of a certain percentage of the cost, and a deductible amount that must be reached in employee out-of-pocket payments before insurance will pay anything at all.

To complicate matters, a plan can have different copayments, coinsurance amounts, and deductibles for different types of medical benefits.

It is common for members to pay a portion of the health insurance premium, but those premium payments can vary depending on whether the employee alone is covered or whether one or more dependents are also included under the policy, when the employee was hired, or how many years the employee has been on the job.

NEA’s Work for Health Care Reform
Against this complicated background, President Barack Obama took office in January 2009 after campaigning hard on the issue of health care reform. As early as mid-2007, though, the National Education Association began to ramp up its focus on national health care reform, pushing for reform that would lead to quality, affordable health care coverage for everyone in this country. At heart, NEA understood—and continues to understand—that health care reform is an education issue. With some 8 million children in the United States lacking health insurance, NEA members see day in and day out the negative impact of the uninsured on the country’s education system. Kids without insurance perform less well in school because they miss class more and show up less ready to learn. At the same time, although the vast majority of NEA members have good health benefits, they increasingly face painful trade-offs between salary increases and the maintenance of health care benefits. The Association also understands that increasing health care costs create a serious drag on state and local government finances, and that the vast number of uninsured adults in the country—an estimated 37.6 million adults aged 19 to 64—is both a moral and a financial concern. Typically, an employer-sponsored insurance policy covering a family costs more than $13,000 a year, and one recent study found that, on average, more than $1,000 of that premium amount goes to make up for the cost of health care received by those without insurance, including through emergency rooms.  In addition, NEA is deeply concerned that greater controls over, and competition in, the health insurance marketplace are necessary if we are to succeed.

Although it is true that national attention to comprehensive health care reform has taken on great political importance over the last two years, NEA has supported broad-based health care reform for much longer than that. Every year, NEA’s primary legislative and policymaking body, the Representative Assembly (RA), gathers to adopt legislative priorities, approve policy resolutions, and carry out other business necessary for governing the Association. Over decades, the RA has adopted multiple health care-related resolutions premised on the belief that “affordable, comprehensive health care, including prescription drug coverage, is the right of every resident.” The Association supports a single-payer health care system and has worked to promote reform that moves the country in the right direction on health care. As a result, many years’ worth of health care resolutions, active engagement on reform, and recent RA directives for NEA to redouble its reform efforts have formed the framework for the Association’s recent endeavors in this area.

To complement the conceptual and policy framework within which NEA has worked on health care reform, beginning in 2007 the Association systematically met with over 2,500 members and local leaders around the country to discuss reform. Working with small groups, NEA staff explored group members’ hopes, fears, and goals related to health care reform, and used open-ended survey responses to further evaluate how best to move forward. In 2008, in the context of a presidential campaign noted for its attention to reform proposals, and 2009, as reform clearly became the priority policy issue for the White House and Congress, NEA’s RA directed the Association to vigorously pursue reform.  The RA noted that NEA’s policies and legislative program “express the belief that all residents of the United States, its territories, and the Commonwealth of Puerto Rico should have access to quality, affordable, comprehensive, and secure health care coverage. The assembly’s directives, in the form of what NEA calls New Business Items (NBIs), were approved through a vote by the 9,000 or so delegates present at the meetings.

Putting meat on the bones of a policy and legislative skeleton requires the coordinated work of multiple NEA departments and the hands-on leadership of NEA President Dennis Van Roekel, who took office in the fall of 2008, just as health care reform began its steep ascent on just about everyone in Washington’s list of political priorities. Among the key NEA departments involved in the health reform initiative are Collective Bargaining and Member Advocacy, Government Relations, Campaigns and Elections, Public Relations, and Interactive Media. Beginning in the fall of 2009, the directors, managers, and staff of these departments have met daily to prioritize, strategize, and coordinate their activities on health care reform. Work priorities include engaging NEA affiliates and members on the need for, and goals of, health care reform, and enlisting their on-the-ground support; analyzing and responding to what has turned out to be several thousands of pages of proposed legislation; meeting with elected officials and government leaders, including President Obama, Speaker of the House Nancy Pelosi, and Senate Majority Leader Harry Reid; working with congressional and White House staff members on policy details; working with the news media; including a focus on health care reform in NEA’s own publications; and developing internal briefing and policy papers to help NEA staff and leaders to effectively address issues related to reform.

Another important component of NEA’s work on reform consists of working with other unions and health reform coalitions, including Health Care for America Now (HCAN) and the National Coalition on Health Care (NCHC). HCAN in particular has grown to be a crucial component of the effort to make fundamental changes in this country’s health care system. By bringing together labor unions and diverse nonprofit organizations in a closely coordinated group, HCAN has been able to forge consensus on difficult policy issues, identify and work through coalition members’ differences, and ensure that efforts to lobby politicians and mobilize the grass roots are as effective and efficient as possible. At the same time, HCAN serves as a forum for analysis of health reform proposals, so that each individual organization and union can benefit from the others’ analyses. NEA is a founding member of HCAN and a member of both its steering committee and its executive committee. Launched formally in July 2008, HCAN has grown to include more than 1,000 local and national groups.

From a policy perspective, NEA has focused its energy on several priorities: making sure insurance companies are held accountable and face more competition, that the health benefits of middle class workers are not taxed, that those without insurance gain coverage, and that health care costs become more affordable.

The Murky Future of Health Care Reform in the United States Throughout 2009, NEA labored on health care reform with the understanding that the path to final, comprehensive reform legislation would be difficult. The Association, however, has moved forward with the belief that much-needed reform would come and that a reformed system would be better than what we have now, even though we could not foresee the exact nature of the changes that would ultimately be signed into law. A January 19, 2010, special Senate election in the state of Massachusetts fundamentally altered both the practical possibilities for reform and the political landscape in which the reform debate had been taking place. When a Republican won the Senate seat held for decades by the Democratic stalwart Edward Kennedy, the Democratic Party lost a crucial 60th vote in the Senate that had allowed them to overcome Republicans’ use of parliamentary procedure to block many Democratic reform initiatives. The election’s outcome also led many Democrats to call for a re-evaluation of both the process and the content of health care reform efforts. At the writing of this article, the White House had just released its own health care reform plan, giving much-needed impetus to reform efforts in Congress. President Obama’s plan was broad, suggesting that the White House would not be pushing for a significantly scaled-back proposal, as some Democrats and many Republicans had urged.

The president released his plan in advance of a meeting he had organized for leaders of the two political parties to publically discuss competing health care reform proposals. His goal was to bring Republicans into the debate and allow the American public to weigh options for reform. Ultimately, comprehensive reform may pass, or a scaled-down version could become law. It is also possible that no significant health care reform legislation will become law at all. With midterm elections slated for November 2010, Democrats are under stiff pressure to move on from health care and to focus on jobs and the federal deficit, among other concerns.

NEA’s concern about health care reform long predated the current reform debate and initiatives, and the Association will carry into the future the same policy and legislative agenda that has formed the basis of its current work. Health care reform is just as urgent today as it was two years ago, and the Association will continue to urge Congress and the White House to move swiftly to ensure quality, affordable coverage for all.