Wednesday, August 20, 2014

Health Reform Law Under the Dome

Here’s one for the old dome.


These days the word “dome” is much in the news.

I think of this because I am old, bald, and sport a bald dome.

To begin, there is the Stephen King science fiction novel Under the Dome and the CBS TV series based on the novel. The plot concerns what occurs in a small Maine town, when town's inhabitants try to cope with the calamity of being suddenly being trapped under a dome, cut off from the outside world by an impassable, invisible barrier that drops out the sky.

Then, there’s Israel’s “Iron Dome.” That’s the mobile electronic defense system, consisting of 10 mobile radar units guided by a sophisticated computers that permit the Israeli government to identify the precise site from which Hamas rockets were launched, to show the rockets’ trajectory and direction, and to shoot down those rockets that would land in populated areas.

Of course, there’s always the Teapot Dome, a generic term referring to any political scandal that take place.

Finally, there’s all the capital domes in Washington, D.C. from whence all health laws flow. Well, not all.

There’s all those state capitol domes, 30 of which Republican governors or state legislatures control. These states have their own sets of health care laws, have jurisdiction over health plans in their states, and, according to the wordage of the Affordable Care Act, are the only government entities, that can offer subsidies to those enrolling in the health exchanges. The states can also decide whether or not they participate in the federally funded Medicaid program. Twenty six states have decided to participate.

As noted in Stephen King’s novel, this state of affairs - a dome dropping out of the sky cutting off citizens from the real health care world - causes confusion and dissension. The confusion and dissesion exists not only between the federal government and the states but also among the inhabitants of health care community itself.

As Tip ONeil , the late Democratic leader of the House of Representatives, observed,” All politics is local.”

It has been said “All politics is local.”

By one who was partisan and vocal.

Who will win, those who remain at home?

Or those who roam in U.S. capitol dome?

Who will prevail: state locals or U.S. bicoastals?

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