PBN: A lot of health care reform advocates had gotten disillusioned in the last few weeks and said the Senate bill was so bad, it was worse than nothing. How did you feel?

ASEN: First, we do need to acknowledge the enormous steps that the Senate bill takes. It will help extend coverage to 31 million Americans who don’t have it; end price discrimination by gender; significantly reduces the doughnut hole for Medicare Part D right away; and even eliminate copays for preventive health care. … The bill would also restrict how much insurers can spend on costs other than health care, and stop them from being able to impose lifetime caps on coverage. Finally, it would improve the long-term financial stability of the Medicare program, which is critical.

That said, the House bill does all that and goes much farther in making coverage affordable. Thankfully, the Senate bill is not the final word. Despite our concerns about it, we do believe passing even this flawed Senate bill was the right step, because it allows the process to move forward. … We weren’t about to come out against the Senate bill and join those whose primary cause is to maintain the status quo – that only would make life worse for the millions who are uninsured and for those struggling to afford their coverage now.

PBN: What are some of your biggest concerns about the Senate reform bill, and how big a deal was the lack of a public option?

ASEN: All of our concerns relate to making coverage as affordable as possible to people. In order for people to afford coverage at work, there has to be a strong standard for all but the smallest employers to contribute. The Senate bill’s requirement on employers of 50 or more is very weak, in that there is no requirement to help provide coverage for part-time workers at all, and not strong language about offering more than bare-bones coverage. … Another concern is the amount of money that people buying insurance on the individual market will have to pay in premiums and out-of-pocket costs before subsidies kick in. Having subsidies is great, but if people can’t really afford their part of the bargain, the subsidies won’t work for some subset of the population. That’s why for people who buy coverage outside of work, having the choice of a public option is really critical.

PBN: How much does the Senate bill do to make coverage affordable?

ASEN: Anyone who is buying their own insurance now will certainly have a better deal, and [coverage will be] more affordable for most everyone else who doesn’t have insurance now. But more affordable than now, when it’s totally unaffordable for millions of people, is not good enough. … Under the Senate bill, a family of three with an income of $41,000 would have to pay an average of $2,100 more on these costs than they would under the House bill. A family of three making $70,000 would have to spend an average of $1,339 more under the Senate than the House bill. That could be the difference between whether this will actually make coverage more affordable to people.

PBN: Gov. Donald L. Carcieri and several other governors are dead-set against the Senate version of reform, saying it will devastate state budgets with its Medicaid provisions, and also harm small business. Do you see any merit to what they are saying?

ASEN: The bill actually provides a really good deal to the state. First off, we’re sending hundreds of millions of dollars in state money to our hospitals now to help them care for the uninsured that this bill is going to help us reduce dramatically. Second, the federal government will pay the full cost of the Medicaid expansion for the first few years, and then 90 percent after that – far more than the feds normally kick in for Medicaid. For the state to pay only 10 percent of the costs of providing Medicaid, which is already a very cost-efficient program, while bringing in hundreds of millions of new dollars to the health care system which is such a huge part of our economy, is an opportunity we can’t afford to give up.

As for small businesses, they are harmed most by the status quo, where they are treated much less fairly than larger businesses by the insurance industry. … By having a chance to buy coverage through the new exchange, small businesses have a lot to gain from this legislation. They also will have access to some tax credits to help them buy coverage.

PBN: What will you be doing in the coming weeks to ensure passage of a reconciled bill, and are you confident it’s going to happen?

ASEN: We are mobilizing the hundreds upon hundreds of Rhode Islanders who have been active in this campaign for over a year to make sure the members of our delegation know just how important it is to their constituents that they finish reform right. They’re calling in to our Senators and Representatives’ offices, also contacting the President and leaders of the House and Senate, and speaking out in other ways. We’re working to show the broad base of organizations, too, who support reform but know that we can’t settle for the Senate bill. … I am confident that we will get reform that goes a long way toward addressing the problems we face. Will it go far enough to make people feel that we haven’t missed an opportunity? That’s up to us to demand.