Health-Care Conflicts Increase With Odds of Passage
Oct. 19 (Bloomberg) -- Democratic lawmakers, fresh from oneof their biggest legislative victories in the health-caredebate, must now navigate fault lines in their own party overhow to remake the U.S. medical system.
Leaders this week will try to heal rifts over issues suchas whether to create a government-run insurance program, whetherto require employers to offer insurance and how to fund thenation’s broadest health-care changes in four decades.
The legislation, President Barack Obama’s top domesticpriority, got a boost last week when the Senate FinanceCommittee approved an $829 billion plan to curb medical costsand extend coverage to tens of millions of the uninsured.
“We have a ways to go,” said Montana Senator Max Baucus,the panel chairman. “But we are going to get health-care reformpassed this year because the need is so great.”
Senate Majority Leader Harry Reid is working with WhiteHouse aides and committee chairmen to merge that bill with onepassed by the Senate health panel. Speaker Nancy Pelosi is doingthe same in the House. If each passes legislation, they wouldfashion a compromise for new votes in both chambers.
Some elements that would be part of final legislation areclear. Americans would be required to buy insurance, helped bypurchasing exchanges and government aid. Insurers would face newrules, with preventive care, electronic records and cost-effectiveness research playing a larger role in treatment.
Bipartisan Support
Many ideas, such as requiring insurers to accept clientsregardless of preexisting medical conditions, have bipartisansupport, said Senator John Thune, a South Dakota Republican.Still, only one Republican, Maine Senator Olympia Snowe, hasvoted for any of the congressional committee plans.
“It really comes down to Senate Democrats,” Thune said.“They’re writing this bill in Senator Reid’s office.”
Democrats control 60 Senate votes, enough to overcomedelaying tactics and pass legislation. So far, they aren’tunified, and some including Nebraska Senator Ben Nelson say theywon’t vote for legislation that lacks Republican support.
Much of the debate in meetings this week will center on thepublic option, a government-run program to compete with insurerssuch as Hartford, Connecticut-based Aetna Inc. Republicans andDemocrats including Senator Blanche Lincoln of Arkansas opposethe idea, saying it would undercut the market.
Public Option
Reid must steer a path between the health panel, whichapproved a public option, and the finance committee, whichrejected it. Snowe wants a trigger for a public option ifinsurance isn’t affordable enough in the future, an idea theWhite House may accept.
“The trigger seems to me a place they may well wind up,”said Rogan Kersh, a public policy professor at New YorkUniversity. “It lets the big majority of members in the middle,and I think the administration, say ‘this feels good enough.’”
Pelosi said the House is set on a government-run program;the question is its structure. One possibility is to allow theplan to harness federal purchasing power while requiring it tonegotiate rates with providers, as private insurers do.
Another way is pegging a public option’s payments to thelower rates of Medicare, the government program for the elderly.The Congressional Budget Office says this method would save themost money.
There are compromises, such as one offered by DelawareDemocrat Thomas Carper, that would allow state-created publicoptions.
Taxes
One of the thorniest issues is how to pay for programs andsubsidies that help people buy insurance.
House members oppose Baucus’s proposal to tax insurers onhigh-end plans. The No. 2 Senate Democrat, Dick Durbin ofIllinois, said he expects changes after unions warned the ideawould hurt workers.
The House would place a surtax on couples earning $1million or more. And lawmakers are considering taxing insurerprofits.
The House and Senate health committees also approved amandate that employers offer insurance or pay a penalty, an ideathat Baucus knocked down. In his Oct. 17 weekly address, Obamasignaled he’s willing to take on the insurers and criticized theindustry for putting out what he called “bogus” information.
“Every time we get close to passing reform, the insurancecompanies produce these phony studies as a prescription and say,‘Take one of these, and call us in a decade,’” Obama said.“Well, not this time.”
Doctor Fees
The Senate must also resolve how to spare doctors a 21percent fee cut next year for treating Medicare patients, whichstems from a 1997 law intended to cut the federal program’s costby ratcheting down those fees. Congress has postponed the cutsfor seven years to encourage doctors’ participation in Medicare.
Senate leaders are considering allowing doctors to be paidan additional $247 billion over the next decade, a price thatdrew criticism from some Democrats.
Reid is negotiating with Republicans to allow votes onamendments to the legislation, said spokesman Jim Manley.Minority Leader Mitch McConnell said Republicans “will probablyconcede the need” to cancel the cuts for at least a year “butpay for it.”
At the end of the wrangling, the odds of final passage ofsome legislation are “100 percent,” said Ira Loss, seniorhealth analyst at Washington Analysis.
“This president got elected promising to do somethingabout the health-insurance problem,” he said. “The worst thingthat can happen to his presidency is if he doesn’t get a bill.”
To contact the reporters on this story:Kristin Jensen in Washington at kjensen@bloomberg.net;Laura Litvan in Washington at llitvan@bloomberg.net
Last Updated: October 19, 2009 12:20 EDTSource: Bloomberg
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