Health Care Reform Bills: Coming Soon to a Nation’s Capital Near You

President-elect Barack Obama won’t take the oath of office for more than two months, but the drive for health care reform is about to get under way. Senate Health, Education, Labor and Pensions Committee Chair Ted Kennedy has been working from his home, where he’s fighting brain cancer, seeking to pull together a consensus bill. Meanwhile, Senator Max Baucus, Chair of the Senate Finance Committee introduced his health care reform plan today.

Senator Baucus’ Finance Committee and Senator Kennedy’s Health, Education, Labor and Pensions Committee share jurisdiction over this issue. According to Politico, the staffs of the two committees have been meeting with stakeholders since the summer and the two committee chairs have been in contact. The details of Senator Kennedy’s plan have not yet been released.

Senator Baucus’ health care reform plan contains several elements that align with the reforms President-elect Obama called for during the campaign. These include the creation of government-run “exchanges” to allow Americans to shop for coverage from multiple carriers and a requirement that carriers accept all applicants regardless of pre-existing health problems. Significantly, Senator Baucus goes a step further and would require all Americans to purchase coverage “once affordable options are available.”

Requiring everyone to purchase coverage was a contentious issue during President-elect Obama’s hotly contested primary fight against Senator Hillary Clinton. She was for a mandate to buy; he opposed it. As has been previously noted, a requirement to sell insurance without a requirement to buy results in higher premiums. Senator Baucus apparently agrees noting that the uninsured incur medical costs that are then shifted to those with insurance. By bringing everyone into the system, Senator Baucus believes the average cost of insuring each American will be reduced. By including an alternative for those who cannot afford coverage he avoids one of the most vociferous objections to requiring consumers to buy coverage.

Senator Baucus’ health care reform plan would also allow those between the ages of 55-and-64 to purchase Medicare if they lack access to public insurance programs or a group health plan. According to the New York Times, four million people in this age group are currently uninsured. He would expand the State Children’s Health Insurance Program to include children in families at or below 250 percent of the federal poverty level ($44,000 for a family of three) and he would lift the ban preventing legal immigrants to enroll in SCHIP until they’ve been in the country for five years. Like President-elect Obama, Senator Baucus supports tax credits for small businesses that provide health insurance coverage and for individuals and families, below 400 percent of the federal poverty level, who purchase their own coverage.

We haven’t heard from the Republican side of the aisle on this issue yet, but it shouldn’t be long now. There proposals will likely be more market oriented and less far reaching.

The key question is whether lawmakers in Washington have the bandwidth to fashion a comprehensive health care plan while simultaneously dealing with a crashing economy, a host of international issues and energy policy. Personally I think they’ll make the time. Health care reform is too entwined with people’s sense of financial and is too much a part of the economy to be put off. As I’ve written before, if health care reform is positioned not as a cost item, but as in investment in the nation’s infrastructure, it becomes very compatible with other economic stimulus efforts.

On the other hand, it is interesting that Senator Baucus, the Chair of the Senate Finance Committee, has apparently left out the funding mechanism for his reform package. That in itself is a telling reminder of how difficult achieving meaningful reform in today’s economic climate will be. That it is difficult, however, does not mean it’s impossible.

Note: I haven’t been able to find

Hillary Clinton on Health Care Reform: Part II

“We’re going to have universal health care when I’m president — there’s no doubt about that. We’re going to get it done,” said presidential candidate Senator Hillary Clinton in Iowa on March 26th.  Whether this prediction comes true depends on a lot of things, most important among them: will she ever be the president and will she have the political clout to get meaningful reform enacted? As discussed in my last post, her track record on this isn’t so good.

What would Clinton health care reforms look like in a Hillary Clinton administration? She hasn’t yet provided a lot of details, but in the past week she’s at least begun to provide their outline.

Speaking at a Las Vegas candidates forum on March 25th, Clinton noted “fixing” health care would be an incremental process taking two terms of her presidency. “We all are going to try to start as soon as possible.  We can move quickly, but make no mistake, it’s going to be a series of steps.”

Clinton favors “guarantee issue” provisions, which requires insurers to accept all applicants regardless of their health conditions. At least that’s what she implied in Las Vegas. According to the Las Vegas Review Journal, Clinton claimed “Insurance companies make money by spending a lot of money and employing a lot of people to try to avoid insuring you ….” The Review Journal further reports her as calling for “an end to ‘insurance discrimination’ against people with pre-existing medical conditions.”

Let’s hope she’s not considering her home state of New York’s approach to guarantee issue, which is pretty much a disaster. As previously posted in this blog, the New York approach costs its citizens thousands of dollars each year. Consider: the average annual premium for a single New Yorker is $3,743 compared to $1,885 in California. For a family, the average annual premium in New York is $9,696 while a California family pays, on average, $3,972 per year. Given this, one hopes Clinton is considering a more nuanced approach to guarantee issue.

Unlike some of her challengers for the Democratic Party presidential nomination, Clinton seems to reject a single payer system. Here’s a portion of the transcript from the Iowa town hall meeting:  “I think we have to have a uniquely American solution to health care because we’re a different kind of country than anybody else.

“I think we will move toward requiring employers to participate the way Massachusetts does or the way California is considering. … And if you don’t insure your employees you’re going to have to pay some kind of per-employee amount so that everybody can be given insurance.” (Here’s the full transcript of the town hall meeting as posted by ABC News. The health care reform discussion begins on page 2 of the transcript).

While not supporting a single payer approach, Clinton does see the government as being an insurer of last resort for consumers who don’t get coverage from other sources such as their employers. And she would require individuals to buy coverage, presumably through this state program, with costs being borne by employers who don’t purchase coverage. As she notes, this mirrors the health care reform proposals enacted in Massachusetts by then Governor Mitt Romney and proposed in California by Governor Arnold Schwarzenegger.

Clinton is staking out a middle ground on health care reform. She’s going to get tough on insurance companies, but continue to rely on employer sponsored coverage. She’s supporting a government health plan for more Americans, but it won’t be completely government run. This may surprise some, and it should serve as fair warning for all. Remember: even if her presidential bid fails, Senator Clinton will be a powerful voice in the U.S. Senate on any health care reforms the new president has to offer.

Hillary Clinton on Health Care Reform: Part I

The botched attempt to pass comprehensive health care reform remains one of the seminal events of the Clinton Administration. It was the first time a First Lady was given responsibility for passage of such an immense public policy undertaking. Hillary Clinton undertook the responsibility with zeal, deploying a massive task force to thoroughly examine the issues and deliver a solution to the American people.

What they came up with went down in flames.

In part, this stems from the political deafness displayed by now Senator Hillary Clinton and members of her task force. There was the brilliant way they demeaned and ignored members of Congress, the rightousness in which they cloaked their arguments and the arrogance. Oh, the arrogance.

In one memorable instance for insurance agents, Hillary Clinton told Lori Proctor, a broker from Ohio, that there being no role in her plan for agents was OK, because, “… someone as bright as you could find something else to do.” An arrogant response to a legitimate question, made more foolish by making it in front of a Wall Street Journal reporter.

My favorite example of the Clinton Task Force arrogance came from Walter Zelman, formerly a deputy California Insurance Commission under (now Lieutenant Governor) John Garamendi. He explain that when Garamendi tried to remake California’s health care system it required a document of only a couple dozen pages. Now, as a member of the the Clinton Administration, he was pleased they had hundreds of pages worth of reform because that’s what it took to cover all the possible consequences of the Clinton plan. The audacity of believing a group of people could impact one-fifth of the nation’s economy and not come afoul of the law of unintended consequences, struck me as monumental folly — and unmatched arrogance.

I led the National Association of Health Underwriters’ legislative efforts during the Clinton health care debate. At one point I had the priviledge of testifying before four Congressional sub-committees in a single week. What the Clinton forces did manage to do is raise health care reform to the dominate political issue of its time. What they failed to do was accomplish anything, a squandering of an opportunity that impacts the country — and the health care reform debate — to this day.

So now Hillary Clinton is running for president. What would be in store for the country if she were to win? That’s the topic of my next post.