The reality is that Congress will miss President Barack Obama’s August deadline for health care reform. The Administration had wanted each Chamber to pass a bill before Congress recesses in early-August. Members of a Conference Committee would then spend the recess working through differences between the bills and Congress would be in a position to send legislation to the President’s desk in October. That was the plan.
Now there is a strong likelihood Congress will be unable to pass out a bill before the summer recess. Part of the reason is that moderate and conservative Democrats are balking at the price tag for reform and some of the provisions being pushed by their more liberal colleagues. At the same time, the Senate Finance Committee and its Chair, Senator Max Baucus, has not given up on fashioning a bi-partisan bill, no mean feat on legislation as complicated as health care reform.
What this means is that lawmakers will return home in August with numerous questions concerning health care reform unanswered. They will hold town hall meetings, listen to constituents, and return in September to make the final effort to reform America’s health care system. While this will push the work of the Conference Committee back by a few weeks, it does not mean the President’s real deadline — signing a bill into law this year — will be missed. It just means the Conference Committee will have a bit less time to do their work. (A short civics lesson: a Conference Committee is an ad hoc working group comprised of both Senators and Representatives from both parties whose job it is to reconcile bills on the same topic passed by the Senate and House. Their compromise bill, if approved by both Chambers, is then sent to the President for his signature or veto).
The summer recess will hardly be relaxing for most members of Congress. While home they will be confronted on a daily basis passionate advocates on all sides of all the many issues tied to health care reform. Cost containment, universal coverage, preventive care, taxes, mandates and more will be part of their daily diet. Whether the cumulative effect of this stew of meetings, confrontations and discussions will be to encourage a more progressive or a more moderate approach to reform is an open question. Certainly millions of dollars will be spent by interest groups of all political persuasions, especially in the districts and states of moderate Democrats. The 24-hour cable news networks will be so inundated with health care reform advertising next month they may have no room for their regular fare of prescription drug, debt relief and Vonage commercials.
While the deadline is being missed, what elements are likely to be included in the reform package is becoming clearer. It is all but certain, for example, that an exchange will be created with the intention of helping consumers shop for health insurance will be created (although the nature of this exchange is still to be determined). There is also, surprisingly, a growing consensus on requiring every American to have health insurance. As reported by the Washington Post, the idea of an individual mandate “Is one of the few common threads running through all three bills being considered in Congress, greatly increasing the likelihood it will survive the legislative process.” Given that another virtual certainty is that carriers will be obliged to accept all applications for coverage without regard to pre-existing conditions, this is a good thing. States in which there is a mandate to sell coverage, but not one to buy it, premiums sky rocket. In New York and New Jersey, where this imbalance exists, average premiums for individual coverage are more than twice as high as they are in California which has neither mandate.
Not everyone supports a balanced approach to guaranteed issue. Many Republicans oppose the concept of requiring individuals to buy health insurance. One Republican proposal, The Patients’ Choice Act, introduced by two Senators and two Representatives, all self-proclaimed conservatives, emulates the New York and New Jersey model. Meanwhile some Democrats are concerned subsidies to help low income Americans afford the premiums they’d be required to pay will be inadequate. Nonetheless, as the Washington Post article explains, support for the concept is widespread.
Even President Obama, who opposed the mandate to purchase idea during the campaign has come around as long as there are exemptions for those who simply cannot afford the premiums: “I was opposed to this idea because my general attitude was, the reason people don’t have health insurance is not because they don’t want it, but because they can’t afford it. And if you make it affordable, then they will come,” he said in a recent interview with CBS. “I’ve been persuaded that there are enough young, uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down.”
So yes, Congress will miss the August deadline for passing health care reform. At the same time, critical elements of what will eventually emerge in the reforms are becoming increasingly clear. The only deadline that really matters is passing legislation before the silly season of mid-term elections arrives. And that’s a target date Congress is likely to meet.