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Support Growing for Major Changes to Health-Care System

President Obama met with members of Congress last month before signing the State Children's Health Insurance Program legislation, which was designed mainly for children from families that are not poor enough to receive Medicaid but that are unable to afford private health insurance.
President Obama met with members of Congress last month before signing the State Children's Health Insurance Program legislation, which was designed mainly for children from families that are not poor enough to receive Medicaid but that are unable to afford private health insurance. (By Bill O'leary -- The Washington Post)
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By Ceci Connolly
Washington Post Staff Writer
Saturday, March 28, 2009

The fault lines are emerging in the upcoming battle over health-care reform.

Recent movement on Capitol Hill and by major health-care players suggests that consensus is growing for action this year, but deep rifts remain over how to pay for expanded coverage and whether a new government-sponsored program should be offered to people who have trouble buying private insurance.

A coalition of hospitals, insurers, employers, physicians, drug makers and consumers released a report yesterday endorsing a set of policy changes that could cut in half the number of uninsured Americans.

Most notably, the group, known as the Health Reform Dialogue, calls for creating an "individual mandate" that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.

"We should seek to ensure coverage for all," the group concluded after six months of private, professionally facilitated negotiations.

The results are noteworthy because it is the first time that such a varied mix of special interests -- "strange bedfellows," in the words of one participant -- have coalesced around significant changes to the U.S. health system. The signers include the American Medical Association, the National Federation of Independent Business, two hospital groups, AARP and the liberal consumer advocacy group Families USA.

"We're narrowing the range of disagreement," said Karen Davis, president of the Commonwealth Fund, a nonprofit private health-care foundation that was not involved in the effort. It is striking, she observed, that the Health Reform Dialogue and influential lawmakers have all but ruled out the prospect of a European-style single-payer system, opting instead to build on the existing employer-based insurance arrangements.

Equally striking, however, were the fundamental questions left unaddressed by the group of health-care heavyweights.

"A day late and a dollar short," said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.

The coalition's report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage.

Two unions -- the American Federation of State, County and Municipal Employees and the Service Employees International Union -- declined to sign yesterday's document, in part because of their support for a "public plan option," something President Obama endorsed during his campaign.

House Speaker Nancy Pelosi (D-Calif.) has advocated including the public option in a bill, while Senate Finance Committee Chairman Max Baucus (D-Mont.) has said that it should be "on the table" for consideration.


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