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.
The idea is anathema to the insurance industry, however, which fears that a government-sponsored program with the ability to set prices would have an unfair advantage and severely undercut the private market.
"A government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan," said Nick Simpson, spokesman for Rep. Roy Blunt (R-Mo.).
Republicans and some interest groups also protested a decision in the House to use a procedural maneuver known as reconciliation that would make it easier to pass comprehensive health legislation in the Senate.
In its version of a budget blueprint approved in committee Thursday, the House added language that sets a mid-September deadline for enacting health reform. If lawmakers do not act by then, a bill could be attached to the final budget, which would require 51 votes in the Senate, a much easier threshold than the 60 needed to defeat a filibuster.
R. Bruce Josten, an executive vice president at the U.S. Chamber of Commerce, said the group opposes that tactic because "it cuts off debate, and health care clearly becomes partisan."
White House Chief of Staff Rahm Emanuel authorized House leaders to move ahead with the strategy, which several Democratic sources have described as a "fallback" in case Congress does not reach a bipartisan compromise over the summer.
Helen Darling, president of the National Business Group on Health, said her members did not object to the strategy.
"What we want is for reform to happen this year," she said, referring to growing concern in the business community that soaring health costs are hurting U.S. global competitiveness.
Both the House and Senate also removed Obama's detailed proposal for a 10-year $634 billion health reserve fund from their budget plans. The president's proposal outlined a combination of tax increases and spending reductions that would have been set aside as a "down payment" for extending health insurance to millions of uninsured Americans.
In the blueprints, which are expected to be voted on next week, lawmakers removed the specifics and approved budget plans that simply acknowledge the desire to have a health reserve fund that would not increase the deficit.
Administration officials said that was all they needed to move ahead. Obama's specific ideas on remaking the health system "will come back into play" once Congress begins drafting legislation, said Peter Orszag, director of the Office of Budget and Management.
"I'm in business," Nancy-Ann DeParle, director of the White House Office of Health Reform, said in an interview.