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Health-Care Overhaul 2010

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Sen. Edward M. Kennedy Details Vision for Health-Care Reform

Sen. Edward M. Kennedy (D-Mass.) listens during a White House forum on health-care reform in March. Kennedy has just produced a draft reform bill.
Sen. Edward M. Kennedy (D-Mass.) listens during a White House forum on health-care reform in March. Kennedy has just produced a draft reform bill. (By Chip Somodevilla -- Getty Images)
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By Ceci Connolly
Washington Post Staff Writer
Sunday, June 7, 2009

Three months after he was diagnosed with incurable brain cancer, Sen. Edward M. Kennedy (D-Mass.) vowed in an emotional Democratic National Convention address last summer that health reform would be "the cause of my life."

Nearly a year later, Kennedy, rarely seen in public, has put that vision to paper in legislation that would provide generous government subsidies to families buying coverage, place significant responsibilities on employers, create a new long-term-care program for millions of people with disabilities, and perhaps reach into the profits of insurance companies.

The 170-page bill, still labeled a draft, is by far the most liberal approach to health-care reform being discussed in Washington and potentially is quite expensive. It does not identify how the expansion of health coverage would be paid for, except to require businesses to provide insurance for workers or pay penalties.

After spending "scores of hours in the Kennedy workhorse meetings" that assembled a diverse range of stakeholders, Neil Trautwein, a vice president of the National Retail Federation, said he was surprised and disappointed that the team had resorted to a "lot of the same old tired ideas we have fought against for many years."

Much of the business community will "do everything we can to block" the proposed employer mandates, he said.

A source who has met often with Kennedy aides said they have estimated that the "employer mandate" could raise $300 billion over a 10-year period, which would suggest either high levies, a program that targets even the smallest businesses or a combination of the two.

On the House side, by comparison, Democratic leaders have examined an employer requirement that would raise $50 billion to $200 billion over a decade. In other respects, however, House Democrats are following the Kennedy outlines but at perhaps smaller levels.

"Senator Kennedy is on the cusp of achieving his dream, a fight he has led for four decades," said Sen. Ron Wyden (D-Ore.), who has his own bipartisan health bill. "What's needed now is a lot of heavy lifting to make sure the legislation creates a path to affordable coverage."

The bill "reflects a revamping of the whole insurance system," said Charles N. Kahn III, president of the Federation of American Hospitals.

It would prohibit the denial of coverage based on preexisting conditions and would insist that any insurance policy that includes children must provide that coverage through age 26.

Most striking, the legislation would require that insurers report to the federal government how premiums are being spent -- clinical services, claims processing, etc. -- and give a rebate to beneficiaries if a percentage of the premium does not go to patient benefits. Insurers would be forced to clamp down on administrative costs or profits.

Over the long run, the industry would probably adapt to the new standards, but in the short term it "takes a harsher edge with insurers," said Dan Mendelson, president of Avalere Health, a research and consulting firm.


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