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.
Noting that firms have a "fiduciary responsibility" to shareholders, he said: "Why limit their profits and not the profits of the defense industry?"
At the same time, insurers would acquire millions of new clients, Mendelson said, pointing to the proposed expansion of the Medicaid program to 150 percent of the poverty level of $16,000 for an individual. That provision would create 20 million more insurance customers, according to Mendelson's modeling. The chief spokeswoman for the insurance industry declined to comment yesterday.
Kennedy spokesman Anthony Coley said aides would not discuss details while Democrats are "still actively engaged with Republicans in trying to find common ground."
As expected, the draft includes creation of a new government-sponsored insurance program that would pay doctors and hospitals Medicare rates, plus 10 percent. That could be good news for physicians, said Mendelson, since most reform plans aim to tighten doctor payments.
But Kahn said it might be problematic for hospitals, which are less likely to benefit as greatly from millions of newly insured who are younger and healthier.
Modeled after a Massachusetts reform implemented three years ago, the Kennedy approach would insist that everyone buy insurance, though subsidies would be given to people who could not afford it. The draft document suggests offering premium aid to people earning as much as 500 percent of the poverty level, or $110,000 for a family of four. That idea has Republicans outraged and fellow Democrats nervous about the cost.
Rep. Jim Cooper (D-Tenn.) said the draft by Kennedy aides and other ideas circulating among party leaders are unrealistically generous, while an employer mandate hurts workers and consumers.
"Congress just doesn't get it," he said.