What would improve the House health-care bill

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Saturday, November 7, 2009

MUCH OF the criticism of the health-care measure before the House of Representatives is overwrought. Another part is simply wrong. Unfortunately, that does not mean that this is a good bill. As we have said, it does not do enough to control costs, and it is not funded in a sustainable way. Expanding coverage for the uninsured is imperative, but so, too, is getting the country on a credible fiscal path.

As an example of the hyperbole, take the ludicrous assertion by Minority Leader John A. Boehner (R-Ohio) that the Democratic measure "is the greatest threat to freedom that I've seen in the 19 years I've been in Washington." Come on. The proposal has been endorsed by the American Medical Association and the AARP, hardly wild-eyed radicals.

As an example of the simply wrong, take the assertions that the measure would result in insurance subsidies for illegal immigrants and federal financing of abortions. The House bill explicitly states that illegal immigrants are not eligible for federal insurance subsidies or to enroll in the public option. Although the language is being negotiated, the bill would, unlike the Senate Finance Committee version, permit illegal immigrants to purchase insurance on their own through the newly created exchanges. This should be welcomed, not discouraged. Fewer uninsured people means less uncompensated care costs dumped on hospitals, and it would bring younger, healthier people into the exchanges. In other words, the illegal immigrants would be helping the federal treasury, not draining it.

The controversy over abortion funding is similarly phony. Federal law prohibits the use of federal money for abortions except in cases of rape, incest or where the life of the mother is endangered. The House bill would leave that restriction in place. It would exclude abortion from the list of benefits that plans participating in the insurance exchange would be required to offer. Instead, the exchanges would have to include one plan that covers abortion, along with one that doesn't. Even so, the plans that cover abortion would have to take steps to make sure that federal funds are segregated from those used to pay for abortions.

Now to our concerns. The measure would cover 36 million more Americans, according to the Congressional Budget Office. That would be a major achievement. And yet: At what cost? The CBO says that the measure would be fully paid for -- in fact, it would bring in money -- both during the first 10 years and in the following decade. But will the planned cuts to Medicare spending be implemented -- or will they be abandoned once they start to pinch? That is a risk, and the measure does not include enough other ways to get health-care costs under control. The bill would help spur needed changes in Medicare reimbursements to reward quality rather than quantity of care. But it is missing two important elements that the Senate Finance Committee bill begins to address: a commission to remove at least some of the politics from the business of determining Medicare payment policies and a tax on high-cost insurance plans. The House bill instead taxes the rich, tapping revenue that will be needed to narrow the overall federal deficit.

The House will probably pass the bill. But there's a lot of work to be done before its final enactment will be possible -- or desirable.


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