Even if health bill passes soon, wait for reforms could be long

By David S. Hilzenrath
Washington Post Staff Writer
Monday, November 30, 2009

The White House has a message for Americans suffering under today's health insurance system: "Help is on the way."

But not as fast as you might think.

Measured against the promises President Obama and congressional Democrats have made about health-care reform, the bill the Senate begins debating this week could be setting Americans up for disappointment: Some of the main reforms would not take place for several years, and even when they do, some observers say, the bill does too little to make sure they would be enforced.

Until 2014, insurance companies could continue to deny coverage or charge higher premiums based on people's medical history. Another highly touted reform -- banning annual and lifetime limits on coverage -- would take effect in 2010, but it would permit significant exceptions.

Even with those rules in place, "there's no power to really hold the insurance companies accountable," said consumer advocate Betty Ahrens, executive director of the Iowa Citizen Action Network. "It's toothless."

Jim Manley, a spokesman for Senate Majority Leader Harry M. Reid (D-Nev.), said the bill was a compromise. "This is not the legislation we would have written in a perfect world, but Senator Reid believes that this bill has the best chance possible to get the 60 votes necessary to overcome a Republican filibuster," Manley said.

The delay in implementing some key reforms contrasts with the urgency of Obama's call for action.

Although some changes might take years to implement, Obama said in July, "We shouldn't have to wait a long time to make sure that people don't lose their insurance because of a preexisting condition."

Delaying relief until 2014 means that Obama could face reelection -- and Congress be transformed by two elections -- before voters begin feeling the legislation's full effect.

It would also reduce the cost of the bill during the 10-year budget window measured by the Congressional Budget Office.

Deferred until 2014 would be a federal mandate that everyone buy insurance, subsidies to help people with lower incomes pay for it, and the creation of marketplaces called exchanges, in which individuals and small businesses could comparison-shop for health plans.

The bill would offer interim relief for some people with preexisting conditions by creating a temporary insurance plan just for them, but only people who have been uninsured for six months could join.

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