With the release by the Ways and Means Committee of the first House health reform bill , the debate is about to get much louder and more strident. The ‘bill’ is more of an outline than anything else, although it’s a pretty detailed outline.
It is also very much a ‘moderate’ plan, one that has the fingerprints of the House Blue Dog Democrats all over it.
Notable by their absence from the bill is any mention of a Medicare-based public plan option or employer mandate. This doesn’t mean the Democrats are abandoning either option; rather it indicates a willingness on the part of Baucus, Waxman, Kennedy et al to work with Senate Republicans on compromise language in an effort to gain some GOP support.
Key components of the bills now up for debate include:
– maintains current employment-based insurance structure; employers can keep their plans
– calls for a “public health insurance option [that is] self-sustaining and competes on a “level field” with private insurers”
– an insurance exchange enabling insurers and small businesses to evaluate and select from a list of private insurance options
– prohibits medical underwriting, exclusion of coverage for pre-existing conditions, and rating based on gender, health status, or occupation with some allowances for age rating
– subsidizes coverage on a sliding scale for individuals and families with income up to 400% of the Federal poverty level (family coverage today would amount to 14% of income at that level).
– exempts small, low-wage firms and provides a small business tax credit for those providing health coverage.
-eliminates the Medicare Sustainable Growth Rate formula (used to determine physician compensation) and increases reimbursement for primary care providers
What’s not there is more telling than what is.
There’s precious little discussion of how to pay for this, and specifically whether employer premiums will be taxable and if so to what extent.
As I’ve been saying for months, it’s about the money. Expanding coverage without tough cost controls (note – NOT price controls – that’s very different) is a road to financial ruin. With their recent focus on the cost of the Recovery Bill and apparent strategy to take on the Democrats and the President on the issue of government debt and spending, the GOP has served notice that they will miss no chance to accuse the Dems of profligate spending.
Good for them; the ‘oversight’ is certainly appropriate and necessary, as the most important part of health reform is cost containment.
Jun
10
Joe–
I agree. This is really all about the money. Policy mavens will worry about every procedural jot and tittle, but this works or becomes a spectacular slow motion train wreck based on (a) how it is paid for and (b) how costs are controlled or not controlled. No political/regulatory mechanism, however clever, can sustain a straight line projection of current cost trends. There are a number of scary parallels between the medical cost “bubble” and the housing bubble that burst two years ago with such colorful results from sea to shining sea. In my part of the country, hospitals, group practices and specialty clinics are all folding up, while per procedure costs continue to rise. Market mechanisms have been utterly unequal to the challenge of controlling medical costs. Now Congress, the circus that writes our laws, has to get it right before the whole things blows. Can this be done and done right by August? Do cows write haiku? Should be interesting.