Consumer Directed Healthcare

Legislation Clears First Hurdle; Debate Is Far From Over
ABC News Medical Unit
Dec. 25, 2009-

Now that the Senate’s $871 billion health care overhaul bill has passed, many may still have questions about the exact nature of the bill — and how it may affect their health choices in the decade to come.

To learn more, the ABC News Medical Unit reached out to some of the nation’s top experts in health care policy. More than a dozen replied. Below are some of their comments on the Senate bill, its potential impact and how it differs from the House bill.

What Will It Mean?
Health reform proponents overwhelmingly spoke out in favor of the bill though some noted that more remains to be done.

“It’s a start,” said Donald Kemper, chairman and CEO of Healthwise Incorporated. “It focuses on reducing the inequities, and that’s not a bad place to start.”

Karen Davis, president of the health care reform group the Commonwealth Fund, called the bill “another milestone on the way to historic and significant changes to the U.S. health care system.”

The Senate’s passage of the bill had its share of industry support as well.

“We applaud the Senate for taking an important and historic step toward expanding high-quality, affordable health care coverage and services to tens of millions of Americans, many of whom are struggling today financially,” said the Pharmaceutical Research and Manufacturers of America in a statement.

But not all were in favor of the bill.

“For the first time in our history, the federal government will tell you what type of insurance you have to have and effectively — where you will get it and even what price you have to pay,” said John Goodman of the conservative think tank National Center for Policy Analysis.

How Is It Different From the House Bill?
Of course, the Senate version of the health care reform bill is only one side of the story. Lawmakers will now begin the task of reconciling the Senate legislation with the House bill, which passed in November.

“The major unresolved issues that the conference committee will have to resolve are one, the sources of financing for the program, and two, the fate of the public option,” said Daniel Blumenthal, chair of the department of community health and preventive medicine at the Morehouse School of Medicine in Atlanta, Ga.

“[The House bill] has better premium and cost-sharing assistance for low-income families,” Davis said, adding that the House and Senate bills have different provisions on abortion coverage, which could also be a major point of contention.
Cost and Coverage
In its current form, the Senate bill asks for $871 billion over the next 10 years. What would Americans get for this sum? Uwe Reinhardt, professor of economics and public affairs at Princeton University in Princeton, N.J., said poorer families would be one group that would come out on the winning end.

“Starting somewhere between 2013-14, but no later than 2014, the bill will channel about $870 billion divided by roughly 6 years … $145 billion a year toward lower-income American families that would otherwise find themselves priced out of health insurance by the ever rising cost of coverage.”

In total, 31 million more Americans would ostensibly receive health coverage with the passage of the bill. But Republicans argue that the Senate health care bill would add an extra $1 trillion to the budget deficit a figure that differs from the nonpartisan Congressional Budget Office’s estimate that it would reduce the deficit by $132 billion over 10 years.

“Politics has caused compromises that may make the ‘victory’ hollow in that $1 trillion will not buy adequate truly affordable health care for a large segment of the population,” said Arthur Garson, dean of the school of medicine at the University of Virginia in Charlottesville.

What It Might Mean for Americans
Health care reform proponents lauded the fact that the bill would provide the same coverage to people regardless of pre-existing conditions.

“The industry will no longer be able to base the individual’s premiums on the individual’s health status,” Reinhardt said.

David Orentlichter, co-director of the Center for Law and Health, Indiana University, concurred. “Insurers will have to charge the same rates to all persons — with some freedom to charge higher rates based on age.”

Others noted that the legislation, if ultimately passed, will have other beneficial effects as well.

“New Medicare payment and quality reporting strategies will improve patient safety, cut medical errors, and increase the quality of care,” said Washington and Lee University law professor and health care expert Tim Jost.

But some expressed concern that the effort could have unintended consequences.

“Every one of these new regulations … will necessarily increase costs of insurance and raised premium costs — exactly what the Democratic leadership claims won’t happen,” said Richard Saltman, an international health expert at Emory University in Atlanta.

“Doctors will be forced to change how they make their medical decisions,” said Scott Gottlieb of the conservative think tank American Enterprise Institute. “The Centers for Medicare and Medicaid Services will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced.”

Going Forward: What It Means for Politics
If there is one matter upon which those from both sides agree, it is that the fierce fight over the direction of health care in the next decade will lead to lasting rifts between those in favor of the bill and those who are opposed to it.

“The nearly complete detachment of one of our main political parties from addressing the challenges of either coverage or cost control is also found nowhere else in the world,” noted Alan Sager, director of the Health Reform Program at the Boston University School of Public Health. And Saltman said the battle is “only the first chapter in a new phase of what will become an increasingly acrimonious and politically volatile period in our health system — one that many politicians on both sides of the political divide may soon wish had never begun.”
Copyright © 2009 ABC News Internet Ventures

Popularity: 1% [?]

ABC News’ Jonathan Karl reports:

Democrats are in an all-out push to pass health care reform that will likely keep the Senate in session non-stop — 24-hours-a-day — between now and Christmas eve.

They are doing this because they think they can pass the bill now and don’t want to risk losing momentum when Congress goes on recess.   The only remaining hold-out is Ben Nelson, however, and if he does not come on board, not even Senate all-nighters can get it done.

To pass the bill, it will take a total of four separate votes, each requiring 30 hours of debate.  And first the Senate must pass the Defense appropriations bill (which requires two votes).

Here’s the current plan:

-    Votes on Defense appropriations at 1am tonight and 7am Saturday. 

-    Saturday morning, Reid introduces his compromise deal – aka “manager’s amendment” – and moves to cut off debate.

-    Republicans likely force a reading of the Reid amendment.  I’m told it’s 500 pages. 

-     The first health care vote – to cut-off debate on Reid’s amendment  – happens as early as  Sunday night after 1am.

-     The 2nd health care vote would come 30 hours later or sometime after 7am Tuesday.

-    30 hours after that, the 3rd vote, possibly by Wednesday afternoon, December 23.

-    Republicans could insist on another 30 hours of debate, which would lead to final vote Christmas eve.

Despite this mad dash to pass a bill by Christmas, Harry Reid still hasn’t released his compromise bill or an estimate of how much it will cost.  I am told we are likely not to see either until tomorrow.

And remember … this bill still needs to be reconciled with the one passed in the House … and that reconciled bill then needs to be passed again in both chambers.   A final bill by the New Year?  Don’t hold your breath.

Popularity: 1% [?]

Washington (CNN) — The health care bill being negotiated in the Senate would allow caps on annual insurance benefits, reversing a previous version of the plan that would have prevented insurance companies from establishing such limits, according to three Democratic aides.

“We were trying to minimize premium impacts,” said Jim Manley, a spokesman for Senate Majority Leader Harry Reid, acknowledging the change.

The trade-off has drawn criticism from the American Cancer Society’s Cancer Action Network, a patient advocacy group.

“We were very surprised by this,” said Stephen Finan, the group’s senior policy director. Finan worries that cancer patients, who often require expensive procedures, could still face major financial losses if annual coverage benefits are capped too low.

Policymakers on Capitol Hill are defending the legislation.

“The provisions in the bill are a big improvement over the current system in which cancer patients have to fight for coverage and often don’t get the preventative services that catch cancers at an early stage. We hope to make the provisions even stronger in the bill Congress sends to the president,” a Democratic Senate aide, who declined to be identified, said about the change.

Aides say senators will continue to review the policy closely as the process moves forward.

“Ensuring affordable health care costs requires a balance between too much insurance market regulation and not enough,” said Erin Shields, an aide to Senate Finance Chairman Max Baucus, D-Montana. “That balance is what this bill aims to achieve, especially with regard to annual limits. Senators want to ensure this provision provides as much consumer protection as possible while keeping premiums affordable.”

CNN’s Ted Barrett, Ed Hornick, John Bonifield and Elizabeth Cohen contributed to this report.

Popularity: 1% [?]

From CNN Associate Producer Martina Stewart

Washington (CNN) – The Ranking Republican on the Senate Foreign Relations Committee said Sunday that the Senate should set aside the impending debate on the health care reform bill and, instead, use the remainder of the year to focus on the appropriate strategy for the Afghanistan war, funding the war, and passing the appropriations bill necessary to keep the federal government running.

“I would just make this suggestion,” Republican Sen. Richard Lugar said Sunday on CNN’s State of the Union, “that in the three weeks of debate we still have ahead of us, we really ought to concentrate in the Congress on the war, on the overall strategy of our country and the cost of it. And we ought to be on the budget – passing appropriations bills in a proper way. . . . We may wish to discuss higher taxes to pay for [the war]. But we’re not going to do that debating health care in the Senate for three weeks through all sorts of strategies and so forth.”

“The war is terribly important,” Lugar continued, “Jobs and our economy are terribly important. So this may be an audacious suggestion, but I would suggest we put aside the health care debate until next year, the same way we put cap and trade and climate change [aside] and talk now about the essentials: the war and money.”

Democratic Sen. Jack Reed, who sits on the Senate Armed Services Committee, disagreed with Lugar.

“Absolutely not,” Reed replied when asked by CNN Chief National Correspondent John King whether the Senate put off debate on the health care reform bill until 2010.

“I think we’re in the midst of probably the most significant debate and conclusion with legislation that we’ve ever had,” Reed told King, “And the health care debate is essential to our economic future. There are – Businesses and individuals each year pay more and more for health care. It has become unaffordable. We have to go ahead and conclude this debate.

“To stop now would be stopping on the edge of, I think, significant reform, which is so important for the country. And frankly, it’s ironic, there’s – under the Bush administration, there was no serious debate about Afghanistan. That was relegated to the sidelines. There was no attempt to pay for it. And suddenly, now, that becomes a critical need that we put aside health care. I don’t think so.

I think we have to push forward. I think the president’s speech [Tuesday about Afghanistan] will be appropriate. I think the strategy we’ll analyze in the committees and I think we can go forward on both fronts and we have to.”

After months of deliberation, Obama is set to give a speech Tuesday evening that outlines his plans for the war in Afghanistan. Also this week, the full Senate is set to begin debate on a health care reform bill crafted by Senate Majority Leader Harry Reid, who managed to garner just enough votes to get the bill to the floor.

Popularity: 1% [?]