Healthcare Reform

Senate

The illness and death of longtime healthcare reform advocate Sen. Edward Kennedy (D-Mass.) shifted the Congressional spotlight to Sen. Max Baucus (D-Mont.), right, chairman of the Senate Finance Committee and leader of the committee’s “Gang of Six” negotiators—three Democrats and three Republicans. In mid-September, Baucus unveiled his preliminary “mark” of the America’s Healthy Future Act. He did so without any Republican endorsement.

The overhaul is less expensive and more moderate than the America’s Affordable Health Choices Act, introduced in the House of Representatives, and a partial bill passed earlier by Sen. Kennedy’s Health, Education, Labor and Pensions (HELP) Committee. Nevertheless, progressives and conservatives criticized the Baucus plan. Even so, Sen. Olympia Snowe (R-Maine) has become a major focus of Democrats’ efforts to find 60 votes and avoid a Republican filibuster, though the seating of a replacement for Sen. Kennedy would help Democrats regain a filibuster-proof majority. One key point: Analysts say bringing Sen. Snowe on board might not win other Republican votes, but she might offer cover for such conservative Democratic senators as Mary Landrieu (D-La.) and Ben Nelson (D-Neb.).

As a last resort, Democrats have raised the possibility of using reconciliation, an arcane process originally intended for budgetary items. Reconciliation requires only a 51-vote majority, but complicated rules and a promised Republican challenge could lead to chaos.

House

Speaker Nancy Pelosi (D-Calif.), left, and Rep. Henry Waxman (D-Calif.) have dominated the stage, but they have had to balance the priorities of the chamber’s progressive wing with the concerns of the “Blue Dog” contingent of conservative Democrats.

Paying For It All

Meaningful reform without breaking the bank is a common refrain in healthcare discussions. Despite heated disputes over taxes, fees, fines, and service cuts to help defray costs, two main mechanisms for savings have emerged, according to the Center for Health Policy Research’s Ku:

1. Curbing Medicare Advantage

With the creation of Medicare drug benefits in 2003, Medicare’s managed-care plans run by private companies were revamped and renamed Medicare Advantage Plans. In return for extra benefits or lower co-payments, the 22% of Medicare beneficiaries enrolled in these plans are generally limited to in-network doctors or hospitals. Based on Medicare Payment Advisory Commission estimates, Medicare reimburses the private plans, on average, 14% more than standard Medicare fee-for-service plans—or an additional $12 billion in 2009.

One cost-cutting idea would be to restore a level playing field, Ku says, and pay managed care on par with Medicare and Medicaid. “This is one of the largest components of savings that people are anticipating,” he adds. A backlash by seniors, however, has led to a “grandfathering” clause that would protect the extra benefits in certain parts of the country, potentially reducing the overall savings.

2. Disproportionate Share Hospital (DSH) Cuts

Both Medicare and Medicaid pay extra to hospitals that serve a high proportion of needy patients. The savings mechanism here is less clear, but the expectation is that because the number of uninsured patients will drop dramatically with legislation, the DSH payments could be scaled back as well. The cuts, phased in over a decade, could amount to tens of billions of dollars in overall savings, though the House and Senate Finance bills differ in how deep the trims should be.

For More Information

• Kaiser Family Foundation
  

  https://healthreform.kff.org

  
  

  The foundation’s comprehensive “Health Reform” page offers a side-by-side comparison of 12 healthcare proposals, including both Democratic and Republican bills.

• Congressional Budget Office
  

  www.cbo.gov
  

  The nonpartisan office has already weighed in on the economic effects of preliminary versions of the competing healthcare reform bills, and will likely do so again.

• FactCheck.org
  

  A project of The University of Pennsylvania’s Annenberg Public Policy Center, the site has debunked dozens of healthcare reform myths.

• PolitiFact.com
  

  The Truth-O-Meter, a project of the St. Petersburg Times, has put recent healthcare assertions into categories ranging from “True” (substantiated assertions) to “Pants on Fire” (for absurd untruths).

• HospitalMedicine.org/advocacy
  

  SHM updates health reform progress and offers a monthly “Washington Update” outlining the society’s policy positions and activities.