Consensus For Universal Health Care Coverage Emerging

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A "consensus appears to be emerging in Washington about how to achieve the elusive goal of providing medical insurance to all Americans," the Los Angeles Times reports. The "answer, say leading groups of businesses, hospitals, doctors, labor unions and insurance companies -- as well as senior lawmakers on Capitol Hill and members of President-elect Barack Obama's administration -- is unprecedented government intervention to create a system of universal protection." Meanwhile, the groups "largely have agreed" to maintain the current employer-based coverage system, through which most U.S. residents have insurance, the Times reports.

According to the Times, there is a "widespread understanding that any expansion of coverage must be accompanied by aggressive efforts to bring down costs and reward quality care." In addition, "key players in the health care debate increasingly back a massive investment of taxpayer money for health care reform despite the burgeoning budget deficits," the Times reports. The prospect of a "federal, single-payer system," as well as the "traditionally conservative concept" of providing incentives for people to buy insurance directly proposed by former Republican presidential nominee Sen. John McCain (Ariz.), are "now virtually off the table," according to the Times.

Details 'Vague'

Beyond these "areas of basic agreement," the details of an overhaul plan "remain vague," according to the Times. While campaigning, Obama endorsed expanding insurance coverage while preserving the job-based insurance system. However, since winning the election, Obama "has provided few specifics" regarding his plans once he takes office, the Times reports. According to the Times, a lack of agreement "over specifics could again lead to a stalemate," as even "the most sanguine advocates of sweeping reform concede that difficult negotiations lie ahead."

Issues include whether the approximately 46 million uninsured U.S. residents would be urged to purchase insurance provided by the government or by private insurers. Consumer advocates favor public options but providers are concerned that a public program could lead to reductions in reimbursement. The issue of how to enforce proposals that would require employers to provide coverage for all workers or that would require all U.S. residents to obtain insurance also remain, according to the Times.

In addition, "few have tackled how the government will control costs and set standards of care, proposals that raise the unpopular prospect of federal regulators dictating which doctors Americans can see and what drugs they can take," the Times reports.


Stuart Butler, vice president for domestic policy at the Heritage Foundation, said, "There are some very big questions and some very big stumbling blocks," adding, "Once you get into the details, the consensus is going to vanish pretty quickly, I suspect." Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said, "Increasing access for the uninsured is not going to come cheap," and "it's clear to me that our economy cannot stand much further deficit spending."


However, Families USA Executive Director Ron Pollack said that progress has been made since previous attempts to overhaul the health coverage system. He said, "There is a growing understanding that you have to give people choice and you can't take away what they have," adding, "One of the big no-nos is that you must not ever threaten the coverage that people have" (Levey, Los Angeles Times, 12/1).

Changes to the Tax Treatment of Health Insurance

Some Democrats are discussing the possibility of taxing employer-provided health benefits, which have long held tax-exempt status, in order to help pay for legislation that would expand health insurance to more U.S. residents, the Boston Globe reports. According to the Globe, the tax benefit is "one of the few large pools of cash available to help fund" a major health care overhaul. In a white paper detailing his overhaul proposal last month, Senate Finance Committee Chair Max Baucus (D-Mont.) suggested that tax subsidies for health insurance could be capped based on income or the generosity of benefits.

"Democrats could face serious political challenges if they try to scale back the benefit," according to the Globe. Labor unions and business groups both would contest such a proposal and Obama and Vice President-elect Joe Biden "could leave themselves vulnerable to accusations of hypocrisy" after campaigning against "'taxing health care,'" the Globe reports. Jonathan Oberlander, a professor of political science and health policy at the University of North Carolina, said, "The problem is a political one," adding, "What middle-class Americans think about when they think about health reform is not a proposal to tax their health insurance. It's just a difficult sell."

However, such a proposal is "difficult to dismiss" because of "competing political pressures," according to the Globe. The Globe reports that there is "unprecedented demand" for health care overhaul and Obama "has promised to deliver one." In addition, an increasing number of moderate congressional Democrats -- "whose support will be needed to pass" an overhaul plan -- would be hesitant to support an overhaul plan without a funding source (Wangsness, Boston Globe, 12/1).

San Francisco Chronicle Examines Prospects for Health Overhaul

Although Obama has pledged to pass a health care overhaul bill by the end of his first term, "[s]ome Democrats suggest that only incremental reforms are likely next year," the San Francisco Chronicle reports. Obama's plan "is not cheap -- it's estimated to cost $50 billion to $65 billion" annually, and in "an era of rising deficits, it may be difficult to persuade Congress and the American people to shell out that type of money," according to the Chronicle.

An expansion of SCHIP, which Congress "could easily pass," is more likely. In addition, a new economic stimulus package could include additional funding for state Medicaid programs and "a massive new investment in health information technology," the Chronicle reports. Robert Laszewski, president of Health Policy and Strategy Associates, said, "Obama could get a down payment on health care" next year even if he is unable to pass comprehensive legislation" (Coile, San Francisco Chronicle, 11/30).

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