Centrists Back Health Care Reform

The tone on Capitol Hill during Tuesday’s debate was more civil, the partisan rhetoric less harsh than previous exchanges on the House floor. But there’s little doubt that the Republican-led House will vote later today to repeal President Obama’s signature health care reform law.

That largely symbolic vote – there’s almost no likelihood the Democratic Senate will follow, nor would the president sign the bill – signals the start of a two-year campaign by newly empowered Republicans in the House to undermine the new law. Proponents of “repeal and replace” will next turn to eliminating the most unpopular elements of the law—including the individual mandate – and to cutting off funding for implementation.

But the administration won a powerful set of centrist allies on Tuesday as it scrambled to set in motion reforms that it believes will be popular with the American people once its key provisions go into effect. The new law, signed by Obama last March,  is designed to provide about 32 million previously-uninsured Americans with coverage either through Medicaid or subsidized private insurance sold through state-based insurance exchanges. The total cost of the program of about $900 billion will be paid for by a combination of tax increases and slower growth in Medicare spending.  The law also places consumer-friendly restrictions on insurance carriers, funds Medicare pilot models in alternative care delivery, and creates a government-run long-term care insurance program.

Republicans contend that the law is overly intrusive and that it will drive up the deficit and destroy jobs.  But a bipartisan group of former senators and high-level health political operatives launched a new program to help states organize viable health insurance exchanges, the centerpieces of the effort to provide coverage for the uninsured and small businesses under the law..

While the state-based exchanges won’t begin operating until late 2014, efforts to get them up and running are already underway in many states, including several whose attorneys general have challenged the law in court. To help them iron out problems encountered along the way, the Bipartisan Policy Center recruited two former Senate majority leaders, Democrat Tom Daschle and Republican Bill Frist.

The center’s Health Project also corralled Sheila Burke, Republican Sen. Bob Dole’s former chief of staff, and Chris Jennings, who was former President Bill Clinton’s top health care aide, to help coordinate and staff the effort. The two have decades of experience on Capitol Hill, and are considered among the most knowledgeable health policy experts on either side of the aisle.

In announcing his support for the project, Frist, a physician, said efforts to repeal the law rather than fix its shortcomings were shortsighted. “It’s not the bill that I would have drafted, but it is the law of the land,” he said at a news conference. “It is the platform, the fundamental platform, upon which all future efforts to make this system better for that patient, for that family, for that community, will be based.”

Republicans may succeed in slowing down the process by going after funding for the Health and Human Services Department that is charged with implementing the law. But it won’t be stopped, Frist predicted. “The appropriations will be a vehicle by which the implementation is titrated,” he said. But there will be countervailing pressures from within the Republican Party. “When I talk to governors in the states, they want the grants to flow even quicker,” he said.

Daschle, for his part, signaled a new flexibility on the part of Democrats to allow greater experimentation in the states. Most of those states have Republican governors and legislatures following last November’s election. The administration has already granted a number of waivers to firms that provide insurance policies that don’t meet minimum coverage rules or have excessive administrative costs. The rules for the minimum benefit packages that will be sold on the exchanges are being written now. The administration’s regulations should “allow states significant breathing room and ample opportunity to adopt the health care reform law to their own needs,” Daschle said.

The recession-induced financial crisis faced by most states has dramatically altered the landscape on which reform will play out. Of the 32 million or so Americans slated to gain coverage under the new law by 2019, about half would find themselves in expanded Medicaid programs – a program that is going broke in most states.

Former Ohio Gov. Ted Strickland, who was recruited to the Health Project after losing his bid for re-election in November, predicted that hard-pressed states in the short-run will continue to make sharp cutbacks in Medicaid programs to help balance their budgets. In one of his last acts in office, he eliminated dental coverage for Medicaid recipients, even though medical research shows that the short-run savings from the cuts will wind up increasing long-term health care costs since untreated cavities often lead to serious infections, oral surgeries and systemic infections.

“What voters want from us now is to deliver pragmatic and practical solutions to the many financing and delivery system problems that we will face in implementing health care reform,” he said. But what voters want and what takes place on Capitol Hill can be two very different things. The weeklong rhetorical hiatus after the attempted assassination of Rep. Gabriel Giffords, D-Ariz., and the tragic killing of six bystanders in Tucson gave way Tuesday to the usual partisan hyperbole.

For instance, the administration began gearing up its own propaganda machine to counter Republican claims that health care reform is “job-killing,” the name given to the repeal resolution.  But rather than focus on whether the bill will dissuade small business from creating jobs–something that’s largely unknowable for legislation that is still more than three years away from implementation–the Democrats highlighted the benefits already enacted under the law.

HHS Secretary Kathleen Sebelius released a report that claimed “between 50 and 129 million non-elderly Americans have at least one pre-existing condition that would threaten their access to health care and health insurance without the protections of the Affordable Care Act.”

The larger number counts every American who takes a pill for hypertension or elevated cholesterol. While that is, by medical definitions, a pre-existing condition, it’s not very likely that many Americans have been denied insurance coverage because they take drugs to manage these warning signs of heart disease.

In fact, some insurance companies are starting to waive co-pays for such drugs. They believe that paying more now to foster better compliance with medication schedules will reduce the incidence of much more costly heart attacks and strokes down the road.

Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect and The Washington Post. His most recent book, “The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs ” (University of California Press, 2004) has won acclaim from critics for its treatment of the issues facing the health care system and the pharmaceutical industry in particular. You can read more pieces by Merrill at GoozNews, where this post first appeared.

11 replies »

  1. “People are out of work for a while much more frequently than in the past. Being able to purchase individual insurance fills a need i our present economy.”
    Then why does COBRA have a 2% enrollment rate? Isn’t 18 months enough time?
    Gary your hitler? Wasn’t it a democrat just this week that dragged out the hitler connection against conservatives? Wasn’t it liberals who always painted Bush as hitler? Not sure if you forgot our history but you sure forgot this week and the last 10 years.
    “Permitting only the wealthy a education”
    Our inner city public schools ran completly by liberals has already accomplished this.
    Women’s right? You mean like a women’s right to go to Gosnell and have him cut the heads off their breathing babies with scissors? Ya can’t take that away.
    College affordability? What cave are you living in, ever since the governemnt started “helping Make college affordable” the cost has skyrocketed, they have been as successsful at that as they have making hosuing affordable….well in that case they actually made hosuing real affordable by collapsing the market.
    “Just when shall Laws be settled by their Merit and not the business of deception and childish cruelty and manipulation.”
    Maybe when Democrats actually pass them the right way, allow other people input, and finish writing them before they are voted on and made law?
    Maybe then Gary instead of wasting time on a healthcare bill majority of America hates the Democrats should have been working on jobs? You want to blame someone else for your failures. If jobs where so important then why didn’t you idiots pass bills to create jobs instead of a bill that kills them?
    Republicans onstruct your stupid ideas because they are stupid ideas that never work. There is a reason cities ran by Democrats are bankrupt cese pools, someone of us prefer you don’t turn the entire country into Detroit.

  2. I don’t know what the answer is in dealing with Health Care Reform. However,it is wrong to attack all that is good for America and solely address domestic programs is wrong. In doing so,They dishonor what our ancestors had fought, bled and died to achieve. If a totalitiarn police state is all that they propose without common sense rules and regulations to protect the complete devastation of our natural resources. Then they would have won in the repeal of Humanity ,Conservation and protection of the environment,womens rights, college afforability,workers regulations and protections,Social Security Disability,SSI and Medicare that is the only High risk program available. National ID cards,military outpost in each town to quell rebellion,unregulated search and seizure,the removal of civil Liberities. So while Conservatives choose to over tax the middle class to support the luxuries of the wealthy.We should simply go along with the dismantling of Progressive America?
    Are we to experience a stone age mentality that cuts life expectency in half, that returns us to the 18th Century living environments.Permitting only the wealthy a education and children to work 16hrs in sweatshops for nichol”s a day. Of Course,People will be enraged by this reckless eltist view! What Next; Political Genicide of those who disagree with such radical views.
    Conservatives throw out remarks about Obama as being Hitler.However, you point a finger at a person and it comes back three times to you.Those doing the pointing are actually following the path of Hitler and promoting a overthrow of Government.
    Some of us have not forgotten our nations history to reject those lessons is to repeat those mistakes.

  3. If you believe that Congressman Cohen from Tennesses is the voice of the Democrat argument to stop this repeal from gaining traction, then what is your plan, jail all Republicans before they repeat the atrocities of Nazi Germany? That is where this debate has degraded to? And the Congresswoman from Texas who has declared this legislation is constitutional and will kill americans if the repeal occurs? What the hell is wrong with these alleged “fine Gentlemen and Ladies of Congress” who stoop to such outrageous rhetoric to manipulate and shock the public to just accept their appraisal is the only one to consider?
    Disgusting and pathetic are too nice of terms to apply here. I would like to speak as frankly and directly, but the blog authors would frown and delete the comment.
    You figure it out! And don’t think this is a Republican partisan comment. They were as outrageous and inappropriate when they demanded our acceptance of an unacceptable war in Iraq 8 years ago. Different party, same extreme agendas.
    Maybe, if they don’t destroy this country in the next 23 months, we can vote them all out and start over? Is that too difficult a concept? For 40% of you it is, 20% extreme liberals and 20% extreme conservatives.
    Maybe we could write a health care bill that excludes extremist citizens. That could save some money!!!

  4. When will the Republican Party stop being obstructionist in this Countries Future? Just when shall Laws be settled by their Merit and not the business of deception and childish cruelty and manipulation. Can any of the Republicans in Congress tell the real truth? Should all US Congress Members be considered Pathological Liars? How much credibility do they collectively have in the eyes of working Americans?
    We spent a entire Year fighting over this Affordability Care Act.Which included the Puppet Masters (insurance) seal of Approval to Key Members of Congress (the Puppets). The entirety of this act has barely taken Hold and again Republicans want to continue obstruct and lie about the entire bill.
    The Majority of these people have been betrayed by the Republican Party. Why,Would I say that you ask? Follow the money and their votes.Republicans are interested in their cash flow in which Big Business is their only sustainable funding.
    We have to many issues to deal with, without having governmental Malfeasance and partisanship affecting the efficient operation of Government. Get on with the peoples Business!!!!!!!

  5. “It also is annoying that supposed experts continue to mix the concepts of preexisting and medical underwriting. Again, the latter practice is typically not an issue in group coverage.”
    Let me commend to you Douthat and Salam’s book, Grand New Party. Lots of good stats in it. People change jobs much more frequently than in the past. People are out of work for a while much more frequently than in the past. Being able to purchase individual insurance fills a need i our present economy.

  6. The comments about the threat of pre-existing conditions practices, including those by Secretary Sebelius, continue to overlook the fact that the vast (90%) percentage of people with private health insurance have employer group coverage, which typically does not apply pre-existing exclusions.
    It also is annoying that supposed experts continue to mix the concepts of preexisting and medical underwriting. Again, the latter practice is typically not an issue in group coverage.
    Those points being made, whether it is the Affordable Care Act or something else, any reform needs to find ways for people to find coverage whose health condition would otherwise preclude them from doing so and for the poor/near poor to afford coverage. At least the Affordable Care Act made progress on those fronts.

  7. RINO’s and Democrats are now Centrists? GMAB. Bill Frist couldn’t get Tort Reform done while he had a majority in the Senate so why should I care how he feels? Puff Daschle? His conflicts of interest have conflicts. Affordable Care Act is pure Orwellian Newspeak.

  8. I am a centrist in philosophy and political mentality, and I do not support this legislation as is, nor am I thrilled to see it all repealed at the same time. Nonetheless, I have to wonder if this author of this commentary is just doing democrat damage control punditry. The status quo is not acceptable, and in the end, if it takes a misguided Republican faux repeal to get the facts all out in the open and expose the Democrat fraud that is in place, then let’s do it!!! For one, I think the public will not be amused or appeased to learn how it impacts on the very doctors that treat them and are most affected by disruptive legislation.
    In other words, the ivory tower docs, the AMA, docs who run boutique practices and not going to be affected by this legislation, and their agenda minded advocates in DC do not represent the masses, just themselves!
    Readers, talk to your PCP, and see what he/she thinks about this legislation. If they are happy, and you are happy, then who am I to tell you how to think and feel. Yet, that is exactly what the Democrats continue to this very day say to you, you should be happy, think and feel as they allegedly do. And mark my words, it will come out those behind this legislation will not participate in it should it come to fruition in 2014. What does THAT say if I am right!?

  9. Rerun.
    The fact is there is no money for more Medicaid and no money for subsidized care.
    Medicare must be cut.
    The states must take back their power from the frauds (er, feds).
    Time to get real again about life and death.
    This blog is still full of citizens who don’t get it.

  10. You wrote that “The larger number counts every American who takes a pill for hypertension or elevated cholesterol…it’s not very likely that many Americans have been denied insurance coverage because they take drugs to manage these warning signs of heart disease.”
    I have to disagree with you here. At Consumer Reports, where I cover health care, we have heard from many people who were rejected because they were on a statin or antihypertensive.

  11. I have recently (last week) been denied health insurance in California. Only vague reasons were stated but the only “blot” on my medical record is high cholesterol (and it’s not even that high).
    Insurance companies only want to insure healthy people and the health care bill would fix that problem. The Republican demagogues are out to destroy health care in America.