Dean Rosen, director of health policy for U.S. Senate Majority Leader Bill Frist (R-TN), said in September the aftermath of Hurricane Katrina had “scrambled” the legislative agenda in Congress. “Catastrophes overtake the planned agenda all the time,” Rosen said, and therefore “we are less likely to see major legislative action on health care this year.”
In addition, Rosen said, the debate over confirmation of President George W. Bush’s appointment of John Roberts as chief justice of the U.S. Supreme Court had pushed aside other congressional tasks.
In his final month with Frist before leaving the senator’s staff to tackle health policy issues in the private sector, Rosen said deductibility of health insurance premiums is still a high priority for many members of Congress, and the only question is “whether we can make room for it in the budget.”
Health insurance is deductible for those who are officially self-employed and file taxes on a Schedule C and for those whose employers purchase health insurance for them. But everyone else must use after-tax dollars to purchase health insurance, including people who have jobs at companies that don’t offer health insurance or who can’t afford their share of the premiums, as well as people who don’t like the options offered by their employers and want to buy insurance on their own.
Bills Pass House, Stall in Senate
Rosen said there continues to be a great deal of interest in legislation freeing up Association Health Plans (AHPs) and in Rep. John Shadegg’s (R-AZ) legislation to allow purchasing of health insurance across state borders.
“But things move much more slowly in the Senate,” Rosen said, “and even though the House has passed these bills many times, they will need a lot more work on the details before the legislation would be acceptable in the Senate.” Shaddegg’s measure has passed the House 12 times, Rosen noted.
Rosen said some of the younger senators, especially those who have served in the House previously, are most likely to lead the charge for bolder legislative action, including the Shadegg bill. He mentioned specifically Republican Sens. Tom Coburn of Oklahoma, Jim DeMint of South Carolina, and David Vitter of Louisiana as the most likely advocates. He said Sens. Jim Talent of Missouri and Olympia Snowe of Maine are the most vocal advocates of AHPs.
The chairman of the Senate Health, Education, Labor, and Pensions Committee, Republican Sen. Michael Enzi of Wyoming, believes the burden of state health insurance mandates and the differences among states in these mandates harm U.S. competitiveness, Rosen reports. Enzi is working on legislation to streamline state insurance rules.
Other Issues Arising
On three other issues, Rosen said:
- Hurricane Katrina has shown many legislators the importance of electronic medical records, which can remain available in the event of a catastrophe. Rosen said the government’s job isn’t to buy the computers but to put the rules of the road in place, including standards of interoperability.
- It’s unclear whether Congress will be able to tackle the reductions in Medicaid spending that have been promised. The congressional reaction to Katrina has been simply to spend more in response to the immediate and intermediate aftermath. Rosen wondered how that will affect Medicaid cuts: Will the money go back out to victims, and will there be a call to expand Medicaid by making it easier to enroll? “Private-sector alternatives should be pointed out,” he recommended.
- The issue of penalties for overly aggressive pain management by physicians (which can result in death and thus be classified as illegal assisted suicide) remains primarily a legal issue, Rosen said, but Sen. Joe Lieberman (D-CT) is interested in the subject, and it could become a congressional issue. Lieberman is considering the issue closely.
Grace-Marie Turner ([email protected]) is president of the Galen Institute.