Health care is being teed up for early action in this legislative year, with veterans of the 1994 Clinton health care reform effort taking steps to avoid the mistakes they believe killed their plan 15 years ago.
‘Act Fast and Get It Passed’
Several key supporters of the Clinton health care overhaul effort remain convinced their delay in getting legislation to Congress 16 years ago was what killed their plan. “Act fast and get it passed” is their new motto.
That may be more of a challenge than they think. People are policy, and the Senate is shaping up to be the power center for action. But there are a lot of competing agendas, egos, and priorities.
Despite suffering from a brain tumor, Sen. Ted Kennedy (D-MA) has returned to Washington, DC and is holding meetings with colleagues and staff as he takes a leading role in advancing his career-long agenda of enacting universal health coverage. I would not be surprised to see the Kennedy health reform bill get the prestigious designation of Senate Bill 1.
Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, released an 89-page overview of his health reform plan at the end of the 110th Congress, stating, “It is the duty of the next Congress to reform America’s health care system.”
Baucus’s plan has many features similar to the plan offered by President-elect Barack Obama, but Baucus takes government involvement even further: He would impose a federal mandate that everyone—not just children—have insurance, and he would allow people aged 55 to 64 to buy in to Medicare.
Features in the Baucus bill that are similar to the Obama campaign plan include mandating employers provide insurance or pay a new tax; expanding existing government health care programs; and creating a new national exchange for health insurance where insurers would be required to sell policies to all applicants and charge younger, healthier people higher premiums to reduce costs for older, sicker people.
It will be interesting to see how this goes over with Obama’s young supporters.
Competing Plans, Personalities
Others are also competing to have their plans heard and implemented.
Sens. Ron Wyden (D-OR) and Bob Bennett (R-UT) have been working for several years to build support for their bipartisan bill. And the leading Republican on the Finance Committee, Sen. Chuck Grassley (IA), has his own ideas, as does Sen. Mike Enzi (WY), the leading Republican on the Health, Education, Labor, and Pensions Committee, which Kennedy chairs.
It’s no wonder Obama selected former Senate leader Tom Daschle (D-SD) as his secretary of Health and Human Services. Daschle will need to use all of his leadership skills as referee.
There is additional drama on the House side, with Rep. Henry Waxman (D-CA) ousting longtime Energy and Commerce Committee Chairman John Dingell (D-MI). Also, Rep. Pete Stark (D-CA), the influential chairman of the House Ways and Means Health Subcommittee, will surely want to play a major role in shaping health reform legislation. These power dynamics will be interesting to watch.
Funding Problems Ahead
Then there is the issue of money. Incoming White House Chief of Staff and former Congressman Rahm Emanuel (D-IL) said during the administrative transition so-called universal coverage will be a high priority in the early days of the Obama administration.
It is difficult to see where the money is going to come from to pay for these massive reform agendas, which were developed before the meltdown of Wall Street, the $700 billion troubled asset relief package, and a projected $1 trillion federal budget deficit.
The Obama plan is estimated to cost an additional $100 billion to $160 billion in the first year alone, which doesn’t seem to fit with the president-elect’s emphasis in his campaign platform on fiscal responsibility. If the White House is going to extend Obama’s health care plan to mean universal coverage, the bill will be even more expensive.
Obama also will be facing the huge flood of red ink in Medicare, as the program is projected to start running out of money in 2017, about the time a prospective second Obama term would end.
It’s impossible to make predictions in the current topsy-turvy political and economic climate, but these political power contests, fiscal realities, and the urgency of other issues, including Detroit’s looming bankruptcy and an unstable geopolitical climate, make the dreams of sweeping government action on health care a major challenge.
SCHIP Could Lead Overhaul
Obama likely will use the pending expiration on March 31 of the State Children’s Health Insurance Program (which will be renamed) as a vehicle to expand health coverage to all children and possibly even enact his mandate for children’s coverage. That probably means funneling more money to the states through Medicaid, since they must pay part of the costs.
After SCHIP, Congress will turn toward additional major health care legislation.
It’s important to remember 82 percent of the American people are happy with their own health care, and only a tiny minority is willing to pay higher taxes to get universal coverage. The employer mandate is a new tax, and it is going to be especially difficult to impose during an economic crisis.
Grace-Marie Turner ([email protected]) is president of the Galen Institute.