Wednesday, May 20, 2009

Have you reviewed the Senate Finance Committee’s policy options for expanding health coverage to all Americans?

Pointing out that the U.S. is the only developed nation that does not guarantee health coverage for all its citizens, the Senate Finance Committee is exploring whether to impose a mandate that would require individual Americans to purchase health insurance, which has proven controversial in states where it has been attempted (Massachusetts, California, etc.). The committee explored the idea in depth in a special policy options paper released recently in advance of a planned private negotiating session last week, where committee members debated options to expand health coverage in the United States.

The committee has since released an additional policy paper on financing health care reform as well. However, I think it is important today to first address the committee’s proposals for expanding health care to all Americans.

The paper refers to the requirement to buy insurance not as a mandate but as “a personal responsibility” to own health coverage. In addition, the committee will weigh three options for a public health insurance plan that would allow all Americans to buy coverage through the government for the first time. However, the committee might also reject the public plan all together, and rely instead on a “reformed and well regulated private market” to expand access to health insurance — a move that could help a sweeping health overhaul draw some Republican support.

Thursday’s session — the second of three — includes some of the most hotly debated aspects of health care reform. Those include questions over whether to create a public plan option to compete with private insurers, and whether to allow Americans between ages 55 and 64 to temporarily purchase Medicare coverage while a reform bill is implemented — an idea likely to draw opposition by private insurers because it cuts into their market. Now, two Senate committees will work over the next four weeks to move bills to the floor. The Senate Health, Education, Labor and Pensions Committee is expected to release bill language before the Memorial Day recess, and the Finance Committee will follow in the first week of June, according to people familiar with the timeline.

The committee proposed three options for the public plan. One would resemble Medicare, an option favored by liberal lawmakers. The second option calls for third-party administrators to oversee the public plan, a middle-road option that resembles a plan proposed last week by Sen. Chuck Schumer (D-N.Y.).

The third option would allow states to decide whether to create public insurance plans. Under the idea of an insurance mandate, those who do not obtain insurance by a set date would pay an
excise tax, although individuals could seek exemptions. Insurers have pushed vigorously for an individual mandate, arguing that it cannot guarantee coverage for Americans with pre-existing conditions unless the risk is spread around by requiring the young and the old to buy insurance. Tax credits would be available to low-income taxpayers and small businesses to offset the cost of buying insurance, the paper states. In addition, the paper seeks to explore several options for mandating employers to provide health insurance coverage for workers or to pay some form of assessment.

Meanwhile, an alliance is taking shape involving key stakeholders in the health care industry, including such principals as the American Hospital Association, the American Medical Association, America’s Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, Advanced Medical Technology Association and the Service Employees International Union. In a joint letter this week addressed to the Obama administration, the various groups state a determination to work together to achieve affordable, high-quality and accessible health care for all Americans.

The groups point out that in order to achieve that goal, their unprecedented unified efforts will be directed at offering concrete initiatives to transform the health care delivery system. Primarily, the alliance will be developing consensus proposals to reduce the rate of increase in future health and insurance costs through changes made across the health care sector. Specifically, the letter outlines:
• Implementing proposals that focus on administrative simplification such as standardization and
transparency efforts;
• Reducing over-use and under-use of health care by aligning quality and efficiency incentive among providers across the continuum of care;
• Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices that reduce hospitalization and manage chronic illnesses more
• Reducing the cost of doing business by addressing specific cost drivers in each sector through simplified common-sense improvements in delivery models, technology, workforce development and regulatory reform.

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