Health care reform on fast track; Senate finance chief, employer groups begin push for action

Despite the nation's deepening economic crisis, the pressure is on to put health care reform on a fast track in Congress.

Senate Finance Committee Chairman Max Baucus, D-Mont., last week launched the opening salvo, unveiling a white paper, ``A Call to Action, Health Reform 2009,'' that outlines a proposal much like that put forth by President-elect Barack Obama on the campaign trail.

``The link between health care costs and the economy is undeniable. Reforming the health care system is essential to restoring America's overall economy and the financial security of our working families,'' Sen. Baucus asserted in a Nov. 12 statement announcing the white paper.

But even before the introduction of Sen. Baucus' proposal, employer groups, labor organizations and consumers already were urging the next president to consider health care reform as essential to restoring the nation's fiscal fitness.

Divided We Fail, a group comprising the Business Roundtable, the National Federation of Independent Business, the Service Employees International Union and the AARP, took out a page ad in last Tuesday's USA Today offering to host a health care reform summit if President-elect Obama commits to taking action early in his administration, perhaps even during the first 100 days.

John Castellani, president of the Business Roundtable, reiterated the invitation during a keynote speech last week at the National Business Coalition on Health meeting in Washington.

``At a time when American competitiveness is most in peril, we simply cannot default to the position we have taken as a nation over the past 10 to 14 years and simply do nothing and run away from the issue,'' Mr. Castellani said. ``Few business pressures today come as close to the pressure of rising health care costs,'' he said. ``It is hampering our ability to compete with other countries, particularly in today's international economy.''

But some lawmakers and policy experts are urging President-elect Obama to take it slow. They say speedy action, at least in part, was what helped undo health care reform efforts led in 1993 and 1994 by former First Lady Hillary Clinton. Too many people became frightened because they didn't have time to review the massive proposal. The plan also crashed because of the Clinton administration's failure to line up support from key federal legislators.

Like the Obama plan, the Baucus proposal includes an employer mandate to either offer coverage or pay some kind of assessment; guaranteed-issue policies; a national insurance pool; premium subsidies for low-income individuals, families and small businesses; expansion of the State Children's Health Insurance Program; emphasis on primary care and prevention; and investments in health information technology.

Among the differences are an individual mandate; a Medicare buy-in for individuals aged 55 to 64; and a total revamp of the Medicare payment system, lowering payments to specialists and increasing them for primary care doctors. Perhaps the most controversial element of the Baucus proposal is the suggestion to limit the current tax exemption for employer-paid insurance, either through a cap or by income level.

While some of the components of the Baucus proposal would take several years to implement, it includes elements that could be launched almost immediately, such as issuing a RightChoices card that would guarantee access to recommended preventive care and cancer screenings to individuals without private coverage who are not enrolled in a public health insurance program.

The Baucus plan came as a surprise for some Washington insiders who had expected the first health reform proposal of the new administration to come from Sen. Edward Kennedy, D-Mass., who had been working on a plan during the summer and fall from his sick bed in Massachusetts following brain cancer surgery.

However, the Kennedy camp welcomed Sen. Baucus' contribution to the debate as well as his timing.

``It provides an important analysis of the urgent need for significant improvements in our health care system, and thoughtful recommendations for reform,'' Sen. Kennedy said in a statement. ``I look forward to working with Sen. Baucus, our colleagues in Congress on both sides of the aisle, and the Obama administration to see that we at last achieve the goal of quality, affordable health care for all Americans. Senator Baucus' white paper brings us closer to that goal.''

``The proposals in the white paper really do track a lot of what President-elect Obama released on the campaign trail,'' said Kelly Traw, a principal with Mercer L.L.C. in Washington. ``And there are a lot of elements that look like what Massachusetts enacted. Those are the things that Sen. Kennedy is purportedly looking to. So it seems to be that at least these key players -Sen. Baucus, Sen. Kennedy and President-elect Obama-have a lot of common ground.''

Frank McArdle, a consultant with Hewitt Associates Inc. in Washington, said the intent is to create a single bill to work from during the lame duck session of Congress that could be ready for Mr. Obama to sign once he takes office Jan. 20.

``We knew that Sen. Baucus was going to be coming out with his white paper, and simultaneously Sen. Kennedy has been working on a proposal, reaching out and having discussions about that,'' Mr. McArdle said. ``My understanding is that Sen. Kennedy was not going to follow suit and release his plan publicly, but now that Sen. Baucus has come out with his recommendations, Sen. Kennedy was going to start working with the Finance Committee to see if they could come up with a common legislative proposal that they could have ready around inauguration day.''

But John Sheils, the Falls Church, Va.-based senior vp heading the Lewin Group's health reform work, is concerned that lawmakers may be moving too fast, which could frighten some constituents the same way as when the former first lady tried to revamp the nation's health care system shortly after President Bill Clinton took office.

``Everybody says you've got to do it in the first 100 days,'' but when legislation moves too quickly, it leads to speculation by third parties not associated with it, Mr. Sheils said, pointing to the ``Harry and Louise'' ads sponsored by a major health insurance trade association, which was concerned about the changes.

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