The Alan Katz Health Care Reform Blog

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Health Care Reform Outline Becoming Clearer as Deadline is Missed

Posted by Alan on July 22, 2009

The reality is that Congress will miss President Barack Obama’s August deadline for health care reform. The Administration had wanted each Chamber to pass a bill before Congress recesses in early-August. Members of a Conference Committee would then spend the recess working through differences between the bills and Congress would be in a position to send legislation to the President’s desk in October. That was the plan.

Now there is a strong likelihood Congress will be unable to pass out a bill before the summer recess. Part of the reason is that moderate and conservative Democrats are balking at the price tag for reform and some of the provisions being pushed by their more liberal colleagues. At the same time, the Senate Finance Committee and its Chair, Senator Max Baucus, has not given up on fashioning a bi-partisan bill, no mean feat on legislation as complicated as health care reform.

What this means is that lawmakers will return home in August with numerous questions concerning health care reform unanswered. They will hold town hall meetings, listen to constituents, and return in September to make the final effort to reform America’s health care system. While this will push the work of the Conference Committee back by a few weeks, it does not mean the President’s real deadline — signing a bill into law this year — will be missed. It just means the Conference Committee will have a bit less time to do their work.  (A short civics lesson: a Conference Committee is an ad hoc working group comprised of both Senators and Representatives from both parties whose job it is to reconcile bills on the same topic passed by the Senate and House. Their compromise bill, if approved by both Chambers, is then sent to the President for his signature or veto).

The summer recess will hardly be relaxing for most members of Congress. While home they will be confronted on a daily basis passionate advocates on all sides of all the many issues tied to health care reform. Cost containment, universal coverage, preventive care, taxes, mandates and more will be part of their daily diet. Whether the cumulative effect of this stew of meetings, confrontations and discussions will be to encourage a more progressive or a more moderate approach to reform is an open question. Certainly millions of dollars will be spent by interest groups of all political persuasions, especially in the districts and states of moderate Democrats. The 24-hour cable news networks will be so inundated with health care reform advertising next month they may have no room for their regular fare of prescription drug, debt relief and Vonage commercials.

While the deadline is being missed, what elements are likely to be included in the reform package is becoming clearer. It is all but certain, for example, that an exchange will be created with the intention of helping consumers shop for health insurance will be created (although the nature of this exchange is still to be determined). There is also, surprisingly, a growing consensus on requiring every American to have health insurance. As reported by the Washington Post, the idea of an individual mandate “Is one of the few common threads running through all three bills being considered in Congress, greatly increasing the likelihood it will survive the legislative process.” Given that another virtual certainty is that carriers will be obliged to accept all applications for coverage without regard to pre-existing conditions, this is a good thing. States in which there is a mandate to sell coverage, but not one to buy it, premiums sky rocket. In New York and New Jersey, where this imbalance exists, average premiums for individual coverage are more than twice as high as they are in California which has neither mandate.

Not everyone supports a balanced approach to guaranteed issue. Many Republicans oppose the concept of requiring individuals to buy health insurance. One Republican proposal, The Patients’ Choice Act, introduced by two Senators and two Representatives, all self-proclaimed conservatives, emulates the New York and New Jersey model. Meanwhile some Democrats are concerned subsidies to help low income Americans afford the premiums they’d be required to pay will be inadequate. Nonetheless, as the Washington Post article explains, support for the concept is widespread.

Even President Obama, who opposed the mandate to purchase idea during the campaign has come around as long as there are exemptions for those who simply cannot afford the premiums: “I was opposed to this idea because my general attitude was, the reason people don’t have health insurance is not because they don’t want it, but because they can’t afford it. And if you make it affordable, then they will come,” he said in a recent interview with CBS. “I’ve been persuaded that there are enough young, uninsured people who are cheap to cover, but are opting out. To make sure that those folks are part of the overall pool is the best way to make sure that all of our premiums go down.”

So yes, Congress will miss the August deadline for passing health care reform. At the same time, critical elements of what will eventually emerge in the reforms are becoming increasingly clear. The only deadline that really matters is passing legislation before the silly season of mid-term elections arrives. And that’s a target date Congress is likely to meet.


13 Responses to “Health Care Reform Outline Becoming Clearer as Deadline is Missed”

  1. As perhaps one of the few people who read Alan’s blog religiously, and who also is facing the very real prospect of having to drop my family’s health insurance because I cannot afford to pay the $1711.50 per month premiums anymore, this debate is more than just an exercise in political ideology.

    Maybe I have been somewhat radicalized by my own experiences in the private insurance market. Remember the old chestnut that suggested that “a liberal is just one mugging away from being a conservative”? Well, I think that a conservative may find he or she is “just one health insurance recision and/or denial of coverage because of a dubious ‘pre-existing’ condition away from being a liberal.”

    If some sort of meaningful reform occurs relatively soon, I think we will all benefit. If, however, stalling and delays and lobbying by special interests effectively kibosh reform, and 14,000 Americans per day continue to lose their insurance, the pressures within the system seem to me likely to build into something that will cause a much bigger pendulum swing in the future–maybe even an “off with their heads” kind of revolution.

  2. I’m certain that this reform will lead to problems. I am friendly with someone attempting to get a mortgage modification and has submitted all the documents to the lender 125 days ago. NOTHING.
    Imagine needing some specialized healthcare and having to wait 4 months or more for a response. Scary.

    We are a free-market capitalist country. Our founders wanted to minimize government intrusion and we are straying from that vision.

    The article at the attached link seems to be a well thought out plan that fits our society and culture. I encourage reading but it will require a few minutes. Healthcare reform Compromise

    I’d like to hear what others think.

  3. Market-based policies are more cost effective for the government – and therefore the taxpayers- than publicly funded healthcare. According to the Kaiser Commission on Medicaid and the Uninsured, January 2005, if every uninsured individual was covered by a government program such as Medicaid, the cost to the federal and state governments is approximately $2000 each. If, however, low-income and modest-income Americans could purchase their own health insurance by utilizing a $1000 tax credit, the federal government would save 50% of that money. With over 45 million uninsured Americans, that savings would be substantial indeed.

    • Mark Goodman said

      This isn’t surprising. Here in California a Medi-CAL participant costs about $800 a month. It would be more cost effective if that person was covered by insurance for probably less then the current cost and the coverage would be more universally accepted. Providers who are willing to accept Medi-CAL are few and far.

      Look no further then S-CHIP.

    • Rob said

      Wait a second. Who says that $1000 a year is going to cover anyone’s private insurance?

  4. besthealthcarerates said

    medical insurance
    Alan I have been follow your blog and have always found your posts to be very informative. Do you feel after last night presidential address that a government run plan is going to happen?

  5. Missing a deadline is not the issue here, passing a comprehensive plan that works is the issue. They need to look at the pros and cons of each change they are thinking about making. You mention that there is support on both sides that every American be required to have coverage. I live in Massachusetts which already does this. We also have the longest waiting time to see a doctor, sometimes appointments take months. These are the types of issues they should be considering and investigating before being concerned with a deadline.

  6. Paul said

    The president is missing a grand opportunity. He has the ability to connect with the public in a uncommonly personal way. He should focus his energy on improving public health through sheer motivation for individuals to change themselves for the better. Inspiring a culture of healthy behavior could tackle preventable diseases (which is huge), and it could be done with little to no cost. Every person that chooses to take the stairs instead of the elevator, rides a bike instead of watching a hour of TV, or cuts the cream sauce in half will yield enormous benefits for our public health. The ROI would be staggering.

    • KenK said

      The only sure way to motivate healthy behavior by Americans is to make sure that behaviors that lead to preventable diseases are rewarded with higher health care out-of pocket expenses. Changing the culture of Americans to a healthier one through the sheer power of inspiration is not realistic, and I’m being very kind.

      • Paul said

        I don’t disagree… monetizing it makes for a greater incentive. My only point is that inspiration, while not alone sufficient, can be powerful. Past presidents have harnessed inspiration to motivate. He certainly could. And I think its a low cost way to generate benefits without sacrificing freedom. Maybe a pipe dream, but if people actually wanted to be healthier then that’s far more effective and lasting than top down public policy decisions.

  7. Ron Masters said


    This is more accurately for the previous post, but it seems to apply to either of the conversations.

    Republicans and Democrats alike must be willing to move reform forward with pieces we know the puzzle needs as opposed to what is the latest great “sound bite”.

    Nor do we need the Democrat talking points sparked by the empty threats of the majority or the minority accused of being “the party of no”, your words, when in reality aren’t the Republicans really saying “Not This One”.

    As for what DeMint said, he is one voice who was heard. Many less vocal who are of more of moderate thought, on both sides of the aisle, see this as an opportunity to create thoughtful change not a quick fix that says “get it change done, the hell with what it costs or whether or not it really will work.”

    Politics as usual, I guess and will defer to your knowledge of that arena. But, need it be this way or is it rolling out “as usual” because of the leadership of both parties or in spite of them? I suggest it’s combination of both.

    As a Republican am I always proud of all my party’s strategies and positions? Nope, as Democrats are you? I think not as well. But they are what we have to deal with, so deal with them we must.

    However, when we have an Administration that wishes to guide legislation which could spend or “invest’ trillions of dollars on health care reform, would not the reasonable person think they would want to get it right as opposed to quick? I would think so.

    Also we should all observe, much as you have pointed out, that the conversation has been changed from reforming health care to beating up on insurers. And the old blurring the line of distinction between insurance and care rises to a new volume. A tactic that left leaning policymakers love to smudge. I believe that politicians have always shown it is easier to motivate the electorate to be against something as opposed to being for anything. As for the insurers Obama has previously needed, maybe it’s an under the bus thing.

    So as this is moved forward the Dems need to include the Reps in the dialogue past just “sound bite” dribble. And the Reps need to come forward with more proposals than cooperatives and association plans and tort reform.

    Maybe a starting place is to take what the carriers have already agreed to (guaranteed issue with an individual mandate), properly fund new fraud initiatives, reform tort to rid the system of onerous awards and defensive medical practice overruns and pay providers for quality of treatment, not just the number of patients seen per day.

    I’m done now.

    Keep the conversation going, don’t let it “prematurely” stop for political reasons.

    We deserve better.


  8. Florida Broker said

    As long as it’s not a government run or public exchange, but rather one that works with licensed brokers, it could be advantageous for everyone. I don’t want to imagine the service (claims assistance, plan education, etc.) that insureds would receive if brokers are excluded.

  9. Well hopefully our elected reps will have to answer some questions. The attempt to rush this legislation through in an effort to avoid such discussions is just mind boggling. I will not be a fan of any type of health exchange or govt plan. Insurers simply cannot compete with an entity that does not have to worry about profits or pay taxes. And what about the role of the agent in all of this?

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