Hillarysworld

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Impact of bipartisan summit to be felt beyond health care

WASHINGTON — Lights. Camera. Traction

That's what President Obama will be seeking Thursday at a televised summit with Republicans and Democrats on his stalled effort to revamp America's health care system.

The session, however, carries much broader implications. Whether or not Obama ultimately gets a health care bill through Congress, the effort could have practical and political consequences for years to come.

Will Obama be able to break bread with Republicans and emerge with potential areas of compromise that lead to bipartisan action? Or will the two parties break knuckles instead and leave Pennsylvania Avenue's Blair House as divided as ever?

"To put it in naval terms, there have been a lot of shots fired at this ship … but it's still afloat," says Sen. Tom Harkin, D-Iowa, an architect of the Democrats' health care plan. "We have one last cordon to go."

 

The stakes are huge for the 46 million people without health insurance and those facing ever-rising premiums, for a federal deficit and debt burdened by soaring health care costs, and for Democrats and Republicans facing crucial midterm elections in November.

Obama raised the stakes this month by calling the bipartisan summit and releasing his own 10-year, $950 billion plan. He took the Senate's less expensive and less expansive version, added provisions favored by liberal Democrats in the House and sprinkled in a few of his own, including new powers for the federal government to block insurance rate increases.

Once Thursday's summit is over, there likely will be three viable scenarios:

• Push the Democratic bill through the Senate with a procedural tactic that would require only 51 votes for approval, rather than the usual 60-vote supermajority that the Democrats no longer enjoy. Although the White House is focused on wooing Republicans on Thursday, it wants an up-or-down vote.

"Sometimes good politics follows from good policy," White House communications director Dan Pfeiffer says. "There's no question that health care needs to be reformed to deal with insurance company abuses, rising premiums and the nation's fiscal health."

• Start the process over and seek areas of agreement with Republicans on what would be a smaller bill.

"There's been this focus on this one bill, and there's been a take-it-or-leave-it approach," says Rep. Dave Camp, R-Mich. "They keep proposing the same thing again and again."

• Congress could simply walk away, as it did during the 1994 attempt to revamp health care.

Democratic leaders say a comprehensive approach is best, but they are open to scaling back Obama's grand idea.

"We may not be able to do it all," says House Democratic leader Steny Hoyer of Maryland. "If we can't, then … doing part is also good. There are a number of things I think we can agree on."

Democrats could go it alone

After coming so close to revamping the nation's health care system already, passage of Obama's plan might seem like an anti-climax. It would be nothing of the sort.

The way millions of Americans get care and pay for it would be transformed in a way not seen since the passage of Medicare and Medicaid in 1965:

• Most Americans would have to get health insurance; federal subsidies and an expansion of Medicaid would help about 31 million of them pay for it. "You would be able to get coverage at no more than a certain price," Alan Weil of the National Academy for State Health Policy says.

• Insurers no longer could deny coverage for pre-existing conditions or impose many other restrictions. "It would send a signal that has to be sent that business as usual is over," says Len Nichols of the non-partisan New America Foundation. "That signal needs to be received in the insurance industry and with providers."

• Medicare's inflation rate would be reduced, which could mean fewer benefits or higher premiums. In addition, new taxes would be imposed on high-income families and high-cost insurance plans to pay for the expansion. Even so, health care costs would continue to grow.

"None of the proposals yet has done enough on cost containment," says Ralph Neas of the non-partisan National Coalition on Health Care, which represents consumers, businesses and health care providers.

There could be unintended consequences.

Doctors and hospitals could be overwhelmed with the number of new patients. Premiums could rise if too many individuals and businesses choose to risk penalties rather than buy or provide insurance. Congress could balk in the future rather than raise taxes or trim Medicare, causing deficits to rise.

"The health system would struggle for a few years to meet the higher demand for care," says Paul Ginsburg of the Center for Studying Health System Change. And "the elephant in the room that no one has focused on is providers' power to get higher rates from insurers."

The political ramifications could be just as uncertain if Obama wins. The White House long has argued that policy success would breed political success for Democrats at the polls. But it's a risky vote for Democrats who represent relatively conservative states or districts.

"This Congress will have been able to do something that no Congress has been able to do," says Doug Thornell, senior adviser to the chairman of the Democratic Congressional Campaign Committee. "This only helps Democrats down the road."

Not so, Republicans say.

"The American people are no less opposed to this government health care takeover today than they will be at the ballot box nine months from now," says Paul Lindsay of the National Republican Congressional Committee.

Seeking common ground

Despite the partisan rancor over health care, Republicans and Democrats do agree on some ideas. If they had to start over with a "new sheet of paper," as some Republicans have demanded, Congress might be able to fill in the clean slate with policies both sides support.

Much of the common ground revolves around policy ideas that are significantly less comprehensive than what Obama has proposed. Lawmakers from both parties, for example, support letting dependents stay on parents' health policies through age 26. They also back ending lifetime and annual caps on benefits.

Sen. Bob Bennett, R-Utah, who co-authored a separate health care bill in 2008 with Sen. Ron Wyden, D-Ore., said that, at this point, a bipartisan approach would work only if "it's a very narrow, very tentative first step of a step-by-step process."

Rep. George Miller, D-Calif., who helped draft the Democratic health care bill, says picking the legislation apart into a series of lesser bills won't work. "A smaller bill allows too many of the bad things in the current system to continue."

Past health care proposals offered by Republicans show there is the potential for bipartisan support on more comprehensive solutions as well. A framework released last year by Sen. Judd Gregg, R-N.H., for example, includes state-based exchanges online that would let consumers compare and buy health care policies — a centerpiece of the Democratic plan.

At Thursday's summit, Republicans likely will highlight a long-standing GOP proposal to let consumers buy health insurance across state lines — a move supporters say would foster competition. Obama's plan includes a provision that would allow companies to sell multistate policies, though on a more limited scale.

Chris Jennings, the Clinton administration's chief health policy adviser who helped develop a health care proposal for the Bipartisan Policy Center last year, said far-reaching plans from both parties often have similar ideas because there are only so many ways to deal with the problem.

Some of the most bipartisan ideas, though, deteriorate when details are revealed. Both Republicans and Democrats support prohibiting insurance companies from denying coverage because of pre-existing conditions. But, insurers warn, such a change would result in rate hikes.

To limit premium increases, the Obama plan would require virtually every American to have some form of health insurance — and that has met with opposition from Republicans.

Wait for another year

Walking away from the debate over health care, as Congress did in 1994, might be the path of least political resistance, but experts such as Drew Altman with the Kaiser Family Foundation say it would have grave implications for families and for the economy.

"I don't think it's a partisan statement of any kind to say that if nothing happens, everything is going to get worse," Altman says. "Costs are going to go up faster than anyone would like."

It took years for Congress to come back around to health care after President Clinton's attempt to revamp the system collapsed. When lawmakers did take up the issue again, they focused on smaller policies, such as children's insurance and Medicare drug coverage.

If the Obama administration's effort suffers the same fate, the nation won't be able to wait that long again, Altman says.

Health care costs are rapidly outpacing inflation. The non-partisan Congressional Budget Office projects that spending on health care will represent 25% of the nation's total economic output in 2025— and close to 50% in 2082 — if nothing is done.

[SNIP]

Democrats hold a 77-seat margin in the House and control 59 out of 100 seats in the Senate.

"There is an institutional memory guiding Democrats on what happens when nothing gets done," Wasserman says. "That's very powerful."

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Full article.
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This is likely to pass this time.



-- Edited by Sanders on Wednesday 24th of February 2010 03:52:14 PM