Federal reform update

As the Senate continues to debate its version of health reform legislation, Majority Leader Harry Reid has taken full responsibility for gathering the requisite 60 votes needed for passage of the 2,074-page bill (Source: “Reid's recipe for getting health-care deal done,” Washington Post, Dec. 4, 2009).

As of yesterday, the biggest stumbling block for passage of the bill was the issue of abortion, with several moderate Democrats indicating that they may vote against the bill if it does not include a ban on abortion coverage in the public plan. Democratic Sen. Ben Nelson of Nebraska also is proposing a measure that would prohibit tax credits for private insurance that includes abortion coverage.

The inclusion of a public option also remains a point of contention, with four Democrats announcing that they would vote against any bill that included one. However, Democrats still remain optimistic that some legislation will be passed.

"We'll get something, and it won't be perhaps what I like," said Tom Harkin (D-Iowa), chairman of the Senate health committee. "If those of us who are strong for the public option, if we have to give up something, then those who oppose it, they have to give up something, too. We'll meet in the middle."

Kaiser brief compares CHIP provisions in House, Senate legislation
A new brief from the Kaiser Family Foundation, Medicaid and Children’s Health Insurance Program Provisions: America’s Affordable Health Choices Act & America’s Healthy Future Act, (pdf, 12 pages), compares the Medicaid and CHIP provisions in the House and Senate health reform legislation with current law.

The side-by-side comparison includes details on Medicaid coverage, maintenance of eligibility, Medicaid financing, benefits and access.

Cleveland Clinic CEO: Reform needs more quality focus
In an interview with U.S. News and World Report, Cleveland Clinic CEO Toby Cosgrove said that he is concerned that the health reform currently under consideration by Congress does not place a high enough emphasis on creating a more efficient delivery system (Source: “Cleveland Clinic's Cosgrove: Congress Needs to Improve Quality of Healthcare,” U.S. News and World Report, Nov. 30, 2009).

“Congress has done a great job in improving access to healthcare, but they've done only an average job of potentially improving quality of care,” Cosgrove said. “They have given economic stimulus funds to promote use of electronic medical records, and they've put together some demonstration projects on healthcare delivery, but they really have not done much to decrease the overall healthcare bill for the United States.”

Charts illustrate subsidy differences in House, Senate billsOn his blog at the Washington Post, economic and domestic policy reporter Ezra Klein has posted a series of informative graphics that illustrate the level of federal subsidies and maximum out-of-pocket expenses that would be incurred in both the House and Senate reform bills (Source: “Comparing the House and Senate subsidies,” WashingtonPost.com, Oct. 27, 2009).

The graphics were created by staff members in the office of Rep. Jim Cooper (D-Tenn.).
Among the differences between the two plans are that the House version would include a steady out-of-pocket maximum and the Senate would change alongside income.

Debate rages on deficit impact of reform bills
While the Congressional Budget Office scoring of the Senate bill concluded that it would reduce the deficit by $130 billion over 10 years, the debate rages over what the actual impact will be.
 
President Obama has reportedly required his senior staff to read a blog entry posted on the Web site for The Atlantic last week that touts the fiscal responsibility of the Senate health reform bill. The entry, titled “A Milestone in the Health Care Journey,” includes quotes from a number of health economists including Jonathan Gruber from the Massachusetts Institute of Technology and  Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush.

"I'm sort of a known skeptic on this stuff," said Gruber in the article. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

On the other side of the debate, critics of the legislation say the CBO scoring was achieved through accounting tricks. (Source: “Three gimmicks that make Senate healthcare bill look better,” Christian Science Monitor, Nov. 20, 2009).

Among the “gimmicks” outlined in the article are that revenues would begin being collected years before expenditures would be made, that the assumption that the legislation would go unchanged for 10 years is unlikely and that, similar to the collection of revenue, a voluntary long-term care insurance program called the Community Living Assisntance Services and Support would start taking premiums right away but would not have to pay out benefits for some years to come.

“They’re playing with the numbers here,” says Robert Laszewski, president of Health Policy and Strategy Associates, a Washington D.C. consulting firm.