POLITICS: Sometimes Health Reform Bills Do Pass...

Joanne Kenen — Tue, 13 May 2008 13:51:00 -0400

We've all done a lot of looking back to the lessons of 1993-94, and the long list of reasons the highly complex, ill-timed and politically-polarizing Clinton health care plan failed. But today the journal Health Affairs published an essay looking back not just at the failures of the Clinton plan but at the successful passage of two major health reform initiatives--the truly bipartisan State Children's Health Insurance Program (SCHIP) and the Medicare Modernization Act, which added prescription drug coverage for seniors.

The article, written by New America's Len Nichols, and Hill veterans Elizabeth Fowler and Christine Ferguson, acknowledges that the drug law remains controversial--a lot of Democrats don't like the basic structure of the drug benefit, and parties are still fighting about payments and changes the law makes to the overall Medicare program. But enough Democrats did back the legislation to see it enacted (barely), and some of them today acknowledge that even if it isn't the bill they would have written, even if they want to change some of it, it is helping seniors get their medication. The authors cite several reasons for its passage. Among them: President Bush took a hands-off approach to the details, letting Congress do its job of legislating. Republican Congressional leaders enforced party discipline so they held together to pass legislation that would help them politically. And, in the several years that lawmakers worked on the issue the two parties' models for delivering the drug benefit evolved to have at least some common ground.

The children's health program has been widely perceived as a bipartisan success from the outset. Clinton backed it, but Congress led the initiatve from the start. "The episode illustrates exemplary congressional leadership, a lack of partisanship, and a president leaving details to Congress while championing the basic goal and message of expanding coverage for low-income children."

Not so, however, for the second chapter of SCHIP, last year's reauthorization battle and Bush's veto. In that case, Bush rejected a bipartisan Congressional initiative and Republicans split among themselves, with the more conservative ones winning the day.

The authors conclude with three lessons (or wishes?) for next year.

Make health reform the top priority.
Be leaders, not partisans.
Develop a broad consensus, but leave the details to Congress.

Hope the folks on both ends of Pennsylvania Avenue next year, whoever they may be, are listening.

IN THE STATES: Alabama City to Cover All Children

Joanne Kenen — Fri, 04 Apr 2008 15:41:00 -0400

Birmingham, Alabama, has announced an ambitious program to cover the city's 5,000 uninsured children through a mix of public-private partnerships blending public funding, philanthropy and an arrangement with a local children's hospital planning a major job-creating and revenue-producing expansion.

The plan isn't a comprehensive solution to all the health problems in the state—Alabama ranked 42 in CQ's 2008 Health Care State Rankings—but screening and covering young people is a sensible step.

Mayor Larry Langford said the city will put up $150,000, and the Blue Cross Blue Shield of Alabama's Child Caring Foundation will match the funds. Eligible low-income children will be enrolled in Medicaid or the state's All Kids program; others will get care through the foundation, the Birmingham News reported.

"It's wrong that we allow these children to go unprotected. It's wrong that we make mothers and fathers worry every day about something as basic as health care,” Langford said.

The city worked out a deal with the Birmingham Children’s Hospital. The paper reported that the hospital could get up to $20 million from the city toward a $450 million expansion. The city will share some of the eventual tax revenue (anticipated from job creation and construction) with the hospital, and the hospital will do health screening and care for the city’s kids. The plan must be approved by the City Council.

State Children's Heatlh Insurance

POLITICS: Sometimes Health Reform Bills Do Pass...

IN THE STATES: Alabama City to Cover All Children