Health Politics

There isn't a lot that can make us grimace more than a headline that says that Harry Reid is talking about allowing health care reform to spill into 2010. Just typing the words hurt.

Forget about the fact that it is just not good for our collective mental health. ("Our" meaning everybody that is working on health care reform... right, left, up, down, and definitely those poor folks at the CBO ) It's not good politics.

Doesn't anybody out there remember the month of August?

The longer the debate drags on, the more enemies of reform can tear down and attack and confuse. They've already started.

Today is a national "Women's Day of Action" for health reform, part of the National Women's Law Center (NWLC) campaign, Being a Woman Is Not A Pre-Existing Condition. The campaign works to educate women about the disparities they face in the current health care system and urge them to fight for reform. The day of action features a rally in D.C. where women can share their stories and an online action network that offers information and a portal to contact Congress and demand health reform.

(We are refiling this post to make the paragraph about the SEC a little clearer for our readers.)

"The American people and I are asking a serious question and one that deserves a straight answer -- why are health insurance costs going up each year?" Sen. Jay Rockefeller (D-WV) questioned in a letter (part 1 and part 2) to H. Edward Hanway, the CEO of CIGNA, yesterday. "Are they spending it to make people well when they are sick and keep them healthy? Or is the money they charge going to profits, to executive salaries, and to figuring out how to deny care to people when they really need it?"

Sen. Rockefeller explains:

An early draft of the House Republicans' health care bill is available at BNA. The Republican bill is much more limited in scope than the current House health reform bill, and is focused primarily on cost -- which represents only one aspect of the problems plaguing our current health care system.The bill repackages a lot of the conservative ideas that have been floating around for years -- and which didn't even get enacted when the Republicans were in control of Congress and the White House.

The bill will not end insurance company discrimination against high risk individuals nor will it provide subsidies to help the uninsured purchase coverage, according to Politico:

Boehner hasn't released the full details of the bill but has said that it would make it easier to buy insurance across state lines, impose strict limits on medical malpractice lawsuits and allow individuals and small businesses to pool their resources to buy insurance as a group. That is designed to boost their purchasing power to help lower individual premiums.

In a floor speech Monday, Rep. Virginia Foxx (R-NC) argued the prospect of passing health reform gave us more to fear than "any terrorist right now in any country."

Foxx has previously suggested that there "are no Americans who don't have health care," and that health reform would cause seniors to be "put to death by their government."  

We guess there's not much else to say about Foxx and health care, except, well, bless her heart.

If voters had been feeling a little differently a year ago, Doug Holtz-Eakin (former Congressional Budget Office director and chief economic policy advisor to Senator McCain's 2008 presidential campaign) would be spearheading the McCain health care team.

And, if voters had been feeling differently a year ago, Holtz-Eakin would still have employer-sponsored health coverage.

But instead of a position with the McCain Administration, he is unemployed -- and the clock is ticking on his current health coverage. He will soon join the scores of Americans who are having difficulty obtaining affordable, comprehensive health insurance. "I worry about where I go next in the way many Americans do," he told the Washington Post.

Holtz-Eakin walked away from the 2008 presidential campaign without a job and therefore without employer-based health care. Since then, he has been able to keep the private health insurance plan he had during the campaign through COBRA (the acronym for the Consolidated Omnibus Budget Reconciliation Act, a 1986 federal law that allows individuals to temporarily extend group health coverage to people whose health benefits otherwise would be terminated). 

In the health care debate, the public option frequently takes center stage. But, according to the latest CBO estimates for the House health reform bill, all that attention may be unwarranted. The numbers are in -- the public option in the House bill will likely cover only two percent of Americans (around six million of those under 65) by the time it is fully implemented in 2019.

This low estimate shows that the public option will likely be a small "niche" operator, reports the AP, and that House leaders have designed the public option to accurately target those who have difficulty acquiring private coverage, but are not eligible for Medicare or Medicaid. The public option will be available to those working in small business or individuals seeking to buy coverage on their own.

The CBO projects that those who are less healthy will probably be attracted to the public option because of more relaxed rules about accessing specialists and medical services, reports the AP. Taking on higher risk patients will likely make public option premiums higher than private coverage -- so most consumers will seek private insurance -- and a massive exodus from private coverage is unlikely.

(Reposting to fix a typo in a Brendan Borrell's name)

A few good reads from this week that we didn't have time to blog about (some travel, two magazine deadlines and Halloween costumes to prepare) but still wanted to share:

Reuters Health, under the relatively new direction of Ivan Oransky, has an investigative piece by Brendan Borrell looking at some of the intrigue and controversy surrounding a couple that has to a certain extent become the face of the growing medical tourism industry.

Kaiser Health News' Julie Appleby (expanding on and explaining some fine analysis by the Center on Budget and Policy Priorities) raises some concerns about affordability under the Finance Bill.  She writes:

Proponents of the Senate Finance Committee's health care bill say the legislation will limit the amount that lower- and middle-income people must pay for health insurance to a maximum of 12 percent of their incomes.

My colleague Meredith and I ventured over to Capitol Hill yesterday for the unveiling of the 1,990 page House health reform bill. We sat by the steps of the West Front of the U.S. Capitol. Having arrived relatively early, we started a conversation with the couple sitting next to us. We learned that the U.S. Capitol building has some 541 rooms and 648 windows, construction began in 1793 and the new dome is built out of 8,909,200 pounds of cast-iron. (Meredith, who has lived in Washington for several years now might have known that but I, a recent Boston transplant, was fascinated.) We also learned about what has been going on inside the building over the past several months, leading us up to this very morning.

House Leadership will unveil its merged health reform bill at 10:30 a.m. today at the West Front of the U.S. Capitol Building. The Affordable Health Care for America Act should be posted on the House Rules Committee website at 10:00 a.m. We'll have more thoughts later, but early details on the legislation formed from the Tri-Committee bills are as follows:

• Coverage: The bill is expected to lower the ranks of the uninsured by 35 to 36 million. As expected, the bill contains sweeping changes to the health insurance market, such as guaranteed issue, community rating, and an end to the practice of exclusions based on pre-existing conditions. It requires all Americans to purchase insurance, provides subsidies to make insurance affordable and establishes insurance exchanges to create a new marketplace for consumers.
• Cost: The bill will come in under President Obama's target of $900 billion over ten years. The bill is deficit neutral running surpluses in the first half of the 10-year  budget window, but deficits in the second. Democrats in the House say they expect the bill to be budget neutral in the second 10 years as well.
• Public Plan: The bill will contain a public plan with negotiated rates. The move is seen as compromise to help appease concerns of some of the moderate and conservative Democrats in the House.
• Medicaid: The bill expands Medicaid eligibility to 150 percent of the federal poverty level for all adults -- an increase from previous drafts which had set eligibility at 133 percent of FPL.
• Financing: The bill is funded largely savings from changes in Medicaid and Medicare and a a 5.4 percent surtax on individual making more than $500,000 and couples making more than $1 million -- an increase from the original thresholds. The fix to the sustainable growth rate formula has been carved out and will be introduced separately. There is also an 2.5 percent tax on medical device makers and an increase in the cuts faced by drugmakers.