Where does health reform stand?

2009-06-22 12:29

Washington - President Barack Obama wants the US Congress to send him a sweeping overhaul of the $2.5 trillion US healthcare system by October to help put the struggling US economy on a path of growth.

Below are some questions and answers about the state of play for the legislation in the Senate and the House of Representatives, where Democratic leaders, who control the agenda, believe they are on track to meet Obama's goal.

Q: What is the state of play in the Senate?

* Senate Finance Committee Chairperson Max Baucus is pushing for strong bipartisan support to help ensure final passage of legislation that could maintain public backing as changes are implemented throughout the healthcare system. He says he is optimistic he will achieve that goal.

* The Finance Committee had hoped to have a bill ready for panel consideration next week but that may slip until after the week-long July 4 holiday break. Committee members are pushing to bring the cost of the bill, which the Congressional Budget Office estimated at about $1.6 trillion, down to about $1 trillion over 10 years. That cost would be covered by savings in government health programs and tax increases.

* The Senate Health, Education, Labour and Pensions Committee has begun amending draft legislation, and the public sessions are expected to last several days. Senator Christopher Dodd has taken a lead role in managing the bill in that committee in the absence of its chairperson, Edward Kennedy, who is battling brain cancer. Dodd and Kennedy have both expressed a desire for a bipartisan bill.

* There is broad agreement on the need to promote disease prevention and to reward hospitals and doctors for providing better quality of care instead of the quantity of services. Those changes would be driven by the government's Medicare insurance program for people 65 and older and the disabled.

* There is also agreement on maintaining employer-provided healthcare coverage. For those without employer-provided insurance, the proposed legislation would set up an insurance exchange - a clearinghouse - in which individuals and small businesses could shop for medical plans and compare benefits and prices.

* A sticking point is whether a new government-run insurance plan should compete with private insurers in the exchange. Republicans say they cannot support legislation that includes a new public plan, arguing it would drive private insurers out of business and lead to a government-run healthcare system. Many Democrats insist on a new public plan, arguing it can be set up to compete fairly with private insurers and that it is the only way to keep premiums low.

* Obama also wants a new government-run program as an option for people to select. The Kennedy/Dodd bill includes one, while Baucus has said his plan will, too. The issue is how to design it to keep enough Republicans on board to give the Democratic majority bipartisan political cover.

* Senators are considering a potential compromise that would create nonprofit insurance cooperatives, owned and operated by their members, to compete with private insurers to provide coverage to individuals and small businesses.

Q: What is the state of play in the House?

* Three House committees are working on the legislation - the tax-writing Ways and Means Committee, the Committee on Energy and Commerce, and the Committee on Education and Labour.

* They have announced their draft bill which suggested all Americans should be able to get insurance regardless of medical history and that coverage should be mandatory for individuals and businesses.

* The House bill includes a new public plan and is unlikely to win backing from Republicans. A sizable group of conservative Democrats - the so-called Blue Dogs - are also cool to the idea and instead support a "trigger" that would put a new public plan into effect in the future should the private sector fail to meet price and competition targets.

* House Republicans have drafted a far less costly alternative they say would help make medical coverage more affordable. The bill would not include the sweeping insurance market reforms called for in Democratic proposals.

Q: What about the special interests?

* Groups representing insurers, doctors, consumer groups and businesses have refrained from broad attacks against reform. Most agree the current system of rapidly rising costs and millions of uninsured people cannot be sustained.

* The American Medical Association, which historically has opposed a broader government role in the healthcare system, said it opposes expansion of Medicare to cover the uninsured or a government plan that offers the same payment structure as Medicare. However, the doctors' group said it was open to considering a public plan or a potential compromise.

* Some nursing organisations support an expanded government role in providing healthcare for all. The American Nurses Association backs a so-called single-payer system in which the government would finance medical coverage, but that is unlikely to win broad acceptance among lawmakers.

* Various drug and device industry groups, including the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organisation and the Advanced Medical Technology Association, have said they broadly support healthcare reform efforts. While more coverage could expand the market of people using their products, it also could result in price cuts and other cost controls.

* Health insurers oppose a new government health insurance program, saying it could erode the private insurance marketplace and trigger higher costs. The industry's lobbying group, America's Health Insurance Plans, has said it would support some marketplace reforms as long as lawmakers mandate that all Americans purchase some kind of health coverage.