Volume 17, No. 4, Fall 2009
By Congressman Bill Delahunt
The issue of health reform continues to dominate the legislative agenda here in Washington…and throughout the nation.
Here’s what’s happening.
One of the biggest challenges in this national debate has been communicating to the public what exactly is in these bills. And actually, the Congress as yet does not even have a single final bill to debate and probably won’t act on one until mid- November.
Let me attempt to map the complex process of getting a final legislative proposal.
The bill in the House, America’s Affordable Health Choices Act, represents the combined effort of three committees–Education and Labor, Energy and Commerce, and Ways and Means. In July, each committee passed its own version of the bill and they’re now being blended into one to be voted on by the full House.
In the Senate, responsibility is divided between the Health, Education, Labor and Pensions (HELP) Committee and the Finance Committee. HELP finished its work in July, and Finance at this writing is in the final stages. Those bills similarly will be combined for consideration by the full Senate.
Once each chamber passes its version, differences are sorted out in a conference committee, comprised of legislators from each of the five committees. That combined single bill must pass each chamber before going to the President to sign.
The bills’ similarities outweigh their differences. All establish health insurance exchanges of some sort (such as exists in Massachusetts and for federal employees) that facilitate enrollment. They contain market reforms that establish essential benefits: preventing insurers from denying or dropping coverage; limiting cost-sharing or co-pays for primary care and other services; and prohibiting lifetime limits.
All expand and encourage primary and community-based care, wellness and preventive care, and health information technology. All include exemptions for low-income individuals and small businesses. All phase out or reduce the Medicare Part D “donut hole,” which burdens too many seniors with exorbitant prescription drug bills during periods of insufficient coverage.
A limited number of issues still remain to be negotiated and debated.
No. 1 is the inclusion of a public option, cooperative, or other system that ensures real access and an efficient marketplace. The House and the Senate HELP bills both include this government-run public option that would be available to certain small businesses and individuals who are unable to get coverage through other means.
In all proposals this plan would be self-funded through beneficiary premiums–not the Treasury–and would be subject to the same requirements as the private plans.
The Finance bill calls for a non-profit, consumer-owned cooperative rather than a public option.
The other primary issue is how we pay for this. The Senate HELP bill does not include offsets because they lack jurisdiction over the financing mechanism. The House bill uses a combination of surtaxes on the wealthy and reducing costs in other programs, like overpayment to Medicare Advantage plans.
Other difficult issues remain, but most of what we have already promise important and necessary changes in our healthcare system.
The United States spends approximately twice as much per person on healthcare than any other industrial country, yet we tragically have little to show for it. The American people deserve more than that.