Volume 17, No. 3, Summer 2009
By Congressman Bill Delahunt
One of the more pressing issues facing Congress this year will be reforming our healthcare system to provide adequate coverage for every American.
The United States spends more on healthcare than any other country. Even so, 46 million Americans do not have health insurance. President Barack Obama has made addressing this problem a priority and it is expected that in the coming year that the Congress will have an opportunity to act on his initiative.
Our aim is to provide adequate health coverage to every American, while improving medical quality and cutting costs. This is an ambitious goal, but one that I believe to be within this Congress’s reach. At this point, numerous options are being considered and I think it’s helpful to lay out the primary proposals that have been considered thus far.
The Senate Health, Education, Labor and Pensions (HELP) Committee, chaired by our own Senator Edward M. Kennedy, released a revised version of its plan just prior to the July Fourth holiday. The draft of this bill—the Affordable Health Choices Act—mandates that companies with more than 25 employees provide them with coverage. If they choose not to, they must pay a penalty, $750 for each full-time worker or $375 for each part-timer. The HELP Plan also includes a public health insurance option administered by the Department of Health and Human Services (HHS) that would compete with private plans.
The public option would set rates based on the average of local private rates. President Obama says he believes the public option will go a long way in “keeping the insurance companies honest.”
The non-partisan Congressional Budget Office (CBO) estimates that this plan will cost $611 billion over the next decade. However, the cost could end up closer to $1 trillion if Medicaid is expanded to provide coverage to the poor and near-poor who do not currently qualify, but who still would have trouble buying their own insurance. The CBO estimates that 97 percent of Americans will have adequate health coverage under this plan.
The Senate Finance Committee, chaired by Senator Max Baucus (D-Montana), concurrently is developing its own bill. It lacks both an employer mandate and a public option, but some alternatives have been proposed. The bill requires individuals to acquire insurance on their own from private companies, but also creates state health exchanges to facilitate enrollment in private plans. It’s possible that an insurance co-op provision would be part of the final draft.
While the Senate works out its version of a healthcare plan, the House also is devising a plan based on the combined efforts of three Democratic Congressmen, Henry Waxman and George Miller of California and Charles Rangel of New York. Their proposal establishes a Health Choices Administration to be headed by a Health Choices Commissioner. This body would establish a Health Insurance Exchange to facilitate enrollment in insurance plans with a public option to compete with private plans. Additionally, the bill establishes both an individual and an employer mandate.
As with the HELP Bill, employers who choose not to cover employees would pay a penalty.
CBO has yet to release cost estimates for this bill and its authors still must determine how they will pay for it if estimated costs run much higher than $1 trillion.
Many provisions included in these bills promise important and necessary changes in our healthcare system. Others need to be reconsidered and revised. But no matter what plan we eventually decide upon, we need to be sure that all Americans have adequate health coverage.