Health Care Update

By March 8, 2006Health Care

Enzi-Nelson Bill Scheduled for Markup: Here’s a link to a NAM letter in support of moving forward S. 1955, the Health Insurance Marketplace Modernization and Affordability Act of 2005. The letter also strongly discourages bad amendments. The bill is scheduled for markup today at 10:00 in 430 Dirksen Senate Office Building.

Democratic Amendment Hopper Overflows – at last count, some 68 amendments have been filed for possible offering by committee Democrats to S. 1955, though of course, many if not most will not be offered in fact. Some raise (I’ll withhold – temporarily until later this document – my opinion of Sen. Kennedy’s Medicare for All substitute) interesting questions that the minority Ds would highlight if they were in charge. Of course this bill probably wouldn’t be on their agenda, even with Sen. Ben Nelson’s (D-NE) support. Others are purely mischief-oriented, designed to weaken the bill in key respects. All should be rejected in order to move this bill forward.

I should note (having worked there both in majority and minority status) that were the party-control shoe on the other foot, there would be Republican mischief-making and agenda-painting amendments. The minority party of either stripe only has so many tools with which to work.


Frankenstein Lives … In Arkansas – and no, I’m not talking about that well-known retailer with headquarters there. Rather, Republican Governor Mike Huckabee (a potential Presidential contender and an amazing health promotion story) is working to secure waiver authority for a unique blend of the public and private to expand coverage for low-income workers, frequently employed by small businesses.

This Frankenstein blend combines limited (if not bare bones) coverage complete with an annual worker deductible of $100 and copays of 15% of each service up to a maximum out-of-pocket of $1,000 per year. Employers can participate (so long as every last worker participates) by paying $15 per month for each worker with income less than twice the poverty level; $100 per month for workers with higher incomes.

It’s a bold experiment, trying to leverage employer dollars into limited public coverage. I worry about the potential for inflationary pressure on the limited benefit package as well as the “soft” mandate on employers. Many a bad mandate starts soft and opens the door to other mandates. In addition, the rhetoric from the Governor about employers possibly “cherry-picking” participating workers is both gratuitous and unwelcome … downright un-presidential, if you ask me.

Pounding Drums for National Health Care – there is an appreciably growing drumbeat (and fierce party fervor) for national health care in certain policy circles, though this is probably a 2008 issue. I came across the strongly left-leaning Center for American Progress today with former Senate Majority Leader Tom Daschle leading the charge to answer the perceived call for “major health care reform” with big reforms. And then there is Sen. Kennedy’s Medicare-for-all amendment (previously echoed by Reps. Dingell and Stark, among others). Big health care reform didn’t die with the Health Security Act.

There are other comparable efforts out there, including the unconsciously left-leaning Citizens’ Health Care Working Group and the National Coalition on Health Care. The former group is holding pulse-taking hearings across the nation, though their guiding questionnaire and the majority of their working group composition leaves little doubt as to which direction their report will likely take and land … politically charged … on the doorstep of the 2006 elections. It’s a likely train wreck barreling down the track and really hard to decide whether to participate to add a little private sector perspective or to steer entirely clear. I’ll leave that to your better instincts.

Uninsured vs. Health Care Cost and Value – the common element to these groups and other strange bedfellow groups I’ve suffered through seems to be a great faith in programmatic expansion. Never mind that most of the states are crying “Uncle Sam” when it comes to Medicaid costs … these advocates continue to push largely for more and more public expansions.

The NAM Board took a different tack in their March 3 Resolution. Rather than focusing on adding participants to a largely broken system, the NAM is focused on improving the value – cost and quality – delivered by our health care system.

It’s a difference in both focus and emphasis as the uninsured proposals commonly assume a steady-state entrance into the existing marketplace … which continues to hemorrhage more uninsured due to cost and quality issues. Wouldn’t it be better to invite the uninsured into a system that actually works?