As Obama Wades Into Health Debate, Tough Choices Await

Main Category: Public Health
Article Date: 23 Jun 2009 - 3:00 PDT

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"As the legislative debate over health care intensifies on Capitol Hill, there is growing clamor for President Obama to step in," the Washington Post reports. The administration has so far left the crafting of legislation in the hands of Congress, but a series of tough choices await the President, who at some point must define "what he'll accept and what he won't" in a final bill. His job is made more difficult by recent cost estimates. "A preliminary estimate of the Senate Finance Committee's draft bill put the price tag of universal coverage at $1.6 trillion over 10 years. That was considerably more than anyone anticipated and forced the committee to delay work on the bill. The cost of the incomplete plan drafted by the Senate Health, Education, Labor and Pensions Committee was pegged at about $1 trillion over 10 years, but the CBO said that would still leave 30 million (rather than the current 46 million) people without coverage."

Among the toughest of those decisions:

- Whether to tax employer-sponsored health benefits. Sen. John McCain, R-Ariz, championed the idea during last year's campaign and organized labor "an Obama constituency" strongly opposes it, creating political risk. However, the Senate Finance Committee has identified it as a key, untapped source of revenue.

- Whether to create individual mandates for people to buy insurance. Obama also opposed this idea as a candidate, but proponents say it may be necessary to achieve universal coverage, and by extension, get insurers, who would pick up millions of new customers, on board for broader reforms.

- Whether to create a public insurance plan. Republicans appear "unalterably opposed" to the plan, so achieving a bipartisan bill could require a playing down the idea. However, administration sees the plan "as critical to holding onto liberal support" and as "an essential weapon in holding down" costs in the private sector (Balz, 6/21).

Though the administration hasn't yet left its mark on the bill by demanding Congress move on any of these controversial ideas, House Democrats said their bill, released Friday, "was written based on the vision President Obama set forth during his 2008 campaign and in recent months," CQ Politics reports. The bill includes several contentious ideas, such as the public plan, and "Republicans have complained that they had no involvement in drafting the bill, despite Obama's calls for bipartisanship" (Armstrong, 6/19).

Despite GOP objections, a recent New York Times/CBS News Poll shows strong public support for "government administered insurance plan," with 72 percent in favor, and majorities saying the government would do better at both providing health coverage and holding down costs than the private sector, the New York Times reports (Sack, 6/20).

In addition, Reuters/The Washington Post reports: "[O]pposition is building even as a group of senators tries this week to negotiate a proposal they hope will quiet critics and win bipartisan support." Sen. Max Baucus, D-Mont., a reform ringleader, "is working with only few Republicans and there are no guarantees he will succeed" as support for the sweeping reform and liberal measures like the public plan meet with deep anxieties about growing deficits and massive federal sending (Smith, 6/21).

Associated Press/Boston Globe: "Congressional Democrats are off to a halting start, blindsided by a high cost estimate and divided over how to proceed. The confusion has emboldened Republican critics of the administration's approach to its top domestic priority. While too early to rule out eventual success, it seems Obama will have to be more forceful and hands-on" (Babington, 6/21).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

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