We told you about yesterday morning's session of the Health Action 2009 conference, when we heard from members of Congress likely to play key roles in health reform. Now we want to catch you up on the afternoon session, when we heard from some congressional staffers who will actually write the legislation.

The panel featured Yvette Fontenot, who works for Chairman Max Baucus (D-MT) at Senate Finance, Karen Nelson, health policy director for House Energy and Commerce Chairman Henry Waxman (D-CA), and John McDonough, senior advisor to the Senate HELP Chairman Ted Kennedy (D-MA). 

Health Care for America Now's Jason Rosenbaum has excellent summary of the discussion over on HCAN's blog. Here are some of our takeaways from the panel:

• Expanding Coverage: Fontenot, who played a large role in crafting the Baucus White Paper, laid out the vision for expanding coverage, which has a focus on building on what we've got, reforming existing insurance markets so they have standard (and fair) rules, and instituting an exchange similar to the Massachusetts Connector.

Nelson stressed Waxman's commitment to getting everyone covered through a combination of private and public systems. McDonough made the interesting point that Massachusetts tried to reform its insurance markets in the mid-1990s (guaranteed issue, community rating, etc.) without requiring all individuals to purchase coverage. The result? Premiums doubled the following year. As Fontenot said, you can't have people buying an insurance plan on the way to emergency room.

• Financing Coverage, Financing Reform: All three agreed that we can't require all individuals to obtain coverage without assuring that it's affordable, and making insurance affordable would require subsidies. Fontenot suggested these might be provided through some sort of sliding-scale tax credit and McDonough noted that the tax system was not the only way to deliver this assistance.

In terms of financing those subsidies and reform in general, Nelson suggested looking at spending with a longer time frame. Fontenot agreed, asserting that the focus should be on bending the cost curve and some financing mechanism might look at capping the employer tax exclusion for health insurance to make the system more progressive. McDonough pointed out that the CBO sometimes fails to accurately reflect the savings generated by things like Health IT as they interact to make other potential cost saving mechanisms more effective, (chronic disease management, safety and prevention, etc.)

• Changing the Delivery System: McDonough argued that while health reform debate starts with covering everyone it is closely and necessarily followed by a discussion of how to reform and improve the delivery system. Fontenot noted the broadening consensus on what changes are needed on the delivery side.
  

• Timing of Reform: Soon. Ideally, McDonough argued, health reform would be taken up immediately after the stimulus. Nelson noted that committee chairs want to act swiftly, and know the risk of getting bogged down in details.

 We just got through two very informative roundtables with Dr. Atul Gawande, and Families USA executive director, Ron Pollack. Highlights to come. First, lunch.