Coverage

When Bill Frist was Senate Majority Leader, he did not advance the cause of comprehensive, bipartisan health reform and will be remembered for his role in the Schiavo case (although he did take heat for working with Democrats to expand federally-funded stem cell research). Mostly he pushed for malpractice reform (in a very partisan model) and for small business purchasing pools (also from a GOP perspective).  If there were compromises to be had under his watch, he didn't have them.

Better late than never.

We've watched Frist over the past few months. As we've noted, he has backed a fairly expansive approach to prevention and population health, and recently endorsed the individual mandate (which was a centrist Republican idea before it became a Democratic idea). Now he tells Karen Tumulty of TIME that he'd vote for the Democratic health care reform bill in Congress -- even if there's a lot in it he isn't crazy about. (He later told ABC News Radio that he doesn't like the Baucus bill as currently drafted, according to the Politico.) 

We get so caught up following the health reform goings-on in Washington that we sometimes forget how desperately important it is to real people -- like cancer patients. Health reform will only be as good as its ability to improve the health and welfare of all Americans -- including those who are sick or who have been sick.

Emphasizing patients over politics, the American Cancer Society Cancer Action Network asked Dan Brodrick of Gainesboro, Tennessee to tell his story. Watch it here:

A recent statement from the Senate Finance committee outlined how small business health insurance exchanges, tax credits, and grants for workplace wellness as part of health reform would all make quality coverage more available and affordable for small businesses. In this guest post, San Diego small business owner Vince Mudd explains why he -- and the workers he insures -- can't wait. Mudd is CEO of San Diego Office Interiors, a design-build interiors company and the president of International Realty and Development.

Through his involvement in the regional Chamber of Commerce, the San Diego Regional Economic Development Corporation, Campanile Foundation at San Diego State University, and State Compensation Insurance Fund, he has worked to ensure that health related issues -- and their impacts on small business -- are understood by policy makers, business people and the public.

Many politicians and pundits claim that efforts to reform our health system are moving too quickly. Yet for millions of small business owners like me, health reform cannot happen soon enough.

The idea that we can solve our health care problems by allowing people to buy an insurance policy "across state lines" sounds tantalizingly easy. Unfortunately it's not true. It will make our problems worse and be devastatingly risky for many Americans. Yet the idea has been resurrected in bills proposed by the Republican Study Committee (RSC), Congressman John Shadegg (R-AZ), and Senator Jim DeMint (R-SC).

Don't be fooled: without significant and nationwide market reforms (like those put forth by the committees of jurisdiction in both the House and Senate), selling health insurance across state lines will lead to less-comprehensive insurance packages, higher costs for families, and reduced access to care. It is a step backwards for not only our insurance markets, but also, and more importantly, for the American people who struggle every day to secure quality, affordable coverage.

Last year, New America published a detailed explanation of why this policy is an unviable solution. Our paper and two-page summary can be found here, and previous blog posts can be found here, here, here, and here. But this is the bottom line:

The public plan option, in the Senate at least, is beginning to remind us of one of those really really convoluted word problems back in sixth grade math.

"If there are 60 Democratic senators, and 50-something (maybe) back the public plan and none really want to kill health care reform but 15 want to make the playing field more level and four want to leave it to the states, and two are named Nelson and twenty are up for re-election and 9 come from red states... and one is named Reid" how many cookies did Johnny eat?

And would Johnny have eaten all those cookies if he had better primary care?

As Congress debates the details of health reform, it may be valuable to recap the high cost of doing nothing. 

A new Urban Institute report examines the likely impact of another health reform failure on insurance coverage and government, employer, and family spending in all 50 states. In The Cost of Failure to Enact Health Reform: Implications for States, the Urban Institute uses the Health Insurance Policy Simulation Model (HIPSM) to project cost and coverage implications for the worst case, intermediate case and best case scenarios.

As you might expect, even the "best" case scenario is none too good. Under any scenario, the status quo would significantly add to the financial burdens of Americans of all income levels. Middle-class families would fare the worst.

Let's take a look at a reform-less United States of America in 2019:

Every slide comes to an end, and the latest Kaiser Health Tracking Poll finds that public support for health reform increased from August to September.

As with previous polls, a majority of American's continue to support health reform, with 57 percent of respondents saying it is more important than ever to address the issue -- a 4 point increase from August's survey. The percentage who said their family will be better off also increased six points (42 percent vs. 36 percent in August), as did the share of those who think the country will be better off if health reform passes (up eight points from up eight from 45 percent in August to 53 percent).

Democratic support for reform remains steadily high (77 percent favor tackling reform now), and the shift in polling reflects a softening in opposition from Republicans and independents. The percent of respondents who felt they would be worse off if reform past fell by 12 points from August to September for Republicans and by 10 points among independents.

As we noted in our wrap up of last week's Senate Finance proceedings, one of the biggest issues for health reform going forward is the question of affordability. Over at the New York Times Prescriptions blog, David Herszenhorn weighs-in:

Democrats proposing an overhaul of the American health care system have gotten themselves locked in a box around the question of affordability.

This is not the question of whether the proposed health care legislation is affordable for taxpayers and the federal government -- an issue that seemed to be answered when the Congressional Budget Office said the Senate Finance Committee's bill would eventually help reduce federal budget deficits.

The affordability question vexing Democrats is whether those with moderate income will be able to afford health insurance, even with the subsidies the legislation would provide and all sorts of new rules aimed at controlling costs.

Herszenhorn suggests that so-called curve bending provisions of the legislation -- the stuff that will lower rates of health care inflation and reduce overall costs -- will take too long, while raising the subsidies would cost too much. He thinks one option available to Democrats is to lower the affordability threshold for the individual mandate so that more individuals and families would be exempted from a requirement to purchase insurance. (Currently, individuals and families would be exempt if the cheapest option available, with subsidies, cost more than 10 percent of their income.)

While Herszenhorn's piece is certainly to attune to the political challenges of health reform, we think his take on the policy options available is a bit too glum.

With the Senate Finance Committee still to debate how (or if) to include a choice of public health insurance plan or co-op in the new insurance marketplace, it is a good time to clarify the implications of a public plan that takes effect when competition is lacking or prices are too high, the so-called "trigger" option. Senator Snowe (R-ME) is expected to introduce a version of this idea in an amendment to provide a "safety net fallback plan to ensure access to affordable coverage."

The amendment (Snowe Amendment # 1 - Coverage, p. 207) would establish a non-profit government corporation to offer a competing plan in any state where 5 percent or more of its residents do not have access to "affordable" coverage (with affordable defined consistently with the original Chairman's Mark on a sliding scale between three percent and 13 percent of income for individuals between 133 percent and 300 percent of the federal poverty level (FPL). Chairman Baucus has since modified his mark, moving the sliding scale affordability test to between two percent and 12 percent of FPL. More than likely, Senator Snowe will modify her amendment accordingly. 

Some have argued that a "trigger is an excuse for not doing anything." This assertion is simply wrong. It should not get in the way of serious consideration of this viable option.

During mark ups of the America's Healthy Future Act in the Senate Finance Committee yesterday afternoon, Senator Chuck Grassley asked Chairman Baucus if he should book a plane ticket home or if they would be their all weekend.

It looks like the ranking Republican from Iowa got his wish, as the Senate Finance Committee adjourned at 12 pm Friday. The Committee will resume markups next Tuesday, when, as Politico reports, they are expected to take up amendments related to the public health insurance option.

So while we wait patiently for what may be the most closely watched debate in C-Span 3's history, here's rundown of some of the major changes to the chairman's mark, as well as some outstanding issues going forward: