Health Politics

Friday, the Kaiser Family Foundation released the latest results of the monthly Kaiser Health Tracking Poll. Public opinion is holding fairly steady from last month's poll, starting a gradual rebound after support for reform dipped during the raucous August congressional recess.

A majority of respondents (55 percent) believe it is more important than ever to tackle health reform right now. By party, that's 73 percent of Democrats and 55 percent of Independents, but only 30 percent of Republicans. A majority of Republicans believe they would be worse off if health reform passes, while only 29 percent of Independents and only seven percent of Democrats believe health reform would hurt them. According to the Kaiser Family Foundation's Mollyann Brodie, 8 out of 10 Americans are in favor of eliminating insurance denials based on pre-existing conditions, making it the most popular of all the reform provisions currently under consideration. The poll also found a majority of Americans are confused about the timetable of reform, thinking insurance market reforms and help for the uninsured will occur immediately after the bill is passed -- in reality, changes will be phased in over the course of several years. 

In the odyssey of health reform, the public plan is the Proteus of our wonkish mythology -- constantly shifting, capable of divining the future, but never willing to give you a straight answer. Sorry, Politico's Pulse already took the soap opera metaphor, "As the Public Option Turns" so we had to get Homeric.

Still, trying to get a handle on where the public plan stands is like wrestling a wet seal.

Earlier in the week, Democratic House leadership felt confident they had the votes to pass a "robust public option" tied to Medicare payment rates, but the latest whip counts suggest the leadership still has some work to get 218 votes in the House.

Meanwhile, in the Senate, Majority Leader Harry Reid (D-NV) is leaning toward including a public insurance option that would allow the states to opt out. The White House is said to favor a trigger option, hoping to keep the Republican Penelope from Maine weaving at her loom.

All this is subject to change, and next week, it will no doubt change again. And the week after that, too.  However, lawmakers should not let the protean politics of the public plan obscure other key aspects of reform. Insurance market reforms like guaranteed issue and community rating, may not have the same siren call of public plan debate, but they are critical in making health reform work.

A new issue brief from the Robert Wood Johnson Foundation and Health Affairs provides a thorough overview of the issue, looking at why insurance market regulation is needed, what's proposed in the various bills, and the possible objections and barriers to proposed solutions.

Health care and bankruptcy. The two really shouldn't go hand in hand. Too often they do.

The Senate Judiciary Committee's Subcommittee on Administrative Oversight and the Courts held a hearing on medical bankruptcy earlier this week, "Medical Debt: Can Bankruptcy Reform Facilitate a Fresh Start?" Subcommittee chairman Sen. Sheldon Whitehouse (D-RI) introduced legislation that would make filing for bankruptcy less difficult for Americans with significant medical debt. His legislation, the Medical Bankruptcy Fairness Act of 2009, would also make it easier for those in medical bankruptcy to keep their homes, according to BNA (subscription required).

The Nationals may have never had a shot at the playoffs, but Washington's senators are still playing hardball in October.

Much of the action centers on the public plan, which has reemerged as one of the central issues in merging the Senate's HELP and Finance bills.

Senate Finance Chairman Max Baucus told reporters on Monday that he believed a "pure public option" did not have the votes to pass the Senate, but that there were many options on the table that could form the basis of a compromise.

Every Christmas, our Uncle Billy makes Italian sausage. In addition to various ground meats, he uses a rotating cast of cheeses and spices, along with the some well-guarded Testa family secrets (our guess: orange zest added to the fennel seeds). It's a big undertaking, full of cranks and casings. But it's nothing compared to the sausage making ahead for Congress on health reform.

The New York Times sets the stage in the House and Senate, laying out the challenges faced by Speaker Nancy Pelosi and Senate Majority Leader Harry Reid as they try to craft legislation that can pass their respective chambers of Congress and be merged into a final bill that President Obama can sign into law.

The challenge for Ms. Pelosi is to write a measure with sufficient coverage and benefits to appease the left wing of her caucus without alienating too many of the moderate and conservative Democrats whose votes she needs. [...]

Mr. Reid may have the more difficult job since Ms. Pelosi, of California, has a larger majority as well as stricter House rules that limit opportunities for Republicans to slow the process.

Unlike many university presidents, former HHS secretary Donna Shalala makes time to teach, and she offers a course on health reform.  When she assigned a paper on how to fix US health care, one student handed in a one-sentence paper:

"Campaign Finance Reform."

Shalala, now president of the University of Miami, gave him an "A."

As an academic, HHS secretary during Bill Clinton's health reform effort (and its aftermath), the head of a large university (which means a large purchaser of health insurance) and, for a time, a member of a health insurers' board of directors ("I wanted to see it from the other side") Shalala has seen health policy from many perspectives.

Addressing  a workshop for writers who specialize in health and health policy in Miami the other night, Shalala said she is increasingly confident that reform will pass.  "I think we are going to get a bill," she said. "You can see the contours of a deal." 

The center of the Democratic party, she continued, was pretty close to where the center of the country is.  Consensus is in reach -- even if we have "a lot of people moaning and groaning."

Much of the debate in Congress right now still centers on the public plan, and the need to make sure there is adequate competition in the new insurance exchanges that would be established under health reform.  We have also written several times about fresh approaches to dealing with malpractice reform, which President Obama has said is overdue.

Senate Democrats recently revisited an old idea that could potentially address both of these challenges -- ending the exemption that medical malpractice companies and health insurers currently enjoy from antitrust laws.

Remember duck, duck, goose? The Senate health reform version might be Snowe, Snowe, Snowe, Collins.

Maine's Republican moderate Sen. Olympia Snowe is currently the only Republican supporting a Democratic-led health care bill. But if the Democrats get down to business, they might be able to lure Sen. Snowe's fellow Maine senator -- Susan Collins (R-ME) -- across the aisle as well.

Over at InsureBlog, Hank Stern takes exception to Len Nichols' thorough debunking of the recent report produced by PriceWaterhouseCoopers for AHIP.

Like the Latin title of Hank's post (Res Ipsa Loquitur...), most of his points speak for themselves.

If he wants to object to the idea that "Good policy research uses nationally and statistically representative data so that its conclusions reflect behavior of the actual population," that's his prerogative.

If he's ignorant of the IRS tax code that governs the non-partisan work of the Robert Wood Johnson Foundation and the Urban Institute, well, we guess that's fine, too.

But if he thinks there's no difference between the research produced by such independent institutions and stuff that's made to order for private interests, he should take a look at the work PriceWaterhouse did for the tobacco industry in the early 90s. An independent review of that study found "serious methodological problems and errors of omission." (h/t Media Matters) The same could be said of their latest work. AHIP got what it paid for and InsureBlog should be less credulous of the talking points it's buying.

The hope of bipartisan and comprehensive health care legislation lives on today thanks to the vote in the Finance Committee of Sen. Olympia Snowe (R-ME).  The bill reported out of the Finance Committee is bipartisan.  Not just because it received support from members of both parties, but because you can see both Republican and Democratic values in the solution. 

For Republicans, the bill relies heavily on market forces and incentives, and it slows the rate of health care cost growth to the tune of reduced budget deficits.  For Democrats, the bill finally provides all Americans access to quality health coverage and strengthens the Medicare program for our nation's seniors. 

As Sen. Snowe and others said, this bill is not perfect.  It will likely be improved along the way.  But it does get serious about solving the access, quality, and cost problems in our health system.  While addressing these challenges on a bipartisan basis requires tough choices, it does not require lawmakers to abandon their underlying goals. It is in her willingness to find policy solutions that will actually solve our health care crisis that Sen. Snowe outshines her colleagues on her side of the aisle on the Finance Committee. 

Let the record show that the Senate Finance Committee approved bipartisan health reform legislation today, and that America took a giant step toward becoming a better country.