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Racing against the clock on health care

By
July 8, 2009

President Barack Obama is struggling to show progress in a race against the clock to revamp the nation’s health care system this year.

Problems in Congress threaten to overshadow a White House event Wednesday designed to boost Obama’s health overhaul.

Leaders from hospital industry trade groups were expected to appear with Vice President Joe Biden to announce that hospitals are ready to give up about $155 billion over 10 years in government payments. The money could then be used to help pay for covering millions of uninsured.

But Congress, not the health care industry, is the source of Obama’s troubles.

Lawmakers returned Tuesday from their July 4 break with lots of questions about the complex legislation and deep misgivings about key elements under discussion.

Democratic senators in particular are having second thoughts about a proposed new tax on generous health insurance benefits provided by some employers. Without the tax — Republicans favor it as a brake on cost increases_ the prospects for a bipartisan deal in the Senate appear to be in jeopardy.

Obama’s ambitious timetable for passing a bill this year keeps slipping. Timing is critical because lawmakers might be reluctant to vote on such a charged issue as health care next year, when all House members and one-third of senators face elections.

"We’re not there yet," said Sen. Max Baucus, D-Mont., who, as chairman of the Senate Finance Committee, has spent countless hours seeking a compromise with Republican colleagues. "I’m trying the best I can to get there soon."

Another senator deeply involved in the bipartisan negotiations said the proposed new tax on the costliest employer-paid insurance benefits is quickly losing favor with Democrats.

"It’s clearly a very difficult issue," said Sen. Kent Conrad, D-N.D., citing recent polls. "You go to the public to ask them what they think and they don’t like it."

A compilation of surveys reviewed by senators showed at least 59 percent of the public opposed to taxing health care benefits to "pay for reform."

As a result, Conrad said, "we’re looking at other options" to help finance a bill whose price tag is expected to reach $1 trillion or slightly more. Those other options may be hard to sell to Republicans whose support Baucus has been cultivating.

Baucus has long championed a tax on health benefits as the best way to pay for health care while simultaneously restraining the growth of the cost in coverage in the future. But the idea has drawn strong opposition from organized labor, a core Democratic constituency. House Democrats have been highly resistant, too, and Obama campaigned hard against it in last year’s run for the White House.

The deal with the hospitals — the one bright spot right now for Obama — may also be on shaky ground. Officials said it’s pegged to the Senate Finance Committee legislation that Baucus is negotiating, and whose prospects are uncertain. It would follow concessions from drug companies, and an announcement by Wal-Mart last week that it would support an employer requirement to help pay for health care.

Of the $155 billion in projected savings, about $40 billion to $50 billion would come from reducing federal payments hospitals receive for providing care to uninsured and low-income patients, according to lobbyists. Those payments are now made through the Medicare and Medicaid programs. The Medicaid cuts would be apportioned by state, as 10 percent annual reductions beginning around 2015.

About $100 billion more would come from reductions in planned Medicare payments to hospitals. A small amount of savings would come from trimming the money hospitals get for preventing patients from being readmitted for additional care.

Hospitals would also get something out of the deal. They won an agreement that if the Finance Committee’s legislation includes a public health insurance plan, it would reimburse hospitals at above the rates Medicare and Medicaid pay, which hospitals have long complained are insufficient.

The issue of a government insurance plan to compete against private companies continued to inflame sentiments on both sides of the political aisle. Republicans remain solidly opposed. Democrats, citing polls that show the public is open to the idea, are talking about a showdown on the issue.

In a sign of higher-level concern over the pace of bipartisan talks, Senate Majority Leader Harry Reid told reporters he intends to meet Wednesday with a small group of Republicans who have been involved in the discussions. While Democrats and the White House have said they would prefer a bipartisan bill, they also must be careful not to let the talks drag on so long that they fall hopelessly behind schedule.

Similar efforts were under way in the House.

It’s still unclear whether the difficulties are enough to imperil Obama’s objective of signing a health care bill this fall, or whether they were merely the type of obstacles that emerge any time Congress attempts to pass major legislation.

House Speaker Nancy Pelosi has set a target of month’s end to enact health care legislation, while in the Senate, Reid hopes to complete legislation by the end of the first week in August.

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Associated Press writers David Espo, Erica Werner and Alan Fram contributed to this report.

4 Responses to Racing against the clock on health care

  1. RSW

    July 8, 2009 at 3:52 pm

    There is no solution to health care reform as long as stockholders’ interests are in the mix. Employer offered health benefits have been covered elsewhere, and if you lose your job, are self-employed, or otherwise not in this loop, the cost of decent private health coverage may not even be a solution worth considering.

    That our health is subject to the bottom line dividends and the “I didn’t profit enough from my stocks this year, so I guess I’ll put my money somewhere else” attitude (which is fair if you make a living through capital gains) needs to be removed from the equation altogether. Until this happens, any compromise among the private and public sector interests is doomed, and the interests the insurance and pharmaceutical industries have is preserved.

    All of us must be covered. If it takes time for some services to be scheduled, so be it. Under the current system, those services aren’t available to the uninsured, and if they are given anyway, they get written off or are performed at the expense of the public sector, which becomes the monied source of last resort. The argument that life saving services must happen right now means nothing to someone with no health insurance.

    The last thing we need is a basic public system that provides little and grants room for insurance companies to sell us riders for everything that we do need.

    In the last hundred years or so, the health care as free market experiment has tended towards bankruptcy, as no one can afford its arbitrary care anymore. It’s obvious that something needs to be done. But prioritizing it the same way that we got Homeland Security, the bankster bailout (which is not yet done, and doesn’t even seem to have a “trickle down effect”) just leads more good money after bad, Washington’s solution to everything.

    And don’t ask your senators or congress critter to understand. They’ve made sure to have taken care of themselves at our expense while lining their pockets through the insurance industry, which has bought out hospitals, doctors, and so forth; and the drug industry, ’nuff said.

    There is no quick fix for this. But that’s what we will get: just another band-aid on top of the body cast that has gripped our health care system for many years, now. Shouldn’t we should force our representatives to slow down and do the right thing, whatever that may turn out to be?

    Oldernwiser

  2. sherry

    July 8, 2009 at 5:34 pm

    Older, I agree all of us need coverage.
    I was all for a national plan until I got a load of the Medicare Part D, and started wading thru that mess for my mother. Lord have mercy.
    Medicare is literally being robbed under Part D.
    The law forbids Medicare from negotiating drug prices, so the recipient is charged full retail, and lo and behold, once you have incurred 2K, you are in the “donut hole” which means you are out of pocket another 2K until you are eligible for benefits again.
    It’s insane. NO insurance company pays sticker.
    However, private insurance companies under the guise of HMO are negotiating these prices, while charging Medicare the entire price. They are getting RICH, while Medicare is going broke.
    We need a solution. I simply don’t trust lobbyist owned Washington to do the right thing.

  3. Janice

    July 8, 2009 at 9:34 pm

    Part D is a prime example of what the private insurance industry will offer, and why they do not want a public option for Americans. They can keep profiting from our tax dollars under the guise of providing options for health care.
    If we want real health care reform, we MUST have a public option.

  4. sherry

    July 8, 2009 at 11:42 pm

    Janice, I agree with you. Private insurance will never stand for it of course.
    My mother was told she can no longer buy Medicare AB or D directly, which is a LIE.

    She was quite upset at the changes in her policy when I suggested she just go back to Medicare. That is when she told me she was stuck with private insurance.

    I told her Medicare is cheaper and she will have better coverage. Come open enrollment, Mom is back to Medicare.

    Now how many seniors are out there thinking they can’t buy Medicare direct? I am betting it is a lot.