By Jason Kosena
THE COLORADO STATESMAN
Many in Washington, D.C., are calling health care reform “legacy” legislation for Democrats in Congress.
With strong Democratic majorities in the House and the Senate and with President Barack Obama steering the discussion, a major overhaul of the health care system is the Number-One-with-a-bullet priority for the party that has been clamoring for health care reform for more than two decades.
For the backers of the overhaul, “legacy” evokes a precious gift handed down from one generation to the next.
But for skeptics, its meaning is closer to a recent coinage that turned previously “toxic assets” into “legacy costs.”
The skeptics in Congress have been erecting roadblocks, hampering the progress that had been gaining speed after Obama took office.
Democratic leaders in the Senate are struggling to find ways to pay for the overhaul, which could run a tab of $1.5 trillion. A plan to tax employer benefits fell flat last week and gave rise to a $600 billion piece of legislation that passed the Senate Health Committee Wednesday on a party-line vote.
The bill — only a sliver of health care reform — would require all Americans to get health insurance while taxing businesses to pay for it. It also would offer government assistance to enable low- to middle-income Americans to pay for the coverage.
The House is making its own progress — at least what Democrats consider progress.
House Democratic leaders offered their version of reform Tuesday afternoon, introducing a measure that would create a government-run health insurance option and prohibit insurers from denying coverage to people because of pre-existing conditions.
It also requires individuals to obtain coverage and imposes a penalty of 2.5 percent on the income of those who don’t comply. Businesses that don’t comply would be charged 8 percent of a worker’s wages. The plan, which Republicans have promised to oppose, would pay the hefty tab by imposing a new tax on the wealthiest Americans and by making cuts to Medicare and Medicaid.
The push for urgency has been spearheaded by Obama, who made daily appeals this week urging Congress to act on the legislation before their August break. National media outlets also reported that Obama has been leaning on top of Congressional leaders behind the scenes, telling them that if health care reform doesn’t pass, the Democratic Party could see bruising losses in the 2010 midterm election.
The fight to reform
Although politicians on both sides agree on the essentials — that health care should be less expensive, that quality of care is of the utmost importance, and that people with pre-existing conditions shouldn’t pay more for their insurance than anyone else — finding a way to reach those goals has led to an emotional and sticky debate.
Some Democrats — including 1st Congressional District Rep. Diana DeGette, of Denver, and 3rd Congressional District Rep. Jared Polis, of Boulder — believe a “public option,” or a government-sponsored health care plan, is the only way to reel in the high costs of insurance premiums and create an affordable method of care for Americans. Advocates of the public option say that inserting government into the health care free market would force private insurers to reduce rates that have been rising by 10 percent to 30 percent annually.
“I think you need to have a public option,” DeGette told The Colorado Statesman last week. “But, it has to be subject to the same requirements that are in the private plans.”
“A public option that would help keep the private insurance industry honest is an important option,” Polis told The Statesman last week.
But opponents, including many Republicans, believe that instead of decreasing costs, a public option will put the United States in the fast lane toward a government takeover of the health care industry. The same opponents say any reform measures that include a public option would reduce open-market competition and provider options.
Republican 5th Congressional District Rep. Doug Lamborn, of Colorado Springs, calls a public option “a flawed line of argument.”
“Right now, there are 1,500 private plans out there,” Lamborn said in an interview with The Statesman this week. “If the government plan were truly only one more competitor, I wouldn’t have any problem, but they are not going out there to spend a trillion dollars to create a plan that is like all the others.
“The government plan would not be operating on a level playing field,” Lamborn continued. “It would set the rules. It would have negotiating power … and it does not have to operate at a profit. In fact, it doesn’t even have to break even.”
Lamborn could be right. Opponents of a public option have spent weeks pointing to studies that show the
only government-run health care programs in the country today, Medicare and Medicaid, pay far less to hospitals for services than private insurers do.
Private insurance companies have lobbied hard against a government option, arguing that their customers must pay more for health care to compensate health care providers for the lack of payment by Medicare and Medicaid.
“It’s a bottomless purse,” Lamborn said.
The Republican Party, often called “the party of ‘No’” by Democrats, hasn’t stood by quietly, however. Although members have differing views on the proper reform, most agree that a “free market” system will bring prices down faster and more efficiently than a public option.
Some congressional Republicans have suggested scrubbing a public option in favor of a program that would give tax benefits toward the purchase of health insurance. Under current tax code, although businesses receive tax credits for purchasing insurance for employees, employees and the self-employed do not.
The plan hinges on the premise that people would use their tax credits to shop for the best deal on health insurance, much in the way they shop for car insurance.
Free market principles suggest that if millions of Americans were shopping for health insurance, competition for their business would be keen, and insurance companies would have to cut rates and increase service to attract business.
“Through a new tax policy I think we can do a better job of encouraging people to purchase their own health insurance through tax incentives,” 6th Congressional District Rep. Mike Coffman said last week.
“I think we should provide subsidies for those who can’t afford their own coverage, but it should be done through a system of private carriers and not through the government,” the Aurora Republican said.
Politics? What politics?
While Democratic members of Colorado’s congressional delegation who hold safe seats have been embracing change, those whose districts tend toward purple rather than blue have been aloof. But the pressure on the middle of the road Democrats is growing intense.
Senate and House Democratic leadership is whipping hard for support of the reform packages, including a public option. The White House is not far from the sidelines either. But private health insurance companies have been putting pressure on moderate Democrats to oppose such a plan, and it won’t be easy for them to decide.
Organizations on both sides of the debate have run targeted television ads in the districts of some moderate Democrats in an attempt to drum up support, and the White House is using Obama’s campaign organization to fund pro-health care ads across the country.
In addition, beltway insiders say that although the debate is raging publicly, Obama has made it clear privately that health care reform is the issue he most wants to see resolved during his administration.
Democratic majorities in Congress were large enough to allow a few Democrats to vote “no” on the budget or the stimulus package or the Cap and Trade bill while leadership looked the other way. But health care reform is an “all hands on deck” issue for the president, and everyone is expected to fall in line.
The pressure on moderates is causing heartburn among some Colorado Democrats, including 4th Congressional District Rep. Betsy Markey, of Fort Collins.
When interviewed by The Statesman earlier this month, Markey said she wants reform that will reduce consumer costs, maintain quality and cover everyone.
She would not, however, say whether she supports a public option similar to the one House leaders introduced this week.
“I think all options are on the table right now,” Markey said.
Markey’s chief of staff, Anne Caprara, told The Statesman that the freshman’s vote on health care reform could end up being the hardest she’ll cast.
“She is very worried about a health care bill, period. She is very worried about it,” Caprara said. “The cost is a huge concern. If we have a bill that we can’t pay for, it’s not going to get through.”
While Markey is struggling with the decision, 3rd Congressional District Rep. John Salazar, of Manassa, is agonizing over it.
Salazar, a member of the powerful Ways and Means Committee and the Blue Dog coalition, voted against the Cap and Trade bill and hasn’t said whether he’ll support the Democrats’ health care reform bill.
Despite repeated requests for an interview by phone and e-mail, Salazar was the only member of the Colorado congressional delegation who would not agree to one. In a written statement sent to The Statesman, Salazar said all Americans should have access to health care and reiterated his belief that no reform plan should create a deficit.
When interviewed by The Statesman last week, 7th Congressional District Rep. Ed Perlmutter, of Golden, declined to say whether he supports a reform model that includes a public option. Perlmutter talked instead about what he hopes reform will accomplish.
“I say the biggest piece for me is that there not be discrimination in health care,” Perlmutter said.
“I have a daughter with epilepsy, and she didn’t choose that as much as the color of her skin or her gender,” he said. “That is her chemistry — and so much money goes into underwriting and into insurance companies saying that ‘You have a pre-existing condition and we are not going to insure that.’ I want to see that all Americans, without discrimination, have health care coverage.”
Perlmutter’s stance is similar to that of U.S. Sen. Mark Udall, of Eldorado Springs, who said affordable, accessible health care should be available to all individuals regardless of pre-existing conditions and income levels. Udall’s office said the Democratic senator would review all the reform options before making a decision.
Udall, who was elected to his first Senate term in 2008, doesn’t face as much pressure on the issue as his counterpart, Sen. Michael Bennet.
Bennet, appointed by Gov. Bill Ritter to fill out Sen. Ken Salazar’s remaining term, is running to retain his Senate seat in 2010. Reprising his style in addressing some other notable pieces of legislation, including the Employee Free Choice Act, or card check, Bennet hasn’t indicated his position on a public option.
When contacted by The Statesman for an interview, Bennet’s office pointed to comments he made on the Senate floor that described in vague terms what he believes reform should look like.
A small group of protesters staged a rally at Bennet’s downtown Denver office last week to demand he take a position on supporting a public option and to show their support for a single-payer system. Bennet, who was in Washington at the time, had staffers come out to talk to the crowd and answer questions. The staffers said Bennet is studying the different reform models, including the public option, before making a choice on which is the best.
Although the health care reform debate has centered on the need for a public option, other cost cutting methods are being discussed.
Coffman and Lamborn, Colorado’s only Congressional Republicans, believe it’s possible to decrease the cost of health care for Americans by changing the way health care providers operate rather than by altering the insurance system.
Lamborn suggested it would be helpful to pass litigation reform to make it more difficult for malpractice suits to be brought against providers. Advocates of litigation reform say physicians order unnecessary tests and medical procedures because they need to protect themselves from litigation.
“The climate in Colorado is not as expensive for providers (for malpractice insurance) as it is in most other states, but there is still a tremendous amount of defensive medicine that goes to ward off lawsuits,” Lamborn said. “It’s a problem that we can fix that can save money.”
Coffman, who strongly believes Americans should be able to shop for their own insurance, said he believes the lack of transparency in the current system makes insurance much more expensive and could be repaired.
Because plans from different providers have so many clauses and stipulations, it’s difficult to compare prices and plans, which is the bedrock of a free market system.
“I think the system isn’t very transparent. Policies are not transparent, and it’s very hard to compare one policy to the next,” Coffman said.
“I think the government could have uniform standards in health care policies at the national level … so that everybody can readily assess that in this basic package, here are five different health insurance carriers and here are the rates that they are charging,” Coffman added.
But Democrats, including Polis — who believe the best cost reducing formula is a public option that creates real competition with the private insurers — agree there are ways to reduce the cost that go beyond coverage plans.
For example, Polis said health providers who focus on lasting wellness rather than particular care issues could save billions in the end.
“We need to work on providing more preventive care,” Polis said. “We need to work on reducing the incidence of diabetes rather than treating (it) in a very expensive way.”
For her part, DeGette said a focus on offering quality care, monitored by a “Quality Commission” would help reduce costs, while Sen. Michael Bennet believes health care coaches can help.
Bennet is working to introduce legislation that will create incentives to encourage communities to hire and train medical technicians to act as transition coaches for patients leaving the hospital.
Although his office declined an interview request with Bennet, a representative said readmission rates could be cut dramatically if outgoing patients had someone to call for advice rather than heading back to the emergency room.
“We know there is data out there, data that comes from Colorado where this idea has been implemented, that shows this can save money,” said Deirdre Murphy, Bennet’s spokesperson.