Medical Device Daily
When it comes down to implementing a plan for healthcare reform, President-elect Barack Obama has a few things going for him that the Clinton administration didn't have when it tried to push through its plan for universal coverage nearly 15 years ago.
Those extra little somethings include a climate that has lobbyist and interest groups (the same entities that maligned Clinton's attempts) on the same page for some type of reform, and Sen. Max Baucus (D-Montana), who has just floated an 89-page plan much similar to Obama's.
"Fifteen years ago when the Clinton [administration] introduced [a plan for healthcare reform] from the time they announced that they were moving in a health reform initiative to the time something substantive was sitting in front of the congress it took several months," Ken Thorpe, executive director of the Partnership to Fight Chronic Disease (Washington), said during a press conference last week. "I think the good news for those who'd like to see a reform package pass is that the legislative outlines of it are there. I think the opportunity legislative specs will happen in January and February. So for an Obama administration that, if they so choose to move on this early, they already have a legislative vehicle to do so."
The organization held the press conference to discuss what the climate of healthcare reform looks like after the election, and to discuss how the Baucus plan impact on such measures.
Baucus' plan would have most employers be required to offer insurance to their workers or pay into a fund, with the contribution based on the size of the firm and its annual revenue. Small employers would get a tax credit if they offer insurance, with the size of the credit based on the size of the company and its earnings.
The only difference is that Baucus' initiative is a mandate, something Obama touted against on the campaign trail.
"As I read the plan through, it really is a more detailed explication of what Obama had in his major plan, because it does focus on primary prevention and modernizing the delivery system to more effectively manage chronic disease," Thorpe said.
There has been shown to be a direct correlation chronic illness and the lack of healthcare. A study titled "Chronically Ill and Uninsured: A National Study of Disease Prevalence and Access to Care in U.S. Adults," published in the Aug. 5 edition of Annals of Internal Medicine, reported that more than 11 million Americans with chronic physical illnesses aren't getting the medical care they need because of a lack of health insurance (Medical Device Daily, Aug. 8, 2008).
While a universal plan seems like the clear path to take, the cost in doing so could give lawmakers pause between signing off on such sweeping reform. But trying to lock down an exact figure during this time could be difficult.
"Medicaid expansions, addressing those in poverty, the S-CHIP reauthorization, making healthcare affordable for families up to four times the poverty line ... any of these plans are going to be in the low triple digits," Thorpe said. "In combination you're probably looking at something in the low $100 billion range, depending on the health plans they end up with and how generous the subsidies are, and a bunch of really key design decisions that have yet to be made. So, at this point, I don't think you can really speculate on what the number is because most of the key decisions that would drive [the reform plan] have not yet been made."
Thorpe was questioned specifically on a part of Baucus' plan that would reduce payments for Medicare Advantage plans.
"Isn't the whole theory behind those plans is that they manage chronic disease and reduce healthcare costs?" Carrie Ghose of Columbus Business First asked. "So, if these for-profit companies that are managing these plans start exiting the system because the rates have gone down, it's kind of like you're unraveling one arm of the sweater to knit the other arm."
Thorpe offered a short interpretation of how the plan could get around this.
"If you look at the back end of his proposal, one thing he does talk about as a middle ground on Medicare Advantage is to say, for those Medicare Advantage programs or plans that move toward being a full-fledged medical home using the NCQA criteria, that at least in the interim there would be payments above 100% of fee-for-service as a way to try to build that type of medical home capacity more generally," he replied. "That's particularly, I think, opportunistic in the Medicare Advantage plans that are fee-for-service."
Thorpe said healthcare reform seems "very likely" this year, and not just as lip service.
"Certainly, the process is different. I think an important thing to keep your eyes on is the process in the Senate. As this progresses, I think that the House will start working with the Senate on putting together a consolidated plan as well. So rather than waiting months and months for the administration to produce a healthcare plan, the Congress will already have produced one very quickly."