Sen. Olympia Snowe holds private meetings to discuss fallback public plan

Sen. Olympia Snowe (R-Maine) last week held a private meeting to discuss a compromise on health care reform legislation that would include a "fallback public plan," implemented in several years if private insurers do not take steps to make coverage more affordable and accessible, CongressDaily reports.

The plan is modeled on the Medicare prescription drug benefit, under which the government can offer prescription drug benefits if private insurers choose not to do so. The government currently does not offer a Medicare Part D directly plan because a sufficient number of private firms have done so.

According to CongressDaily, Snowe is seeking to go further than the fallback option under Part D, in which success is measured on the number of participating insurers. Snowe would measure success by the affordability and accessibility of private plans.

Snowe has had conversations regarding the plan with Senate Finance Committee ranking member Chuck Grassley (R-Iowa) and Sen. Orrin Hatch (R-Utah), CongressDaily reports. In addition, Sens. Ron Wyden (D-Ore.) and Thomas Carper (D-Del.) also have expressed interest in the proposal.

A Republican committee aide said that a public plan that offers the same benefits as private plans and is funded by money from premiums rather than taxpayer money, such as that proposed by Sen. Charles Schumer (D-N.Y.), could be put in place if private insurers fail. The aide said, "If you've done everything you possibly can, and you don't get the result that you need, then a lever there might be helpful as long as the lever doesn't take over the whole system" (Edney, CongressDaily, 5/19).

Other Reform News

• Baucus: Senate Finance Committee Chair Max Baucus (D-Mont.) has "made it clear that he wants to craft a bill that passes ... with a huge majority of Democrats and Republicans," NPR.org reports. Baucus' detractors include advocates for a single-payer plan, which Baucus said would be too drastic of a change for the nation to take on, and those who are concerned that he is too willing to give up on creating a public insurance plan in order to compromise with Republicans. However, Republicans have been "cautiously pleased with [Baucus'] inclusive process," NPR.org reports. Baucus said, "I just want to take advantage of this opportunity where the stars are aligned; it seems to be the time now to finally get the job done, to get meaningful health care reform in this country" (NPR.org, 5/19).
• Huckabee: Former Arkansas Gov. and presidential candidate Mike Huckabee (R) said health care costs would most effectively be addressed by corporate initiatives that seek to improve the health of employees, the Pittsburgh Post-Gazette reports. Huckabee, speaking on Monday at a health summit in Pittsburgh hosted by insurer Highmark, said workplaces need to introduce incentives that would convince employees to take a greater interest in their own health. He added that preventive care needs to replace intervention as the goal of health care providers, noting that doctors are paid based on treatment provided rather than on the health of their patients. Huckabee said he has little faith that Congress will enact comprehensive health reform because "politicians do not typically engage in policy changes that aren't going to be realized within their re-election term." Huckabee added, "Don't look for Congress to fix this. It's going to be fixed in the private sector when companies start showing a better profit, and a better return, because they have healthier employees" (Toland, Pittsburgh Post-Gazette, 5/19).
• Obama: The Wall Street Journal on Tuesday examined President Obama's "unusual" approach of "laying out the big picture" on "his top priorities," including health care, and "letting lawmakers fill in critical details." According to the Journal, Obama's strategy provides him more opportunities to succeed on these matters, but also runs the risk that Congress' decisions could "undermine his goals or embarrass the administration." White House Office of Health Reform Director Nancy-Ann DeParle said that Obama wants to lower costs and achieve universal coverage, adding, "If we achieve those two principles, it will be a victory." A congressional aide working on health care legislation said, "They want a bill to pass, and are happy to leave the details to Congress," adding, "They provide technical support when asked, and they seem to recognize that they will have to help us with the politics later down the road," but "they are definitely not pressing a particular point of view or specific policies" (Meckler, Wall Street Journal, 5/19).
• Mandates: Many members of the Senate Finance Committee have acknowledged that mandating all U.S. residents be insured could be necessary to lower costs for people who already have insurance, but the "concept has yet to be thoroughly tested with voters," Politico reports. Proposals put forward by Senate members last week would require that everyone have insurance by 2013; individuals who choose to forgo coverage would be charged an excise tax of as much as 75% of the premium of the lowest-cost health plan in their geographic area. Obama's aides have said he would not reject such a provision in a reform bill. Baucus and others have attempted to portray the proposal as "shared responsibility," a wording that has proven effective with the public, according to a poll last year by NPR and the Kaiser Family Foundation. In the poll, when asked about a proposal to "place requirements on individuals, employers, the government and insurance companies so that everyone shares responsibility" for providing coverage, 59% of respondents said they would support the plan and 33% said they would oppose it. However, when asked about "requiring individuals to have insurance" or pay a fine, 47% of respondents said they supported the plan and 44% said they opposed it (Budoff Brown, Politico, 5/19).
• Republicans: House Republicans and others at a Monday meeting of the Republican Congressional Health Care Caucus said health reform must focus on quality of care while dealing with the issue of cost, CQ HealthBeat reports. Caucus Chair Michael Burgess (R-Texas) said quality is important to both patients and doctors, but he noted that the concept is "hard to define" and "hard to measure." Mark McClellan, former CMS administrator under former President George W. Bush, said that "there is some reason for optimism in this round of health care reform" because it is focusing on improving care while lowering costs. He noted that under the current payment system, doctors are reimbursed less by Medicare if they seek to coordinate care or provide preventive advice. According to McClellan, who now works for the Brookings Institution, quality measures, payment changes and benefit changes all are required to improve quality of care. He promoted the idea of capping Medicare payments to allow doctors to keep part of the net savings achieved by more efficient approaches to care. He also said that proposals to provide people with subsidies for purchasing private plans would help get "people involved in decisions about their coverage and their care," and "work to (drive) new ways of designing benefits, new ways of paying for care that can lead to better outcomes" (Norman, CQ HealthBeat, 5/18).
• Taxes: White House Office of Management and Budget Director Peter Orszag on Sunday in an interview with CNN's John King said the administration has not ruled out the possibility of changing the tax-exempt status of employer-sponsored health benefits, the Journal's "Health Blog" reports. When asked about the potential for taxing these benefits to fund reform, Orszag said, "It was not in the president's campaign plan, it wasn't in our budget. Clearly, some members of Congress ... are putting it on the table and we are going to have to let this play out." He added, "I think it's premature to be commenting on individual items. We're looking for a comprehensive plan that brings down costs and expands coverage, and there are lots of ideas that are being put on the table and that is exactly how it should be" (Rubenstein, "Health Blog," Wall Street Journal, 5/18). A transcript of the CNN interview is available online.