Searching for consensus, Dems consider potential of paring back health reform

The New York Times: "Passage of a comprehensive [health] bill looked impossible after the Democrats' loss of a Senate seat in Massachusetts. As an alternative, lawmakers in both parties said, some pieces of the bills already passed by the House and the Senate could be pulled out and packaged together in a measure that would command broad support."

The piecemeal reform could include ensuring that insurers could not deny coverage on pre-existing conditions to children; allowing parents to keep their children up to age 25 or 26 on their insurance policies; expanding Medicaid through financial incentives for states to cover childless adults and parents; offering grants to states to establish insurance exchanges; extending tax credits to small businesses to allow them to cover more workers; and ridding the system of out-of-network costs for emergency care. Additionally, Medicare reimbursement changes could be included to reward providers of "high-quality, lower-cost care." Lawmakers would also like to close the Medicare prescription coverage "doughnut" hole (Pear and Herszenhorn, 1/21).

NPR reports that the piecemeal approach "may sound good. But in practice, says health policy analyst Jeff Goldsmith, it comes with its own set of political perils. 'Each one of those pieces has barbs attached to it,' Goldsmith said. 'You can say that health insurance reforms are really very popular across a broad spectrum, but then when you put them in — you know, like eliminating pre-existing conditions or lifetime caps — not only do you not have the health plans at the table, but (opponents) are going to come at you hammer and tongs.' In other words, powerful interest groups that have so far stayed mostly on the sidelines could declare full-out war" (Rovner, 1/22).

The Associated Press echoes the complexities that come with this approach. "Forget about guaranteed health insurance for all Americans — it costs too much. … Still, for Democrats, there is a hopeful precedent. After the Clinton-era health care overhaul imploded in 1994, Democratic and Republican lawmakers coalesced around the idea of a new health insurance program for the children of low-income working parents. That program, still thriving, now covers about 6 million kids" (Alonso-Zaldivar, 1/21).

USA Today: "'We have to step back, take a deep breath and realize that … these bills as they stand now are dead,' said Rep. Bill Pascrell of New Jersey, among the Democrats pushing for a more incremental approach. … Trying to pass only popular provisions of the bill comes with risk. In the case of the new insurance regulations, the industry has said Congress must pair those rules with a requirement that everyone buy a health care plan. Otherwise, the industry says, premiums will increase. Many well-liked items in the bill are linked to more controversial ideas, said the Brookings Institution's Mark McClellan. That is partly because of the complexity of the nation's health care system, he said" (Fritze, 1/22).

The Hill: "House leaders have shied away from committing themselves to the scaled-back approach, but a leadership aide acknowledged that, behind closed doors, the idea is rapidly gaining traction. … While Speaker Nancy Pelosi (D-Calif.) and other Democratic leaders aren't publicly embracing the notion, rank-and-file Democrats are pushing the idea" (Allen, 1/22).