Speakers at White House-sponsored forum discuss possibility of public health coverage option, preventive care

Congressional Democrats intend to pass health care reform legislation by "August or September" that could include an option allowing uninsured U.S. residents to buy into a government-run health care plan, Senate Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee Chair Tom Harkin (D-Iowa) said on Monday, Kansas Health Institute News reports.

Harkin spoke at the third of five White House-sponsored regional forums on health care. The forum was hosted by Gov. Chet Culver (D-Iowa) and speakers included Nancy-Ann DeParle, director of the White House Office for Health Reform, and Gov. Mike Rounds (R-S.D.) (Ranney, KHI News, 3/23).

Attendees suggested ways to reduce chronic conditions, promote disease prevention and expand electronic health records (Beaumont/Leys, Des Moines Register, 3/24). Several physicians raised issues with the current reimbursement system that puts little or no emphasis on preventive care. Harkin said, "You can't talk about reforming something you don't have and right now, we don't have a health care system, we have a sick care system" (KHI News, 3/23). Harkin suggested that the government provide more nutritious food in schools, build walking paths to increase exercise and help physicians who practice primary care pay for medical school. He also suggested that people who smoke or are obese should pay higher health insurance premiums (Leys, Des Moines Register, 3/24).

DeParle said it was too soon to know whether President Obama would require uninsured U.S. residents to purchase health coverage through an existing public plan. She said, "My job is to look at the president's principles and see how we can meet his principles with various ways the Congress might approach it," noting that Obama's principles include "lowering costs and getting affordable care and putting us on a path to covering all Americans" (Beaumont/Leys, Des Moines Register, 3/24). Harkin said, "I am fully convinced that if we don't have a public plan in the mix, [health care reform] is not going to work" (KHI News, 3/23). Gov. Rounds said he opposes a public plan option, pointing to what he sees as inadequate care provided by the federal government through the Indian Health Service (Beaumont/Leys, Des Moines Register, 3/24).

Health Care Reform Leaders

The Obama administration aims to pass health care reform by the end of the year, and lawmakers are "starting to debate the actual details of health care reform," Roll Call reports (Langel, Roll Call, 3/23). Politico reports that closely following key groups and people could provide the "best clues about what proposals have traction." Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.), who has been holding regular talks with lobbyists from about 20 major interest groups, likely will be one of the main authors of the Senate bill (Budoff Brown, Politico, 3/24). Kennedy is expected to have a bill prepared as early as Memorial Day (Roll Call, 3/23).

Kennedy and his staff have been working closely with Senate Finance Committee Chair Max Baucus (D-Mont.), "who laid out a breakneck schedule for a health care overhaul, including a review of health care delivery in April, an examination of ways to expand coverage in May and an examination of financing options before drafting the proposed legislation in June," the Boston Globe reports (Stockman, Boston Globe, 3/24).

According to CongressDaily, Baucus "has taken a good bit of heat over his suggestion to tax employer-sponsored health benefits" to help pay for health care reform, including from members of his own committee. Sen. Jay Rockefeller (D-W.Va.) said he is concerned about taxing health benefits in part because he feels Congress has not yet seriously focused on the public plan option, CongressDaily reports. He said, "For those still fortunate enough to have a job in this economy, we should not add to their worries by jeopardizing their health care coverage" (Edney, CongressDaily, 3/23).

House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) and Rep. Frank Pallone (D-N.J.), chair of the House Energy and Commerce Subcommittee on Health, have expressed a desire to begin drafting language in April and conference with the Senate in August (Roll Call, 3/23).

Meanwhile, House Republicans have been meeting with outside health policy experts to craft their own proposal. The 21-member group, led by Rep. Roy Blunt (R-Mo.), plans to release a framework for overhauling the health care system by increasing access to care and lowering costs through the free market.

Among the other groups Politico suggests following is the "outside/inside group," which is made up of competing health care interest groups that are attempting to find consensus on how to most effectively reform health care. "Participants have been promising a final product for weeks," Politico reports (Politico, 3/24).

Prospects for Reform

As Democrats and Republicans move to more detailed negotiations on health care reform, "what had been a conciliatory tone" between the two parties is "turning more confrontational," Politico reports. According to Politico, the Democrat-supported idea of a public insurance plan designed to compete with private insurers has led participants in the debate to begin to state their opinions "more forcefully and frequently." The debate "is viewed as crucial to determining the level of bipartisan support" for such legislation and whether or not it can pass, Politico reports (Budoff Brown, Politico, 3/20).

"The matter is likely to come to a head first in the Senate Finance Committee," the Wall Street Journal reports. According to the Journal, Baucus has pledged to write a bipartisan bill and aides from both parties say it is "unlikely a public plan will be included in the legislation now being negotiated" because ranking member Chuck Grassley (Iowa) is "adamantly opposed to the provision for a public health care plan" (Meckler, Wall Street Journal, 3/24).

Health Reform Web Site

In related news, the National Small Business Association on Monday launched a Web site called Health Reform Today that promotes an overhaul of the U.S. health system, the Dallas Morning News reports. The organization, which voted health reform as its top priority for Congress, says that in 2008, the number of small-business owners who could provide health insurance fell to 38% from 67% in 1995. The Web site includes policy recommendations, facts and news about health care and the results of the March NSBA Health Care Survey for Small Business. David Stetler, NSBA's chair of health and human resources, said, "The cost of health care is becoming a significant barrier to many considering opening their own business," adding, "Small business creates the overwhelming majority of new jobs and innovations, and Congress must do all it can to ensure that entrepreneurship remains a viable option" (Jean, Dallas Morning News, 3/23).

Broadcast Coverage

WAMU's "The Diane Rehm Show" on Tuesday discussed how health care relates to economic recovery but how the mounting deficit and continuing downturn are affecting the political resolve for health care reform. Guests include Journal reporter Laura Meckler; Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute; and Families USA Executive Director Ron Pollack (Rehm, "The Diane Rehm Show," WAMU, 3/24).