Health reform pressure points: Excise tax, individual mandate, antitrust legislation

News outlets report on several of the pending policy issues of a health care overhaul.

"An agreement to tax high-cost, employer-sponsored health insurance plans, announced with fanfare by the White House and labor unions last month, is losing support from labor leaders, who say the proposal is too high a price to pay for the limited health care package they expect to emerge from Congress," The New York Times reports. "With support for the tax eroding, Congressional leaders are searching for alternative sources of revenue." Many House Democrats also "continue to criticize the tax as bad policy," and say "the tax is bad politics because it would set the middle class against the poor — people struggling to keep health insurance against people struggling to get it" (Pear, 2/15).

Meanwhile, the individual mandate, which would require most Americans to carry health insurance, is now "one of the most abhorrent provisions of the Democrats' health overhaul bills" to Republicans, NPR reports, quoting Sen. Orrin Hatch, R-Utah: "Congress has never crossed the line between regulating what people choose to do and ordering them to do it."

NPR adds "But Hatch's opposition is ironic, or some would say, politically motivated. The last time Congress debated a health overhaul, when Bill Clinton was president, Hatch and several other senators who now oppose the so-called individual mandate actually supported a bill that would have required it. In fact, says Len Nichols of the New America Foundation, the individual mandate was originally a Republican idea." NPR adds that "the summary of the Republican bill from the Clinton era and the Democratic bills that passed the House and Senate over the past few months are startlingly alike" (Rovner, 2/15).

The Los Angeles Times details the pro and con arguments of the individual mandate, as represented by Linda Blumberg, a senior fellow at the Urban Institute, and Glen Whitman, an economist at Cal State Northridge (Borrell, 2/15).

Politico reports that Democrats may "scale back" legislation to end the antitrust exemption for health insurers "to protect insurance companies that offer malpractice coverage to doctors and other health care providers, bowing to industry pressure in the latest concession of the health care fight. On Monday, Democratic aides in the House said the final bill likely won't include controversial new restrictions on medical malpractice insurers. Its authors also appear inclined to strip new authority for the Federal Trade Commission because it sparked similar unease" (O'Connor, 2/16).

Meanwhile, The Hill reports that President Obama, "a longtime ally of the trial lawyers," may resurrect the idea of tort reform. "Obama's hints that he is willing to make a deal with Republicans on medical malpractice reform has got physicians and trial lawyers scratching their heads. As recently as Tuesday, Obama floated the possibility of offering an olive branch to Republicans on malpractice reform as a gesture of bipartisanship. 'I've said from the beginning of this debate I'd be willing to work on that,' Obama remarked during a press briefing." But the president "has not explained where he sees the middle ground and, indeed, has rejected Republicans' top priority in this area: the hard-dollar caps on lawsuit awards in malpractice cases long sought by the physician and business lobbies" (Young, 2/14).