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Health care reform tops just about everybody’s agenda. So why can’t we get anything done?

By Scott Sinder, Sandy Chamblee and John Fielding

Everyone, it seems, has a proposal to fix our health care system—presidential candidates, members of Congress, the Bush Administration and even the businesses that purchase coverage for employees. The plans have a similar goal: to reduce the number of uninsured Americans, currently estimated in excess of 46 million.

It seems unlikely that the Democratic Congress and the Bush Administration will find the common ground, or funds, necessary to enact reform—though given the growing chorus for action, nothing can be ruled out. What seems more likely is a lot of talk leading up to next year’s presidential primaries with candidates floating reform proposals and positioning for 2008. To the extent there is action, it will come from the states.

The Administration. President Bush talks often about giving consumers more control over their health care and using private markets to keep costs down. He supports expanding health savings accounts, creating association health plans and permitting buying health insurance across state lines.

Speaking to Council members at February’s Legislative Summit, Health and Human Services Secretary Mike Leavitt argued that to get better health care and lower costs, numerous segments of the U.S. health care sector must come together in a single functioning system, one that currently does not exist. He proposed a four-pronged approach to creating one:

  • Convert to an electronic medical records system within three to five years;
  • Implement workable quality measures that enable patients to assess doctors and hospitals and make informed decisions on care;
  • Make pricing transparent, which allows it to be given consideration in health care decisions;
  • Provide incentives for all participants in the health care system to increase quality and keep costs low.
  • Any health insurance or service purchased with federal dollars must comply with these mandates, and Leavitt has received commitments from about 50 Fortune 100 companies to comply. 

    In his State of the Union address, Bush said he wants to tax employer-provided health coverage and provide taxpayers with a standard deduction for health insurance of $15,000 for a family and $7,500 for an individual. The net effect would be tax parity between employer-sponsored plans and coverage purchased directly in the marketplace. The administration says the plan would reduce the uninsured by 3 million to 5 million individuals. However, many observers worry the proposal could lead to the end of employer-based health coverage.

    Congress. Of the dozens of health care bills in Congress, here are some of the most important:

  • Single-payer coverage proposals—Sen. Ron Wyden, D-Ore., and Rep. John Conyers, D-Mich., introduced bills establishing government-sponsored health coverage. The plans both would supplant employer-provided insurance and would reduce the market for private-sector insurance. Rep. John Dingell, D-Mich., has proposed national health insurance based on need.
  • Universal coverage proposals—Sponsors seek to expand access to the current system rather than supplanting it, such as with programs that cover children.
  • Association health plans—Rep. Sam Johnson, R-Texas, has reintroduced a bill allowing small businesses to band together to purchase health coverage for their employees.
  • Tax reforms—Several bills seek to increase health insurance take-up rates through tax deductions and credits.
  • States.The states are laboratories for innovation. Maine, Massachusetts and Vermont have established programs providing near universal health care access. Illinois’ program covers all children. Programs in Arkansas, Kentucky, Montana, Oklahoma, Rhode Island and Tennessee target small employers and working families.

    Health care reform legislation is on the agenda in as many as 20 other states. California Gov. Arnold Schwarzenegger’s universal health care proposal would require all residents to acquire health insurance. It provides a mix of employer mandates, public support and insurance market reforms to help consumers and the state pay for the program. This will be one to watch.

    Candidates.Health care will dominate the 2008 presidential campaign. Former Sen. John Edwards, D-N.C., has unveiled the most detailed plan of any candidate. He would require most Americans to have health insurance, offering assistance to middle- and lower-income people principally through tax credits. He calls for new public pools called "health markets," which would be open to both the uninsured and those who have employer-provided insurance. Employers would be required to provide health coverage to their workers or pay a new tax.

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