106th CONGRESS: A Centrist Approach As Consensus Emerges?
Medicare financing, the uninsured and the managed care system will be the three targets of reform for the 106th Congress, according to panelists at a symposium, "Health Policy in the Next Congress -- What Are the Prospects for Reform," held yesterday at the American Enterprise Institute. While there are some doubts concerning the extent of reforms a divided House and Senate might be able to reach, an emerging moderate consensus seems to portend at least some limited action on all three issues.
Uninsured: A Tax-Break Approach
Congressional Budget Office Director June O'Neill noted that as the nation enjoys record-low unemployment, the current status of the 43 million uninsured is "something of a puzzle." She attributes the problem to welfare reform, which has caused a commensurate drop in the Medicaid rolls as people move to employment, coupled with the rejection of employer-sponsored health coverage by many businesses. O'Neill said Congress may consider tax breaks -- up to full deductibility -- for individuals whose employers do not offer insurance coverage. Any such tax credits would potentially be refundable for those whose incomes are too low to pay taxes. Dean Clancy, senior policy advisor for House Majority Leader Dick Armey (R-TX), agreed, saying that while "we do not have a health care crisis, we do have an uninsurance crisis." He added, "Affordable health coverage is the first patient protection." He said Armey is very attracted to the idea of manipulating the uninsurance rate through the tax code, an endeavor which could be financed by the budget surplus. "Why not return [the surplus] in a way to ensure that the waitress in the corner coffee shop has the same access to health coverage as the CEO?" he asked.
"Son Of HMO Reform"
David Kendall, a senior analyst for health policy at the Progressive Policy Institute, said that any HMO reform package considered by Congress must make mandates in four areas:
- HMOs must provide basic information to patients, on both price and quality.
- Patients enrolled in employer-sponsored programs must be allowed to choose among competing health plans.
- An effective process to address patient grievances must be developed.
- Safety concerns, such as a prudent-layperson standard for emergency care coverage, must be established.
Medicare: The Problem That Won't Go Away
The panel also took up the question of Medicare financing. O'Neill said many proposals likely to be debated this year would merely enhance benefits -- such as prescription drug coverage -- and thus costs, at the expense of resolving the overall insolvency of the program. Clancy and O'Neill both emphasized that the strongest Medicare reform plan would orient the program toward the model pioneered by the Federal Employee Health Benefits Program (Jeff Dufour, American Health Line, 1/8).