White House Health Reform Czar Sizes Up Prospects, Challenges
On Wednesday, White House Office of Health Reform Director Nancy-Ann DeParle said she believes that lawmakers will be able to compromise this year on a health care overhaul bill that includes a public insurance option, the AP/Seattle Post-Intelligencer reports (Alonso-Zalidvar, AP/Seattle Post-Intelligencer, 4/15).
At a Kaiser Family Foundation briefing, DeParle said, "I'm actually very hopeful we'll be able to reach an agreement" on a public option, adding, "It is part of the president's plan, ... and the reason it's included is he wanted a mechanism to lower costs and keep the private sector honest by having a competitive public plan in there."
She added that "there are different breeds of public plans that could be part of this," but that the main objective is "how do we make sure ... that people who are shopping for a health insurance plan and are looking at things that are low-cost and that are competitive and have some choices" (Jacobson, "NewsHour with Jim Lehrer," PBS, 4/15).
Opponents of a government-run plan say it would leverage its size to pay less for care and offer discounted premiums, which could diminish the ability of private firms to compete for members (AP/Seattle Post-Intelligencer, 4/15).
However, DeParle said, "Advocates of a public plan have increasingly talked about including safeguards to make sure such a plan would not compete with private insurers unfairly or simply dictate prices and take over the market" (Armstrong, CQ HealthBeat, 4/15).
DeParle said, "If objections are over policy, then I think we can work together and have a public plan that people can agree to," but if "it is a philosophical debate, then that is another thing, and people may not be able to agree" (Smith, Reuters, 4/16).
She added, "It's been interesting to talk to people who say, 'Oh, I don't like a public plan.' When you actually start talking to them about what it might look like, you realize you're talking about two different things" ("NewsHour With Jim Lehrer," PBS, 4/15).
According to DeParle, one compromise for a public plan could be to pay providers at the same rates as private plans, although she also said a public plan could operate along the same rules as Medicare, which pays less for care than private plans.
DeParle said that even if the public plan reimbursed providers at the same rate as private plans, it could achieve savings on administrative costs because it would not have to turn a profit (AP/Seattle Post-Intelligencer, 4/15).
Another possibility she discussed would be to model the national plan after insurance plans that state governments offer to their employees, which typically cost less than individual plans but often are administered by private firms (Rubenstein, "Health Blog," Wall Street Journal, 4/15).
DeParle said President Obama has asked her to seek a bipartisan overhaul bill. However, she noted that Democrats are keeping open the option of using the budget reconciliation process to pass the bill in Congress (Reuters, 4/16).
Cost Control Efforts
DeParle also discussed Obama's pledge to offset the cost of health care reform within 10 years.
She said he "has serious concerns about any kind of financing" based on restricting the tax exemption for employer-sponsored coverage or "somehow undermining it," adding, "He's very skeptical of those plans and he's been clear about that."
Senate Finance Committee Chair Max Baucus (D-Mont.) has said making such tax changes, which could generate hundreds of billions of dollars in savings, could be used to finance a potential overhaul (CQ HealthBeat, 4/15).
DeParle added that "we are working with Congress on how this bill will be financed. A lot of it depends on the exact context of the bill they come up with."
DeParle said she has met with lawmakers and their staff almost daily to develop overhaul legislation that would expand coverage to all U.S. residents (Edney, CongressDaily, 4/15).
She said, "We're making a lot of progress in realizing the president's goal of getting health care reform enacted this year," adding, "All the groups who were on different sides of the table 15 years ago are now at the same table, working together and talking about how we can reach these goals."
DeParle said, "No one wants the status quo. They don't start off talking about their position, they talk about how do we get everyone covered, how do we lower costs for businesses and families."
In addition, she said, "Unlike the effort 15 years ago, Congress has put its money where its mouth is" on health reform, she said, citing lawmakers' inclusion of health provisions in the final budget resolution and work by committee chairs to get started on writing an overhaul bill (CQ HealthBeat, 4/15).
DeParle said, "This is very active, what is going on" (Budoff Brown, Politico, 4/15). "It's been, so far, a remarkably harmonious process," she said (CQ HealthBeat, 4/15).
Broadcast CoverageNPR's "Morning Edition" on Thursday included an interview with White House Office of Management and Budget Director Peter Orszag, who spoke about creating incentives to reduce spending on health care and improve the quality of care (Inskeep, "Morning Edition," NPR, 4/16). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.