September 2009 Archives

Health reform advocates are all for promoting wellness, but there's a controversy brewing about whether change should come through legislation or employers, and whether people who fall short of wellness standards should be penalized.

The health reform bill approved by the Senate Health Education Labor and Pensions Committee would allow insurers to charge people who do not meet wellness standards premiums that are up to 30 percent higher.

Safeway CEO Steve Burd wants Congress allow employers to offer health care discounts to those meeting certain wellness standards.

Critics argue that runs counter to efforts in the major health reform bills that would prohibit insurers from charging people different prices on the basis of health status or pre-existing conditions. "Some find it ironic that even as Congress moves toward restricting such practices in the individual market, it is considering allowing employers to move in the other direction," National Journal correspondent Julie Kosterlitz writes in an article (subscription) on the subject on September 26.

"We are deeply concerned about the suggestion that Safeway has to provide discounts on premiums that are dependent on achieving health outcomes," says Dick Woodruff, senior director of federal relations at the American Cancer Society Cancer Action Network. "It's real simple: It's bringing back rating for pre-existing conditions. That defeats everything that we're trying to accomplish" with health reform.

What is the best approach, and what are the dangers?

4 responses: Kenneth E. Thorpe, John C. Goodman, Len Nichols, Donna Shalala

Each health reform bill in Congress achieves part of its insurance coverage expansion by increasing eligibility for Medicaid.

The latest health reform proposal, from Senate Finance Chairman Max Baucus, D-Mont., would expand Medicaid to all U.S. citizens who earn up to 133 percent of the federal poverty level (which is $14,400 for an individual and $30,000 for a family of four), beginning in 2014. Those earning 100 percent to 133 percent of poverty could take Medicaid or a private health insurance plan offered through a health insurance exchange. (The bill approved by several House committees also expands coverage to 133 percent of poverty, while the bill approved by the Senate Health, Education, Labor and Pensions Committee expands eligibility to 150 percent of poverty.)

Because Medicaid is funded jointly by the federal and state governments, there is concern that expanding the program would put significant new financial pressure on already tight state budgets. Under the Baucus proposal, the federal government would pick up more of the tab than it does now for newly eligible people (as much as 95 cents of every dollar it costs to cover these people in some areas).

What should the state's contribution be? What level of out-of-pocket payments should be required for beneficiaries, and what benefits should they receive? How should providers be paid?

4 responses: Karen Davis, Grace-Marie Turner, John C. Goodman, Ron Pollack

Updated at 11:53 a.m. on Sept. 16.

Is state experimentation on medical malpractice reform the right solution?

In his Sept. 9 speech to Congress, President Obama attempted to appeal to Republicans by embracing a plan by President Bush to authorize demonstration projects in individual states to test approaches to malpractice reform. "I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs," he said. "So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine." Obama said he was directing his Secretary of Health and Human Services "to move forward on this initiative today."

In National Journal's regular poll of Congressional Insiders, 68 percent of the Democrats surveyed said they would support a health care reform package that included tort reform, compared to 34 percent of Republicans. The idea was opposed by 29 percent of Democrats and 47 percent of Republicans.

Could malpractice reform significantly reduce health care costs? Would you like to see malpractice reform be incorporated into health care reform?

Baucus Bill Would Cost $856 Billion

Senate Finance Chairman Max Baucus, D-Mont., unveiled a health care reform plan Wednesday that would cost $856 billion over 10 years. The committee will begin consideration next week. Here are the details, as released from his office. What are your impressions?

13 responses: Karen Davis, J. James Rohack, Jason Rosenbaum, Marilyn Werber Serafini, Marilyn Werber Serafini, Jack Lewin, J. James Rohack, John C. Goodman, Karen Davis, Newt Gingrich, John C. Goodman, Paul B. Ginsburg, Raymond C. Scheppach

Updated at 8:10 p.m. on Sept. 9.

What is the single most important point that President Obama made in his speech to Congress? Will his speech break the stalemate in Congress?

(This question asked previously: What is the best thing Obama could say in his speech to Congress Wednesday night to improve chances for health reform legislation this year?)

24 responses: Grace-Marie Turner, Stuart Butler, Jack Lewin, Sen. Chuck Grassley, R-Iowa, John C. Goodman, Len Nichols, J. James Rohack, Jason Rosenbaum, Sen. Mike Enzi, R-Wyoming, Ron Pollack, Karen Davis, Rep. John Dingell, D-Mich., Rep. Pete Stark, D-Calif., Karen Ignagni, Rep. Henry Waxman, D-Calif., Marilyn Werber Serafini, David B. Kendall, Marilyn Werber Serafini, Henry Simmons, John C. Goodman, Marilyn Werber Serafini, John C. Goodman, Uwe Reinhardt, Donna Shalala