January 2010 Archives

Updated at 10:33 a.m. on Jan. 28.

If Washington is going back to the drawing board on health care reform, what will be the easiest, least costly way to accomplish a more modest expansion of health care coverage to the uninsured? Is a modest Medicaid expansion the answer? Low-income subsidies plus an exchange? Should policymakers be satisfied with expanding coverage to just kids? Should the focus be on early retirees, aged 55-64?

If it had to be something short of universal coverage, what would be the smartest, most cost-effective approach?

SOTU: Economy? Health Care? Both?

President Obama urged members of Congress to finish the job of health care reform in his State of the Union address to Congress on Wednesday. "This is a complex issue, and the longer it was debated, the more skeptical people became," he said. "... This problem is not going away. I will not walk away from these Americans, and neither should the people in this chamber.... As temperatures cool, I want everyone to take another look at the plan we've proposed."

Did the president say what he should have? Just how closely are health care and the economy tied? What should happen next?

16 responses: Darrell G. Kirch, Henry J. Aaron, Grace-Marie Turner, Rep. Pete Stark, D-Calif., Andy Stern, Rep. John Dingell, D-Mich., Karen Davis, J. James Rohack, David B. Kendall, Marilyn Werber Serafini, Mary R. Grealy, Sally C. Pipes, Len Nichols, Jason Rosenbaum, John C. Goodman, Rep. John Dingell, D-Mich.

Now that Senate Democrats no longer have a filibuster-proof 60 votes, should Congress scrap health care reform or work on a skinny bipartisan bill? Should the House consider the Senate-passed health reform bill with the promise that certain provisions will be changed in reconciliation legislation?

From a policy perspective, what would work in a skinny bill? What pieces should and could be removed from the Senate bill in reconciliation? Is it possible and wise to have insurance reforms without big expansions?

What are the best and worst things Congress could do now?

8 responses: David B. Kendall, James P. Gelfand, John Sheils, Jeffrey Levi, Kenneth E. Thorpe, Jason Rosenbaum, Grace-Marie Turner, Tom Miller

Updated at 8:13 a.m. on Jan. 19.

Should Congress settle on a single, national health insurance exchange or individual state exchanges in its final health care reform legislation? Negotiations seem to be leading to a single, national exchange.

The House-passed bill calls for the federal government to operate a single, national health insurance exchange. Advocates argue that state-run exchanges could be too small to be effective and wouldn't account for varying needs in different parts of the country.

The Senate-passed bill, meanwhile, would direct states to run individual exchanges. The National Association of Insurance Commissioners backs this idea, arguing in a Jan. 6 letter to Congress that consumers are "best served by insurance regulation that is located firmly at the state level."

Who's right? And what do we already know about state insurance regulation that should influence Congress' decision?

4 responses: Uwe Reinhardt, Karen Davis, Alan Weil, Paul B. Ginsburg

What is the best way for the House and Senate to compromise on divergent tax proposals in their health care reform bills without destroying their ability to control health care spending?

One idea under discussion is to accept the Senate tax on high-end "Cadillac" insurance plans (the House doesn't have it), but raise the threshold so that it would apply to higher premiums. A House provision to tax the wealthy could also remain in the legislation, but also with a higher threshold for who would be taxed.

The Senate's tax on high-end insurance plans would tax health plan premiums over $8,500 for individual coverage and $23,000 for family coverage. The tax, imposed on the insurer, would be 40 percent of the value of the plan that's over the threshold. The threshold amounts would be higher for some -- $1,350 higher for retired individuals over 55, employees in high-risk professions, and temporarily for the 17 states with the highest health care costs.

What is the best way to merge these proposals so that they remain effective cost-containment and revenue-raising measures? What is the appropriate threshold for these taxes?

12 responses: Marilyn Werber Serafini, John Sheils, Gail Wilensky, Uwe Reinhardt, Paul B. Ginsburg, John Sheils, Jason Rosenbaum, John C. Goodman, Jason Rosenbaum, Sally C. Pipes, John C. Goodman, Paul Fronstin

How do you read today's news that the growth of U.S. health care spending slowed in 2008 to its lowest level in 48 years?

What is significant in these numbers, and what do they mean for health care reform?

The Centers for Medicare and Medicaid Services released their findings today, and officials there wrote their analysis in the journal Health Affairs.

National health spending was $2.3 trillion in 2008, an increase of 4.4 percent from the previous year. By comparison, health spending grew 6 percent in 2007. The calculation includes spending for health care goods and services, program administration, private health insurance, public health, and the amount spent on structures, equipment and noncommercial research.

Federal health care spending actually increased, partly because the federal government stepped in to pay a larger share of Medicaid costs. Medicare spending also grew more rapidly in 2008 than in 2007.

The federal government's share of national health care spending grew by 1 percentage point to 35 percent. Moreover, more of the gross domestic product went to health care spending. In 2008, 16.2 percent of the GDP was spent on health care, up from 15.9 percent in 2007.

The GDP finding was expected, according to CMS, because GDP typically grows at a slower rate than total health spending during or after a recession. Indeed, the 2008 experience is consistent with past recessions.

Spending growth for hospital services was the slowest since 1998. While prices were down, so was Medicaid spending, as states implemented strategies to lower their spending on the program. The slower growth was partially offset by increased use of inpatient and outpatient services.

The growth of spending for physician services, nursing home services and retail prescription drugs was also down, and private health insurance premiums and benefits grew at their slowest rate since 1967, according to CMS.

4 responses: James P. Gelfand, Stuart Butler, Karen Davis, Karen Ignagni

Would health care reform still work if the individual mandate disappeared?

Reform opponents are increasingly attacking provisions in the House- and Senate-passed bills that would require individuals to buy health insurance, and some are threatening lawsuits challenging the constitutionality of such a mandate.

Would removing the individual mandate unravel health care reform? Regardless of your support or opposition to the mandate, what effect do you think killing it would have on the workability of the comprehensive package? Is such a mandate constitutional?

2 responses: Len Nichols, John C. Goodman