With the health reform process now shifting to behind-the-scenes negotiations, forecasts that something will pass the full Congress this year seem more credible. For those who share President Obama's commitment to making insurance coverage more accessible and affordable, that should be a reason to celebrate.
But in part because of the bitter partisanship surrounding reform, it's been difficult to work up much enthusiasm for the 10-year, $829 billion bill that emerged Tuesday from the Senate Finance Committee. There also are major points of disagreement between the House and Senate bills, including whether the government will offer its own insurance to compete with private companies. Each point of contention now threatens consensus later.
Yet Wednesday found Kansas Insurance Commissioner Sandy Praeger keeping her hopes up. "I think everyone's trying really hard to find the right solution. I just hope they can step up and be statespersons and not let partisan politics get in the way," the Republican, who chairs the health insurance and managed care committee of the National Association of Insurance Commissioners, told The Eagle editorial board.
All along, Praeger has made the useful point that controlling health care costs will require getting more young, healthy adults into the system. That means mandating that Americans have health insurance (just as drivers must have car insurance) and creating penalties for failing to get covered. But if the penalty is cheaper than the coverage, there's still an incentive for those uninsured by choice to sit out — until they get sick.
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Praeger recognizes that penalties for the uninsured are a tricky issue. But "you want to create a system that has all the incentives aligned properly," she said, "and I'm concerned they're not there yet."
The Senate Finance Committee bill requires that all Americans have health insurance, but the penalties for failing to do so wouldn't be phased in until between 2014 and 2017, and the size of the fines has been reduced.
She sounded optimistic that the legislation would get rid of insurance companies' pre-existing condition exclusions and help those who cannot afford their own coverage through meaningful subsidies.
"The finance committee's proposal is the most reasonable and potentially bipartisan," said Praeger, who foresees problems with the government-run coverage in other bills. No matter what passes, she predicted, Congress still will need to look at the fee-for-service system and do something about medical malpractice lawsuits and more.
Meanwhile, 27,000 more Kansas adults have lost their health coverage this year because of unemployment, a point the advocacy group Families USA will expand on in a report coming next week. And Kansas slipped five spots to 23rd place in the Commonwealth Fund's latest scorecard of states' health systems. Yet the GOP members of Kansas' congressional delegation strongly oppose the current reform bills.
It will be deeply disappointing if legislation affecting a sixth of the nation's economy and nearly all Americans becomes law with only token bipartisanship.