Cath Lab Digest

More to Agenda than Comprehensive Bills

Comprehensive legislation has been the centerpiece of the healthcare debate, but substantial portions of the reform agenda were enacted months before President Obama began calling for a final vote. Implementation of healthcare legislation packaged in smaller bills, such as the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), or tied to larger measures like the American Recovery and Reinvestment Act of 2009 (ARRA), has expanded the federal government’s role in funding health insurance as well as in medical research and investments in health information technology (IT). Facing consistent public opposition to their handling of comprehensive legislation, lawmakers have sharpened their criticisms of health insurers while gathering the votes to pass a Senate bill that could be amended later through the reconciliation process.

Days after holding a healthcare  summit that included Republican and Democrat lawmakers, President Obama declared on March 3 that the reform debate is over. In a speech that criticized “the worst practices of insurance companies,” the president said, “every idea has been put on the table. Every argument has been made. Everything there is to say about healthcare has been said—and just about everybody has said it. So now is the time to make a decision about how to finally reform healthcare so that it works, not just for the insurance companies, but for America’s families and America’s businesses.”

Following the healthcare summit, poll results released by Rassmussen Reports on March 8 had 42% of respondents in favor of the legislative effort and 53% opposed, including 20% who strongly favor the plan and 41% who strongly oppose. Rassmussen noted that support was up to 44% immediately following the summit, but has otherwise remained between 38% and 42% since Thanksgiving. On March 5, Rassmussen reported that 55% of US voters would prefer to see Congress scrap the original plan and start all over again.

Rather than proposing a fresh start or the sort of incremental reforms that his opponents have suggested, Mr. Obama made the case for quickly enacting comprehensive new legislation including rate controls, individual mandates, and universal access. “So the fact is, health reform only works if you take care of all of these problems at once,” he said.

Rejecting calls to scrap current legislation and start the reform process from scratch, Mr. Obama pressed Congress for a vote within weeks. “The insurance companies aren’t starting over. They’re continuing to raise premiums and deny coverage as we speak…So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on healthcare reform.”

In response to Mr. Obama’s remarks, Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP), defended the role of insurers. “Our community includes hundreds of thousands of dedicated, conscientious Americans from all walks of life who are working hard to provide health insurance coverage to more than 200 million Americans,” Ms. Ignagni said. “They do not deserve to be vilified for the work they do every day.”

Despite the president’s all-or-nothing characterization of the reform movement, more modest legislation enacted since he took office has significantly advanced healthcare reformers’ agenda. Stepwise reforms have included the reauthorization and expansion of the Children’s Health Insurance Program (CHIP) via CHIPRA as well as funding of research, infrastructure, and health benefits through ARRA. More recently, reformers have taken stopgap measures to forestall a physician pay cut mandated by Medicare’s Sustainable Growth Rate (SGR) formula.

CHIPRA