Cath Lab Digest

Legislators Try to Hammer out Details of Reform Plan

After receiving an earful from constituents on both sides of the healthcare debate during their summer break, legislators returned to Washington eager to hammer out the details of a reform bill before the end of the year. With public opinion turning against the reformers, President Barack Obama capped off the next stage of the process with a congressional address aimed at defining his goals and reversing the downward trajectory of views on his handling of the issue. Meanwhile, in an attempt to disarm critics of the public option, lawmakers were discussing the possibility of a compromise—a legal mechanism that would trigger the creation of a public health plan only if private insurers fail to meet certain benchmarks.

One of the most divisive aspects of healthcare reform, the debate over whether or not to create a government-run health plan, known as the public option, has fired up both supporters and detractors of the proposal. Mr. Obama has yet to provide a draft bill or a detailed outline of his legislative priorities, but he expressed his support for creation of an insurance exchange that includes a public plan while insisting that he does not want to put insurance companies out of business. When he spoke about health insurers before a joint session of Congress on September 9, he said, “I just want to hold them accountable. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange.”

America’s Affordable Health Choices Act of 2009 (HR 3200), the draft bill that has received the most attention thus far, would create a new health insurance exchange with a public health insurance option operating alongside private plans. The bill also includes requirements for individuals to carry basic health insurance and for businesses to provide employees with insurance or pay new taxes. An income tax surcharge on high-income individuals is also included to help pay for the reforms.

Although the president has repeatedly stated that individuals satisfied with the health plan that they currently have will be allowed to keep their coverage, HR 3200 sets minimum standards for “qualified health plans.” Employer-provided and individual health plans would need to come into compliance with the same requirements as qualified plans after a 5-year grace period, during which time the policies could not be changed and new beneficiaries could not enroll. The bill includes a description of essential benefits package requirements for minimum services to be covered as well as rules on cost sharing and out-of-pocket spending limits.

Legislative Trigger
Rather than creating a public option outright, reformers have begun discussing inclusion of language in a final healthcare bill that would set a deadline for insurers to either meet certain conditions or be forced to compete with a newly created public option. This trigger option is being characterized as a compromise designed to win support from lawmakers who have endorsed some of the broad principles of healthcare reform but who currently oppose creation of a government-run health plan.

On the eve of the president’s speech, Speaker of the House Nancy Pelosi (D-CA) warned insurers recoiling at the prospect of a public plan that they might find a triggered public option even more objectionable. “They’d be better getting a public option now than one that is triggered because if you have a triggered public option, it’s because the insurance industry has demonstrated that they’re not cooperating, they’re not doing the right thing, and I think they’ll have a tougher public option to deal with,” the speaker said.