For almost a dozen years, conventional wisdom has dictated that far-reaching, national health-care reform wasn’t possible in this country. But political winds are blowing in a strong new direction.
Now, states are seizing the initiative, challenging policy gridlock in Washington. Business groups are standing with labor unions and consumer activists and calling for reform. Even the insurance industry has advanced a proposal for universal coverage.
As a new wave of reform initiatives surges across the nation, Congress is showing interest in supporting state innovations and is likely to begin a renewed debate over which direction future national reforms should take.
Republicans are stepping forward with bold plans–a sign that previous partisan divides over health reform are weakening. This month, California GOP Gov. Arnold Schwarzenegger made an enormous splash when he advanced a plan to cover 6.5 million uninsured residents of his state.
Another leading Republican, former Massachusetts Gov. Mitt Romney, makes no secret of plans to tout the universal health-care initiative his state enacted last year on the campaign trail if, as expected, he runs for president. That would pressure other candidates to respond–especially Democrats who traditionally have made health care a priority.
“With two high-profile Republicans backing major reform, it really forces the Democratic candidates to match them in this area,” said Robert Blendon, professor of health policy at the Harvard School of Public Health. “And it’s really going to escalate the issue in the primaries and in the presidential election.”
Last week, organizations that squared off angrily over health care in the 1990s–including Families USA, the U.S. Chamber of Commerce and America’s Health Insurance Plans–stood together in Washington and announced a commitment to what they agree were much-needed expansions of medical coverage for children and low-income adults.
“With such divergent ideologies, it is unprecedented for these groups to have a joint agreement,” said Scott Serota, president of the Blue Cross and Blue Shield Association.
Democrats are hardly staying on the sidelines. In recent days, the governors of Pennsylvania and New York have pledged to expand health-care coverage in their states.
The driving forces
Driving the activity is a deepening sense of frustration over escalating medical costs and growing numbers of people without medical coverage, the underpinnings of the nation’s health-care crisis. While these long-term trends aren’t new, their impact on businesses’ bottom lines, consumers’ pocketbooks and medical providers’ practices has worsened significantly, experts said.
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The result is what former House Speaker Newt Gingrich–a Republican who helped sideline national health reform a dozen years ago during Bill Clinton’s presidency–calls an “emerging consensus that we have to find some way to cover everybody.”
“I do think we may be closer than we’ve ever been” in making real progress on this issue, said Gingrich, who now leads the Center for Health Transformation.
That doesn’t imply the politics of this issue will be easy.
Whether the business community, which tends to dislike mandates, will buy into proposals that would expand its financial obligations for health insurance is an open question.
“I have yet to be convinced,” said Drew Altman, president of the Kaiser Family Foundation. While many large companies believe health reform might help control benefits expenses, many small firms argue they lack the wherewithal to pay.
And there’s deep concern over accelerating medical costs, which will inflate the future price tag for proposals to expand coverage.
With all these obstacles, “I don’t see anything major happening before the presidential election” except the likely reauthorization of a children’s health program by Congress later this year, said Chip Kahn, president of the Federation of American Hospitals, which represents for-profit providers.
Still, others remain optimistic that swelling grass-roots support for health reform will help turn the tide.
“The opportunity for change is here” because the health-care crisis is now reaching financially pressed middle-class families who are losing coverage or being asked to pay more for care, said William Novelli, chief executive of AARP, the large senior citizen organization. “
In this State of the Union address Tuesday, President Bush reportedly will propose tax changes to give an incentive for the uninsured to buy insurance and to limit tax benefits for those with employer-paid coverage.
If current trends continue, 56 million Americans will have no health insurance by 2013, up from 47 million today, according to a new report by AcademyHealth, a policy and research organization.
Financial strains for millions of families are mounting as medical inflation far outstrips salary increases.
Enter the states, which began to plan new strategies when their revenues started to rebound a few years ago, making new spending possible.
Last year, Massachusetts captured enormous attention when it passed legislation mandating that all citizens buy health insurance–a first in the nation. The package of reforms also requires all but the smallest businesses to offer insurance or pay into a state fund.
Ambitious proposal
Now, attention is riveted on California. The sheer ambition of Schwarzennegger’s $12 billion plan is breathtaking.
As in Massachusetts, his proposal combines an employer mandate to provide insurance with an individual mandate to carry insurance. Low-income families would get financial assistance, and public medical programs would be expanded.
But the scope of the health problems in California is astounding: about 15 percent of the entire uninsured population of the U.S. lives in the state.
Not surprisingly, the governor’s plan has been greeted with acclaim and alarm.
Noting that Schwarzenegger’s plan assumes $5.4 billion from the federal government, “there’s a question of whether all that money will come through as hoped,” said Marian Mulkey of the California HealthCare Foundation.
In Antioch, Calif., the Bucher family wonders how it would deal with a mandate that everyone have insurance.
Since Robert Bucher, 42, lost his $10-an-hour security job in November, he and his wife, Debbie, 45, have been uninsured. Debbie could get medical coverage for herself at the preschool where she works, but at $500 a month it’s too expensive. The couple’s two children, ages 8 and 6, one of whom is autistic, are covered by Medicaid.
Under Schwarzenegger’s proposal, the Buchers could purchase health insurance through a state pool for about $750 a year after qualifying for a subsidy. But with a monthly $2,001 mortgage and household income of $2,080, the couple bristle at the thought the state would force them to purchase coverage.
“That would be tight,” Robert Bucher said. “Is he going to make the working families pay for all this?”
Tribune staff reporter Judith Graham reported from Chicago and national correspondent Michael Martinez from Los Angeles.
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States consider reform
Numerous states are considering moves to reform health care coverage, including:
California
Gov. Arnold Schwarzenegger announced a plan this month to cover all state residents.
Indiana
State officials will consider increasing cigarette taxes to cover 120,000 to 200,000 uninsured residents.
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Minnesota
Gov. Tim Pawlenty announced support for universal coverage after his November re-election and wants to begin by insuring all children.
New York
Gov. Eliot Spitzer announced a plan this month to cover all children and cut the number of uninsured residents in the state by half.
Pennsylvania
Gov. Edward Rendell has announced a proposal to cover all state residents.
Wisconsin
State officials have been discussing an effort to cover the uninsured and are expected to act sometime this year.
Source: Tribune reporting
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