Bipartisan Health Bill Still Gets No Respect
What would you say about a health overhaul bill that promises to provide health insurance to virtually every American, to add not a single penny to the federal deficit and to claim supporters ranging from conservative Republican Sen. Judd Gregg of New Hampshire to liberal Democratic Sen. Debbie Stabenow of Michigan?
On Capitol Hill, they're saying it doesn't have a chance.
That's the dilemma faced by Sens. Ron Wyden (D-OR) and Bob Bennett (R-UT), sponsors of the so-called Healthy Americans Act.
Roundly Ignored
Despite being the darling of health policy bloggers and the first bill to be certified by the Congressional Budget Office as covering nearly everyone and fully paying for itself, the measure is being roundly ignored by those actually trying to put together a health overhaul measure on Capitol Hill and in the White House.
That's frustrating for its sponsors, who spent years refining its finer points.
The concept is fairly simple. The plan would change the tax treatment of health insurance provided by employers in a way that would likely prompt many, if not most, to stop offering coverage. That appeals to Republicans, who say the current tax-free status of employer-provided insurance is unfair and encourages overuse of the health care system.
But the bill would also require employers to give workers back what they're spending now on health insurance in the form of a raise. Workers would also get new tax credits, and those who were previously uninsured or did not have insurance on the job would get government subsidies.
Everyone would then take that money and be required to buy insurance, from a new, government-regulated marketplace offering an array of private plans that would compete on the basis of quality and price.
Wyden says it only makes sense to start to move people away from the employer-based health insurance.
"Today the typical worker changes jobs 11 times by the time they're 40," Wyden said. "Right now, health coverage today isn't portable. In fact, when you lose your job, you go into something called the COBRA program, which a bunch of us say is the only federal program named after a poisonous snake."
That's a joke — COBRA is an acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985, the law under which the insurance continuation provisions were enacted.
Bringing The Parties Together
Bennett says one reason he thinks the measure hasn't caught on is that neither he nor Wyden is senior enough on the committees charged with writing the health overhaul bills.
"I've discovered that hell hath no fury like a committee chairman whose jurisdiction is being challenged," Bennett said. "They weren't interested in a couple of guys out in the hall."
But Len Nichols of the non-partisan think tank New American Foundation, an early backer of the measure, says there's another reason the bill isn't up for serious consideration. As with single-payer health insurance, it would simply represent too big a change for most people.
"Too many people were afraid of giving up their employer coverage," said Nichols. "It turns out employers weren't as ready to run away from it as some people thought. And unions were deathly afraid of removing it from their ability to recruit and retain workers."
Nichols, however, says Wyden and Bennett have accomplished something major for the health care debate: "They showed you can get Republicans and Democrats around two core ideas: Cover everyone, but be serious about costs."
And Bennett hasn't quite given up on the bill for this year: "We're hoping that when everyone finishes throwing his or her hands up in horror, and saying, 'What do we do now?' the two guys standing out in the hall can say, 'Look, will you let us in the room and let us get in the discussion and tell you what we've done?"
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MADELEINE BRAND, host:
Another bill that backers complain isn't getting enough attention has support from Democrats and Republicans.
NPR's Julie Rovner reports on the lack of love for the so-called Healthy Americans Act.
JULIE ROVNER: Oregon Democratic Senator Ron Wyden says when he'd go home to town hall meetings he'd typically get a bunch of people stand up and say they wanted a single-payer system. Then, another bunch of people would stand up and say, no, they hated that idea.
Senator RON WYDEN (Democratic, Oregon): Then invariably somebody would stand up, often in the back of the room, and would say, we want what you people in Congress have. And then there would be an immense amount of applause. Now, people weren't exactly sure what we congresspersons had. But they figured if we had it, it was good.
ROVNER: In fact, members of Congress have the same health coverage as the other nine million federal workers. They choose from a menu of dozens of private insurance plans and that was the origin, three years ago, of what would become the Healthy Americans Act.
The idea, says Wyden, is a straightforward one.
Sen. WYDEN: What you've got to do is give everybody access to an array of good choices, like members of Congress have, and then make sure that they can get a financial reward for shopping wisely.
ROVNER: Wyden built his bill carefully. It's based on a fairly simple though somewhat radical idea. He'd make changes to the tax code that would prompt many, if not most businesses, to stop offering coverage. But he'd also require those employers to give workers back the money they'd been spending on their health insurance.
Those who didn't have employer coverage would get help from the government, and the bill would create a new government-regulated marketplace where everyone could buy affordable coverage.
Sen. WYDEN: That's because with choices there is competition. And remember, these are, in effect, big insurance pools. You're not out on the street just shopping by your lonesome.
ROVNER: Wyden got assurance from the Congressional Budget Office that the bill would cover almost everyone and pay for itself - a very big deal. Then he began to reach out to Republicans. One of the first he found was Utah's Bob Bennett. Bennett says he likes the bill precisely because it would effectively start the system over from scratch. He says too much is now based on tax law from the 1940s and the Medicare law passed in 1965.
Senator BOB BENNETT (Republican, Utah): We don't practice health care in anything like the way we did in the 1940s and the 1960s today. Both of those systems are completely obsolete and we need to start a clean sheet of paper, begin all over again and do something that makes a whole lot more sense. And the Wyden-Bennett bill moves in that direction better than any other.
ROVNER: Wyden's approach began to attract not just support from his colleagues but from health policy bloggers.
Mr. JONATHAN COHN (Writer, The New Republic): And I mean if policy wonks were the only voters in America, this thing would have been passed about a year ago.
ROVNER: Jonathan Cohn writes "The Treatment," a health policy blog for The New Republic magazine.
Mr. COHN: It's not because we all think its perfect -I certainly don't - but the plan works. The basic idea behind it is a very sound idea.
ROVNER: Yet much like single-payer, the bill has never really been under serious consideration. Len Nichols of the New America Foundation says it may be a little bit ahead of its time.
Dr. LEN NICHOLS (Health Care Economist, The New America Foundation): And it is in many ways a vision of where we may be headed but it's just too big a lift for our political, and maybe even our economic system in the short run.
ROVNER: Translation: too much change is simply too scary.
Dr. NICHOLS: Too many people were afraid of giving up their employer coverage. It turns out employers weren't as ready to run away from it as some people thought. And unions were definitely afraid of removing it from their ability to use health insurance as a way to recruit and retain workers.
ROVNER: But Nichols says the bill has done something very important for the health care debate.
Dr. NICHOLS: They showed you can get Republicans and Democrats around two core ideas: cover everyone, but be serious about costs.
ROVNER: And backers are still hoping that some elements of the bill might be incorporated into a final compromise, if and when there is a final compromise.
Julie Rovner, NPR News, Washington.
BRAND: So many ideas, so many bills, the debate over health care can be confusing. So we're inviting you to send us your questions. We'll get Julie Rovner to help us answer some of them on the air. So send your questions by going to npr.org. Click on Contact Us and please put the word health in the subject line. Transcript provided by NPR, Copyright National Public Radio.
