- The Washington Times - Tuesday, June 2, 2009

Top health care reform advocates on the Hill are going to have to pare their options this week — something they had been reluctant to do until now — as their self-imposed deadline to pass a bill draws closer.

With lawmakers returning from a weeklong Memorial Day break, congressional leaders say they are still on track to pass a plan by August and two of the most anticipated proposals — from the Senate Finance and Senate Health, Education, Labor and Pensions committees — are expected to be marked up this month.

The two most contentious issues continue to be whether the plan includes a “public,” or government-run, insurance program, and how the overall plan is funded.

President Obama and his fellow Democrats have pushed a public plan that would operate as Medicare does for all Americans and make access more affordable. Republicans have signaled that they’re not going to vote for such a proposal.

“The biggest concern is the talk of a government takeover of health care,” said Senate Minority Leader Mitch McConnell, Kentucky Republican. “Americans suspect that what’s being sold as a government ‘option’ would soon become the only option.”

The plan put out by Senate health committee Chairman Edward M. Kennedy, Massachusetts Democrat, would mandate that everyone have health care insurance coverage and have employers contribute to the cost. It resembles the reform plan implemented in his home state of Massachusetts.

The approach differs sharply from more vague suggestions by the Senate Finance Committee, signaling that the panels may clash over key details. But the offices of Mr. Kennedy and Senate Finance Committee Chairman Max Baucus, Montana Democrat, released a statement saying both remain committed to the goal of overhauling the nation’s health care system as a top priority this year.

“We intend to ensure that our committees report similar and complementary legislation that can be quickly merged into one bill for consideration on the Senate floor before the August recess,” the two lawmakers said.

The other chief concern — how to pay for reform — does not appear to be quite as contentious.

Most Republicans oppose taxing employer-provided insurance, but a group of conservative Republicans in the House and Senate proposed a bill last month that would do so, signaling there’s room for compromise.

Mr. Baucus said he opposed a Republican plan, released by Sens. Tom Coburn of Oklahoma and Richard M. Burr of North Carolina and Reps. Paul D. Ryan of Wisconsin and Devin Nunes of California, because it taxed all plans. Mr. Baucus, expected to be the central player in the upcoming Capitol Hill debate, has said he favors taxing only the most expensive employer health plans.

Physicians, hospitals and others in the industry are wary of the idea of a government-funded public health insurance plan because they worry it would reimburse them at low rates — one of the chief criticisms of Medicaid — and, in the long run, undercut them in the marketplace.

But industry groups reiterated Monday that they want to be part of the process this time around. In the early 1990s, outright opposition from industry groups helped torpedo the health care overhaul championed by first lady Hillary Rodham Clinton.

The trade associations that last month promised Mr. Obama that they would cut health costs over the next decade offered more specifics Monday. In a letter to the White House, the groups said they could bank $150 billion to $180 billion in savings by using health care services more effectively; $350 billion to $850 billion through increased preventive care; and $500 to $700 billion through clerical and backroom efficiencies.

Mr. Obama is also pressuring Congress to act.

“If we don’t get it done this year, we’re not going to get it done,” Mr. Obama told a group of volunteers in a conference call last week.

Organizing for America, the president’s political group, is recruiting volunteers to push lawmakers to pass a reform plan.

Underlining the debate over health care reform is a cost that most consumers don’t even realize they pay as part of their health insurance premiums or doctor visits — the “hidden health tax” to treat the uninsured. But it’s one of the many reasons the nation’s health care costs continue to rise, according to many consumer groups and experts.

“As more people join the ranks of the uninsured, the hidden health tax is growing,” said Ron Pollack, executive director of Families USA, a nonprofit group that advocates for a government-sponsored health care plan. “That tax hits Americas businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health coverage as part of health reform.”

The group released a report last week that found that the average family’s “hidden tax” hit $1,017 last year.

Families USA and the actuarial company Milliman Inc. found that in 2008, the uninsured received $116 billion in care from health care providers.

The uninsured paid about 37 percent of those costs themselves, while charities and government programs covered 26 percent, according to the report.

That left about $43 billion in unpaid health care bills. Families USA said those costs were shifted to insurers in the form of higher charges, and, ultimately, from the insurers to families and individuals.

Consumers face additional expenses from two areas — the costs of federally funded Medicare and Medicaid, as well as at least a portion of the “charity care” that hospitals and doctors provide to the poor.

Some groups call it the “hidden tax” because it is folded into health care costs often without consumers realizing it.

Health care providers who receive federal grants — nearly all of them — are required to treat all patients, regardless of their ability to pay. Some of those bills are never paid and the provider has to accept the costs.

There is some federal assistance available to doctors and hospitals that treat a large number of poor, uninsured patients. But it doesn’t cover all of it. Invariably, some of that cost is passed on to consumers, said Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation.

Consumers pay for Medicare and Medicaid both in their taxes and, often times, in bills to private providers.

The rate at which providers are reimbursed for treating Medicare and Medicaid patients has fallen in recent years, again forcing providers to recoup those costs from patients who can afford to pay.

As the debate over how to reform health care comes to a head this summer, advocates for reform say at least some of those costs need to be contained.

“The truth is that right now, in the status quo, we have in effect an individual mandate on every taxpayer in the United States,” Mr. Moffit said. “The mandate on each one of us is to guarantee the care of those who cannot or do not get health insurance.”

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