Republican attacks on Baucus health plan ignore its GOP ideas

Kaiser Health NewsSeptember 17, 2009 

WASHINGTON — Republicans are denouncing the Democrats' latest health care proposal, even though some Republican ideas are embedded in the plan.

The Senate Finance Committee bill that Chairman Max Baucus, D-Mont., unveiled Wednesday contains several provisions that were inspired by Republicans, including testing new ways to handle medical malpractice cases, creating avenues for consumers to cross state lines to buy insurance and immediately launching a high-risk pool that would cover people with pre-existing medical conditions.

Moreover, the bill's scope and cost have been whittled down. The Congressional Budget Office put the price tag at $774 billion over 10 years, less than other Democratic proposals that Republicans said were too expensive. Also, the plan doesn't include a public insurance option, a proposal that President Barack Obama and liberal lawmakers favor but that most Republicans and many conservative and moderate Democrats reject. Rather, it would spend $6 billion to help create nonprofit cooperatives that would sell insurance to individuals and small businesses.

"This isn't everything Republicans wanted, but it isn't everything Democrats wanted either," said Elizabeth Carpenter, the associate policy director at the centrist New America Foundation in Washington. "You can see the negotiation process here, a bipartisan process in this bill."

Many of the Republican-inspired provisions are more modest than Republicans wanted. Still, their inclusion suggest that the gap between the parties on a health care overhaul might be a little narrower than the heated rhetoric indicates.

Not much attention has been paid to the fact that three comprehensive health care bills that Republicans introduced in the Senate and the House of Representatives have a few key elements in common with all the Democratic bills: They'd create health insurance exchanges to help the uninsured and small businesses find affordable coverage, they'd provide subsidies to people who need them to buy policies and they'd impose new regulations on insurers.

Republicans say the differences remain large, however.

None of the three Finance Committee Republicans who spent months negotiating with Baucus — Sens. Charles Grassley of Iowa, Michael Enzi of Wyoming and Olympia Snowe of Maine — signed on to the Baucus bill Wednesday. "The proposal released today still spends too much, and it does too little to cut health care costs for those with health insurance," Enzi said in a statement. The others echoed his cost concerns.

Baucus said the legislation still would get Republican support, but others are skeptical.

The Republican gains in the bill "are second- and third-tier items," said Robert Laszewski, the president of Health Policy and Strategy Associates, a consulting firm in Alexandria, Va. "What they were successful in doing is getting Democrats to round the edges of some of the elements, but not enough to please any significant number of Republicans."

By including some Republican ideas, Democratic leaders might be preparing to make the case that they made concessions to the party even as its leaders refused to negotiate. Obama has been saying that with or without Republican votes, many elements of the final Democratic plan would reflect at least some Republican thinking.

That flies in the face of criticism from Republicans that they've been shut out of substantive talks for months. "There has been absolutely no effort whatsoever on the part of the White House to reach out and, if they really do want our participation, to just say, 'Come on in,' " House Minority Whip Eric Cantor, R-Va., told Kaiser Health News last week. "None. Nor any" on Capitol Hill.

The Republican-inspired provisions include:

  • Cross-state sales of insurance to individuals and small businesses: The Baucus bill would allow two or more states to form "compacts" that would allow individuals to buy policies from insurers in the other states. The insurers would be subject only to the laws and regulations of the states in which the policies were written. In a separate measure, insurers could create national policies with uniform, federally set benefits that could be sold in any states in which the companies are licensed. The policies would be exempt from state benefit rules.
  • Medical malpractice: The legislation says Congress should consider creating state demonstration programs to evaluate alternatives to the current litigation system. Republicans had called for creating special malpractice courts and limits on damage awards.
  • High-risk pool for people with pre-existing medical conditions: Within a year of the enactment of the legislation, a high-risk pool would be set up for people with pre-existing conditions. The pool would continue until 2015, when the new state insurance exchanges would be up and running and insurers would be required to sell policies to all who apply, regardless of their medical conditions.
  • Prevention and wellness incentives: Medicare beneficiaries would become eligible for annual "wellness visits" with their doctors, paid for by the government program. They no longer would have to pay out of their pockets for certain tests and treatments, such as flu vaccinations or diabetes screening. Financial incentives also would be offered to beneficiaries who completed certain "healthy lifestyle" programs targeting risk factors such as high cholesterol, diabetes or smoking. This isn't just from the Republicans; Democrats embrace the idea as well.

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization that's not affiliated with Kaiser Permanente.)

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