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Congress Braces for Showdown Over Health-Care Reform

Cost, financing remain volatile issues in the drive for bipartisan support

FRIDAY, July 17 (HealthDay News) -- The beginnings of legislation to overhaul the nation's health-care system started to emerge from Capitol Hill this week, raising hope among some health-reform advocates that this may, at long last, be the year that Congress enacts a law to help America's uninsured and make health care more affordable.

"I think we're in a very good position to meet the president's ultimate schedule of getting a good health reform bill to his desk by mid-October," said Ron Pollack, executive director of the consumer advocacy group Families USA, in Washington, D.C.

Yet many aspects of health reform -- from what it will cost to how the nation will pay for it -- lack bipartisan support. A bill introduced by House of Representatives Democrats on Tuesday drew sharp criticism from Republicans, fiscally conservative Democrats and like-minded policy analysts, raising questions about whether lawmakers can complete the bulk of their work before the August recess -- the aggressive timetable set by President Barack Obama.

"We've already been hit with the sticker shock of just how much this is going to cost -- a trillion dollars plus in 10 years with higher costs beyond that, so there remain questions about whether this is the right time to be engaging in such an expensive agenda item," said Maya C. MacGuineas, president of the Committee for a Responsible Federal Budget, in Washington, D.C. She said the House measure doesn't do enough to make "a real dent in the growth of health-care costs."

On Thursday, the three committees responsible for overseeing health policy in the House were slated to start to "mark up" the Democratic majority's bill. The legislation would require individuals to obtain health insurance or pay penalties. All but the smallest employers would have to provide coverage to their workers or make contributions toward employees' coverage. The bill also would create a new "health insurance exchange" to offer a government-run health plan alongside private health plan options. And a new tax on higher-income individuals and families would help fund the expansion.

"I can tell you it won't be the bill that they [the House Democrats] actually attempt to mark up because they don't have the votes for it, and so they will continue to negotiate even as we move forward, sporadically, haphazardly, with the process," Rep. John Shadegg, R-Ariz., said in a press conference announcing a Republican alternative. "I think the reason they don't have the votes is because their bill kills health care as we know it today in America. There is an employer tax, there's all kinds of mandates."

In a statement, Rep. Mike Ross, D-Ark., chairman of the Blue Dog Coalition's health care task force, assailed the bill for failing to control the escalating cost of health care. While the coalition, which represents conservative and moderate Democrats, is "committed to passing health care reform," he insisted that "reform that does not meet the President's goals of substantially bringing down costs is not an option."

Shadegg and colleagues offered an alternative plan that would allow individuals to obtain health coverage on the same tax-advantaged basis that employers do. The measure seeks to make individual coverage more affordable by allowing churches, alumni associations, trade associations and other civic groups to create their own insurance pools and offer coverage to their members.

On the Senate side, the Health, Education, Labor and Pensions Committee approved its own version of health reform this week with a vote along party lines, while the Senate Finance Committee continues to wrangle over the details of its plan.

Linda Havlin, worldwide partner with the employee benefits consulting firm Mercer LLC in Chicago, is "firmly convinced" that something will pass this year but says many stakeholders -- employers included -- are anxious about the sweeping, "everything all at once" approach that lawmakers are pursuing amid a recession.

Mercer's recent survey of 329 U.S. employers found a majority of employers (67 percent) prefer a phased-in approach to health reform. Fifty-six percent of respondents agreed that health reform should boost incentives to improve health-care quality and efficiency.

Justine Handelman, executive director for legislative and regulatory policy at the Blue Cross and Blue Shield Association in Washington, D.C., expressed support for the broad framework of the House bill but cited concerns with specific provisions, including the government-run health plan. "We're concerned that it could undermine the existing delivery system," she said.

More information

The Office of the House Majority Leader has a summary and text of the Democrats' health-reform bill.

SOURCES: Ron Pollack, executive director, Families USA, Washington, D.C.; Maya C. MacGuineas, president, Committee for a Responsible Federal Budget, Washington, D.C.; Linda Havlin, worldwide partner, Mercer LLC, Chicago; Justine Handelman, executive director, legislative and regulatory policy, Blue Cross and Blue Shield Association, Washington, D.C.; July 14, 2009, press conference with Rep. John Shadegg (R-Ariz); July 14, 2009, news release, Blue Dog Coalition; Office of the House Democratic Majority Leader, Washington, D.C.; July 15, 2009, news release, Senate Health, Education, Labor and Pensions Committee

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