Democrats focus on healthcare reform
Plan would require all to buy insurance
WASHINGTON - A leading Senate Democrat rolled out a sweeping healthcare plan yesterday, signaling that Democratic leaders in Congress intend to aggressively pursue significant - and probably expensive - healthcare legislation despite an expanding federal deficit and President-elect Barack Obama's intense focus on the ailing economy.
Senator Max Baucus of Montana, the head of the powerful Senate Finance Committee, unveiled an 89-page policy proposal that in many ways resembled the one Obama put forward during the campaign, with an important difference - it requires everyone to buy health insurance. In that respect, it is even more like the plan Massachusetts enacted in 2006 than Obama's, which did not include an individual mandate.
Both Baucus and Senator Edward M. Kennedy of Massachusetts, chairman of the Committee on Health, Education, Labor, and Pensions, have been working for months to lay the groundwork for major healthcare legislation, holding hearings and informal talks with business groups, providers, and consumer advocates.
Kennedy, who is fighting brain cancer but plans to return to Capitol Hill in January, hopes to offer a single Democratic healthcare bill by Obama's Jan. 20 inauguration or earlier. Yesterday Kennedy issued a statement praising Baucus's blueprint, saying it provides "an important analysis of the urgent need for significant improvements in our healthcare system, and thoughtful recommendations for reform."
Baucus told reporters that Kennedy called him with "very complimentary" comments yesterday morning. Advocates for health reform said the senators' clear interest in collaboration bodes well.
"Senator Baucus and Senator Kennedy have really laid the groundwork for getting this done," said Ron Pollack, executive director of Families USA, a national organization for healthcare consumers.
The senators' urgency reflects the Democrats' determination to avoid mistakes that ruined the Clinton administration's attempt to pass major healthcare legislation in 1993, when controversies over gays in the military and trade distracted attention from the healthcare issue and undermined public support for the new administration. Democrats believe they must move quickly to capitalize on Obama's honeymoon period.
Valerie Jarrett, a senior adviser to Obama, said yesterday that while fixing the economy will be the top priority when Obama takes office, he still plans to follow through on majorcampaign promises, including healthcare reform.
"Clearly there's a need for healthcare," she said on "The News Hour with Jim Lehrer" on PBS. "And I think that throughout the campaign, what President-elect Obama heard time and time again is the importance of affordable healthcare for everybody."
Despite the country's enormous economic problems, the political climate will be somewhat better for reform than it was 16 years ago. With health costs spiraling, businesses of all sizes have joined the call for comprehensive health reform. Both the Business Roundtable, which represents the country's largest businesses, and the National Federation of Independent Business joined with the AARP and the Service Employees International Union during the campaign season and launched a massive campaign to call for health reform.
Yesterday, Amanda Austin, a senior manager of legislative affairs for the NFIB, which represents small businesses, said her organization was encouraged by the Baucus plan's "holistic approach" to addressing not only healthcare access but costs.
She said she was optimistic about health reform happening early in the Obama administration because of the strong desire on the part of the public for health reform, the new administration's interest in the issue and the work of Kennedy and Baucus.
"It's the perfect storm, and I'm hopeful that President-elect Obama can . . . find time in the first year while there is that momentum to look at it," she said.
The need for a plan is also greater: There are nearly 47 million Americans without health insurance and another 25 million who are underinsured.
The Baucus plan, in addition to requiring individuals to buy health insurance, would also require large employers to provide it and would bar insurers from discriminating against people with preexisting conditions.
The plan would set up a mechanism to help connect those lacking affordable employer-based health insurance with coverage, either through a new Medicare-style federal program or through a private plan. Subsidies would be available for those who could not afford to pay full freight. The plan would also expand the Medicaid program for the poor, and allow people ages 55 through 64 to buy in to Medicare.
The Baucus plan also contains a number of provisions to help lower healthcare costs, including improvements in information technology, a stronger emphasis on primary and preventive care, and reforming the hugely expensive Medicare program, which he said "now rewards more care, not better care."
One huge unknown is cost. Baucus did not say how much he thought his plan would cost, but he suggested that Congress may have to suspend its own rule requiring legislation to be paid for without increasing the deficit.
A report issued yesterday by PricewaterhouseCoopers estimated that Obama's plan would cost $75 million in the first year - about one-third could be paid for by redirecting money now spent on treating the uninsured - and a total of more than $1 trillion over 10 years.
But Baucus said waiting until the economy improved was not an option. The country cannot move forward economically, he said, without doing something about the skyrocketing health costs that are hurting the ability of American businesses to compete and crowding out other public sector priorities like education. It is an argument his party will doubtless use in the coming months.
"If we're going to have a 21st century economy, and a 21st century playing field for American innovators . . . and workers, then we'd better get a 21st century healthcare system, and we'd better get it now," he said.
Lisa Wangsness can be reached at lwangsness@globe.com. 