The House may have closed the current chapter on health reform, but, as far as the discussions on the implications of the trajectory of the legislation (it goes to the Senate next) are concerned, the parties most excoriated by the House bill’s mandates^[1] want relief — without filibuster politics.

The focus on the Senate’s policymaking is most important, if only for the possibility of using delay tactics to keep Obama from capitalizing on his perceived victory from the House vote. With the usual suspects (Pharma, AHIP, small business) criticizing Saturday’s vote as a referendum on reckless healthcare spending, it is no secret that the push is on for final merging of the Senate bill to resemble the Finance Committee version — the most fiscally viable for these groups. And the public option? Although many of its foes admit that any inclusion therein is unpalatable, the realization of the American public’s desire for some form of social reform as one that cannot be dismissed is stimulus enough for — at least — an olive branch^[2] to be thrown in the direction of progressives.

But, is criticism of the House bill more a PR issue than a strict policy issue? What exactly is the magnitude of harm that can be done to third parties that stand to otherwise profit more easily? Some say not much at all…that the degree of damage to healthcare industry bottom lines is more about maintaining political allegiances than predicting a dire future for healthcare financing out of genuine concern for the healthcare consumer. The easiest way to keep that status quo is not to let up on influencing Senate vote; Insurance and Pharma wouldn’t have it any other way. | LINK to provisions of the House bill

1. Insurers balk at government competition; Pharma winces at drug rebates  and reimbursements payable to the federal government over the next decade. [↩]
2. opt-out or -in clauses for individual states, for example [↩]

President Obama just wants to make everyone happy. At least that was the impression he put forth on the campaign trail: unity among all in the desire for change. Ten months into his first year, he’s had to make much in the way of compromise. On his top domestic policy issue – from contentious townhalls to circumspect senior citizens — Obama has had to rely heavily on his immense powers of articulation more than any other president in recent memory to straddle to the tightrope of public opinion to get his heatlhcare reform ideals passed. His efforts to marry apparent discordant entities (i.e., the role of insurance companies in a public option provision) within the reform debate have been stressed lately on the heels of his recent address to Congress on healthcare reform. As the president knows, it will take more than just a kumbaya approach to reform if one is serious about calling health reform what it is and what it isn’t — insurance reform.

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By now healthcare policy watchers everywhere know that the Baucus Senate Finance bill passed and that Olympia Snowe’s (R-ME) moderate voice was the lone Republican modicum of support. Next up — no more than two weeks (according to Harry Reid [D-NV] — majority leader) of debate before the final floor bill. Besides keeping busy with the pending debate, possible reconciliation, and floor vote; senate Dems are busying themselves with another cause. The deer in the health reform headlights is none other than Insurance itself.  Whatever the reason, the eleventh hour report the industry’s lead lobby — the AHIP — rapidly rolled out on the eve of the Baucus bill vote has complicated matters for themselves. If the AHIP thought that this move would help their cause by drawing a line in the sand, it’s done nothing but inflame all three (four?) sides of the healthcare debate: the Republicans, Democrats, Obama & the WH, and the healthcare beneficiary.

It’s the latter demo that the other three have to contend with over the next crucial 14 days before the most sweeping changes in 65+ years in healthcare delivery occur. Vitriolic townhalls may be a thing of the recent past, but the public’s ire over what is now seen as insurance reform (as opposed to true grassroots healthcare reform) is sure to grow over the next few days – in part due to the latest stirrings by the AHIP. Obama’s spearheading of the reform debate up to this point has generally been heralded as positive, if not mildly successful. But that victory may be a pyrrhic one if many see this detour on the road toward reform as beholden in some part to Insurance.

As the blending of the House and Senate versions of the reform bill coalesce for a vote on its passage, Democrats (who, let’s not forget, own the majority in both houses) must continue to frame the debate on reform as one of guaranteed access that won’t bankrupt the “system” by skewing risk pools, as the AHIP’s report suggests.^[1] Sound fiscal arguments persuasive enough to woo and keep moderate Republican interests like Sen. Snowe are the Dems’ best shots at melding a bill that will please many at the expense of a dilute public option.

1. The AHIP says that young healthy ‘invinvibles’ will not gravitate toward coverage and spread the risk pool, causing an incentive for the sickest, oldest, and neediest to clamor for it — driving up costs. [↩]

This morning’s vote on the health reform bill is as anticlimactic as it is divisive. After weeks and months of speculation, townhall harangues, and political incivility, the Baucus bill^[1] and its more liberal cousin^[2] will merge and go the floor. It’s a foregone conclusion that the bill will be more notable for what it does not contain than for what it does — mainly a so-called public option provision that is enough to satisfy Obama’s more politically Left base.

Fueling the the events today was the release of a report on Sunday (which the White House denounces as a political ploy at influence peddling) from the AHIP lobby detailing the rapid increase in premiums [PDF] if Baucus’s plan saw the light of day. No matter, according to Baucus — as he has the votes to pass his version. Responses are coming out of the woodwork on the heels of today’s vote. A few:

• A leading hospital lobby seems to be backtracking on recent total support of the Baucus plan. The hospitals, which agreed to contribute $155 billion in savings over 10 years toward an overhaul effort, have said that not enough new people would be covered by the finance committee’s final version.
• Some physicians who practice in highly technological subspecialties feel unfairly targeted — as they have complained about provisions in the legislation, including a measure that would penalize physicians in the top 10 percent of spenders. Additionally, some medical device makers oppose a tax provision in the Senate Finance bill that would require them to pay $40 billion annually.
• The AHIP (the organization at the center of the current Hill firestorm) considers the Finance committee’s measure to be one it generally supports but still retains concerns over the ability for insurance companies to reach “higher coverage targets”.

Although there are key differences the White House says Insurance completely ignores, like the utilization of healthcare exchanges to ensure future cost savings; there is generally broad bipartisan agreement on issues of the abolition of preexisting condition provisions, preventive care initiatives, and EHR implementation. The road to complete agreement on how to spend dollars to achieve these goals is a different matter altogether, however.

1. so named as its chief architect is also the Finance Cmte. chair [↩]
2. courtesy the Health Employment Labor and Pension Committee [↩]

It’s just something that makes healthcare policy observers want to ask, “how public is this public option going to be after the merger of House and Senate versions of the reform bill occurs”? Now that the Baucus bill has been released and is being met favorably by fiscally conservative Democrats (as expected) and the more progressive wing of the party (somewhat surprising), criticisms are beginning to emerge in advance of Baucus’s committee’s vote on it next week. Most notably, a current report by the RWJ finds that older Americans under the Senate Finance Cmte. version will be paying more in premiums than much younger adults; this would only apply to those patients finding coverage on the open healthcare market or are uninsured.

This pits the actions of two groups of observers/lobbyists, the AARP and the AHIP, as a potential source of political friction once the Senate Finance version passes. Insurance plans would stand to gain in a plan in which the government would have to subsidize the inclusion of younger patients in a given pool of beneficiaries to offset the high risks incurred by covering, say, those over 65 who lack affordable insurance coverage. The AARP, needless to say, will be watching the merging process very closely in the run up to the final reform bill. They obviously have much to gain if uninsured seniors are not forced to pay premiums which may be as much as 5 times higher than what a younger adult under the Baucus-led bill would pay. | LINK

Just because there’s a congressional recess this month doesn’t mean that health reform is an off-topic issue. Public discourse is in full swing, be it in the form of private special interest ad blitzes, the ongoing droning of politicos and talking heads, or actions by the private third parties themselves. In particular, it’s the latter group (insurance companies) which perceives itself as having the most to lose if any semblance of a “public option” were to emerge. As some entities have reached varying forms of consensus with lawmakers on the pending legislation, it is the insurers which are filling the coffers of Republicans in both chambers at a breakneck pace in an effort to sway the vote away from potential agreements that will increase tax subsidies for beneficiaries under Medicare and Medicaid, but decrease insurers’ profits with the same demographic.

It certainly doesn’t help matters when the House Speaker publicly refers to Insurance as “villains” which “are doing everything in their power to stop a public option from happening”.

Pharma, hospitals, many large health plans, and some physician associations may feel less threatened by any pending legislation in spite of making significant congressional donations — probably because they are ensured of concessions in other areas regardless of the language on the reform bill. Still, some HMOs and insurance plans will probably continue to “look out for #1″ as the race to the bill’s passage rolls on. | LINK

Rather than losing out in government sponsored plans, two leading insurance lobbies announced that they would consider ending high premiums for many patients with significant chronic diagnoses. In a letter to two prominent senators in the healthcare reform & policy sector, the Blues and America’s Health Insurance Plans made their “offer”:

Tuesday, Karen Ignagni, who heads America’s Health Insurance Plans, said insurers want to help reverse [high premiums/costs]. “The private sector can rise to the challenge of solving these problems,” she said.

Ignagni and Blue Cross Blue Shield Assn. President Scott P. Serota made the offer in a letter to senior senators. But it came with a catch: The insurers said all Americans must first buy health insurance to boost the size of the risk pool, a concept opposed by many consumer groups.

“By enacting an effective, enforceable requirement that all Americans assume responsibility to obtain and maintain health insurance, we believe we could guarantee issue coverage with no pre-existing condition exclusions and phase out the practice of varying premiums based on health status in the individual market,” they wrote.

With the insurance companies, there has to be incentive for participation in any plan involving the spectre of government intrusion. It’s called maintaining “skin in the game”. | LINK

How about holding a house party discuss healthcare policy reform, and inviting some unexpected guests: among them — the insurance companies? Interest and advocacy groups representing the entire healthcare delivery spectrum will be holding informational sessions all over the country in anticipation for the culture of healthcare accountability Barack Obama has proposed as a policy point. Organizations from the AMA to America’s Health Insurance Plans, from state medical societies to pharma and device lobbies will all be taking part in these strategic listening sessions in which local physicians are urged to take an active part. Culture of accoutability in healthcare? It appears as though Barack Obama wants full disclosure, like, yesterday. | LINK

The nation’s largest healthcare insurance lobby & trade group (America’s Health Insurance Plans) today announced its plans toward the goal of a universal healthcare access mandate. To be fair, the announcement came with few specifics, of course; however, the route it will take to get there completely discounts the Obama plan which would utilize a national taxpayer subsidized delivery system, a la Medicare.

Guaranteeing healthcare access to all citizens, regardless of socio-economic status will require, in the words of the AHIP, a strong “‘private-public’ partnership that builds upon the principles of employer sponsored care”. The lobby will rely on a national requirement for health insurance coverage as a key stipulation for promising coverage to everyone; that is, coverage required by U.S. law is necessary for third parties to compete for consumers’ healthcare needs (and dollars). Insurance companies should not be forced to participate in government sponsored programs. Interesting. | LINK