Feb. 24, 2010 -- Health care reform has delivered plenty of big moments. Heated town hall meetings. President Obama's September address to Congress. The House and Senate passing historic reform bills. And Republican Scott Brown's unexpected victory in Massachusetts.
This week should provide another memorable twist in this yearlong saga.
It began Monday with Obama unveiling his own proposal, a 10-year, $950 billion overhaul of the nation's health care system. His plan generally mirrors the Senate reform bill, with some key differences. The president clearly aims to reignite momentum for reform, which had dissipated after Brown's win deprived Democrats of their filibuster-proof Senate majority.
And Thursday's bipartisan summit on health care reform will underscore Obama's new hands-on, high-stakes involvement in the debate. Whether it will produce anything substantive, though, is at best uncertain. Lawmakers of both parties predict the meeting will be more theatrics than anything else.
Still, the unveiling of the White House plan ''is a good move by the president,'' says Julius Hobson, senior adviser on health care for Bryan Cave, a law firm. "He's taking ownership and leadership on the issue. It changes the tone.''
The proposal aims to extend coverage to 31 million more Americans, reform the insurance market, and take steps to curb the inexorable rise in health care costs. Obama would create a new federal insurance board that would review -- and perhaps stop -- excessive rate increases by health insurers. The idea follows widespread anger over premium increases of up to 39% planned by Anthem Blue Cross of California.
News of those hikes, and those by other insurers elsewhere, appeared to breathe some life into pro-reform efforts. "It was like throwing one right over the plate in batting practice,'' providing Democrats an easy target, says Donald Taylor, a Duke University health policy professor. The rate increases on individual policies show the instability of that market, he says.
Yet conservatives see the insurance board as another sign of what they call excessive government regulation.
"It's surprising because it takes away so much power from state insurance commissioners,'' says Brian Darling, director of Senate relations for the Heritage Foundation. "It plays into the conservatives' argument that this bill will be a de facto government takeover of health care.''
Details of the President's Plan
Other provisions in the Obama plan include:
- Stiffening the penalties for individuals who choose not to purchase health insurance, and for companies to cover costs if their workers get subsidized coverage.
- Closing completely the infamous ''doughnut hole'' in Medicare's prescription drug coverage.
- Eliminating the special deal to cover a Medicaid expansion in Nebraska, a widely derided feature of the Senate plan; instead, all states would get help in covering those costs.
- Applying a new Medicare tax on unearned income for high-income households.
- Delaying an excise tax on expensive, ''Cadillac'' health benefits plans until 2018, and raising the ceiling on the value of such plans that would trigger a tax.
In a nod to the House reform plan, the White House has sweetened the subsidies for lower- and middle-income families to purchase insurance. But Obama has followed the Senate's lead in jettisoning the ''public option,'' the proposed government-run health plan, approved by the House, to compete with private insurers. And it keeps the Senate's less restrictive language on funding for abortion.
The Obama proposals contain aggressive strategies to attack waste, fraud, and abuse in health care -- initiatives long championed by Republicans. "You could get some real savings out of it,'' says Hobson, who represents family physicians as a lobbyist.
Darling agrees that the anti-fraud measures are a needed improvement. "It's definitely a step in the right direction,'' he says. But Darling adds that these provisions don't make the overall bill palatable for conservatives.
Prospects for a Deal
The White House plan helps set the agenda for Thursday's health care summit. But there doesn't appear to be much optimism that real deal-making will occur under the TV lights.
Still, Taylor says it's a crucial moment for Obama. With Brown's election, Democrats ''have been getting cold feet'' on reform, Taylor says. "The president could have said, 'Let's give up."' Instead, Obama "has wrapped himself up completely in this.''
A deal is very unlikely, Taylor says. But if one should take shape, he says, it could start around Democrats accepting malpractice reform, a leading issue for Republicans.
The GOP has long called for a new start -- a blank sheet of paper -- on health care reform. The House Minority Leader, John Boehner, R-Ohio, says Obama ''crippled the credibility'' of the summit by proposing ''the same massive government takeover of health care.''
The Obama proposal as a whole ''is a nonstarter for conservatives,'' Darling says, citing its federal mandates, tax increases and additional regulation. The summit "is going to be high drama,'' Darling says. But ultimately, he says, the two sides are too far apart to do anything but start over.
Meanwhile, a Kaiser Family Foundation poll released Tuesday shows the public evenly split on health care reform, with 43% in favor and 43% opposed. The poll, though, also found that most Americans support key provisions of the current reform plans.
The summit will give Obama a shot at marketing his plan to Americans in a clearer way, says Bill Custer, a health insurance expert at Georgia State University.
If the meeting descends into posturing, and no reform passes this year, don't expect health care problems to disappear, experts say.
"The underlying trends are so bad for insurance coverage,'' Custer says. Unemployment is rising, COBRA coverage is expiring, small employers are less likely to offer coverage, and large employers will continue to see insurance increases greater than general inflation, Custer notes.
"All the trends that have led us to this point are not going away,'' he says. "It's likely they've gotten much worse.''