Senate Finance Committee Chairman Max Baucus, speaking to reporters this morning at a breakfast sponsored by the Kaiser Family Foundation, sounded extraordinarily optimistic about the prospects for bipartisan support of the health care reform bill that his committee will begin writing in mid-June. “Very high. Very, very high,” he said, saying he puts the odds at 75-80%. For that, he gives a big share of credit to Senator Charles Grassley, the ranking Republican on Finance, whom Baucus calls “a real hero.”
So what will that bill look like? On that, Baucus wasn’t nearly as specific. He did say that the bill would set up “exchanges” where people could comparison shop for insurance politices, that it would impose new regulations on the buying and selling of insurance, that it would do away with current practices where people get charged vastly different insurance rates according to their health history. And it was possible to draw some other clues from his answers to some of the questions that were raised:
1. Will the bill provide universal coverage? It has to come pretty close, Baucus said, if all the other reforms are going to work. Most health care experts agree. By “nearly everybody,” Baucus added he was talking about something like 96% of all Americans. However, he refused to specify how quickly that might be achieved.
2. Will the bill have a government-financed “public option”? This is one of the most contentious questions surrounding the health care debate, with the insurance industry arguing that giving Americans the option of enrolling in a Medicare-like plan would essentially destroy its business model. While Baucus said that “a version will be there,” he also hinted strongly that it will be structured as some kind of compromise. “There are ways to skin a cat,” he said.
One possibility that he sounded pretty enthusiastic about is having the public option as some kind of “fallback”. I’ve heard that fallback idea talked about quite a bit lately, in various guises. For instance, there may be such an option in insurance markets where there is no real competition–which, these days, is pretty much everywhere. Another version under discussion would trigger the fallback if the private health insurance industry failed to bring costs under control.
3. What about single payer? Not on the table. Why? Because it couldn’t pass the Congress, Baucus said. He also said single payer does not focus enough on the quality of care — something that single-payer advocates will certainly disagree with.
4. How will you bring costs under control? As he has in the past, Baucus said the key will be changing the way that health care providers are reimbursed, so that they will be rewarded for the quality of the care they provide, and not the quantity.
5. What about the tax exclusion for employer-provided health care? Baucus hinted strongly that he wants to put some limits on it, because it is “analytically true” that counting health benefits as a kind of tax-free income is regressive, distorts the system, and encourages overuse. But he added: “I’m not endorsing it at this point.”
The answer to many of these questions are likely to be determined by the numbers. Under the budget rules, any health care plan that passes Congress is going to have to pay for itself (as it affects the federal deficit) within 11 years. Baucus said that over the Memorial Day recess, his staff expects to be getting a lot of numbers back from the Congressional Budget Office — numbers that will help determine what is possible and what it not.