By: Health Insurance
Submitted: 2009-10-13 18:03:24 | Word Count: 725
Sixty years is how long Democrats say they've been pushing for legislation that provides health care access for all Americans. They'll have to wait three more if President Obama gets a bill to sign this year.
Under Democratic bills being considered, federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start until 2013. Medicare cuts and a sizable chunk of the tax increases to pay for the changes kick in immediately.
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Health care experts allied with Democrats are concerned that opponents of these changes could undermine what would be an achievement for Obama.
"Just as we are fending off ideological attacks to get the bill passed, we will be fending them off as we implement the law," said Judy Feder, a health official in the Clinton administration.
Peter Harbage, a Democratic health policy consultant, said "there needs to be more focus on what can you do quickly so that real people will start seeing change sooner, rather than later."
Obama administration officials and Democratic lawmakers say the reason for the three-year wait is the time it's going to take to set up insurance marketplaces, write consumer protection rules and reconfigure the bureaucracy to carry out the legislation. It took President George W. Bush's administration two years to phase in the Medicare prescription-drug benefit.
"It's very important to get the execution right," White House budget director Peter Orszag told the Associated Press.
Lawmakers also use a 10-year accounting window to assess new programs. Starting the Medicare cuts and some of the taxes earlier — and pushing the bulk of new spending later — helps keep the legislation's cost within Obama's $900 billion limit. Bush used the same kind of maneuver to push the Medicare drug benefit through Congress.
"The full cost of the program is underestimated in the 10-year window that you are looking at," said Gail Wilensky, who ran Medicare for President George H.W. Bush. "It's not like we've never seen this before."
Congressional Democrats are defensive about their slow-motion rollout. Senate Finance Committee Chairman Max Baucus, D-Mont., addressed the concerns in a recent news release title: "What You Get Right Away."
Among the short-term improvements in his bill would be a benefit for people on Medicare, who already have insurance coverage. Starting in 2010, those who fall into the Medicare prescription plan's coverage gap would get a 50% discount off the price of brand-name drugs.
In 2011 and 2012, certain employers with fewer than 25 workers could get a tax credit for up to 35% of what they contribute toward the cost of employee coverage. That could encourage some companies that don't offer coverage to do so.
To answer Obama's call for an immediate end to insurance company discrimination against the sick, Baucus would set aside $5 billion from 2010 to 2013 to help states provide affordable coverage to people denied because of a medical condition. The money would be apportioned to high-risk insurance pools that many states have set up.
The Senate Finance Committee is slated to vote Tuesday on its health care legislation. On Sunday, Democratic Sens. Debbie Stabenow of Michigan and Bob Casey of Pennsylvania said they would not support changing medical malpractice laws as a way to attract Republican votes.
"I don't think the way to go is to limit the rights of Americans who are injured by negligent or intentional conduct," Casey said on CNN's State of the Union. Stabenow said on the same program that her state already has imposed caps on damages in medical malpractice cases, and "our doctors continue to see their (malpractice insurance) premiums go through the roof."
Utah Sen. Orrin Hatch and other Republicans back changing malpractice laws as a tool to lower health care costs. The Congressional Budget Office last week estimated that changes to these laws, such as limiting the amount of money juries can award to patients for botched care, would reduce budget deficits by $54 billion over a decade.
