Reform has long road ahead, experts say

Days after the U.S. House passed what the President called a “historic” health care reform bill, many in both the health care and political arenas are doubtful a final bill will emerge before the end of the year.

“It would be a miracle,” said Dr. Ken Hayman, emergency department director at Parkridge Medical Center and president-elect of the Chattanooga and Hamilton County Medical Society. “I won’t say it couldn’t occur, but I would worry it would be not well investigated if it were rushed through.”

Late Saturday, the Democrat-led House passed its reform bill in a 220-215 vote. The Senate still must put forth its version of health care reform, then the two bills must be reconciled before a final bill is on the table.

The House bill, H.R. 3962, includes the controversial public insurance option and a broad expansion of Medicaid as well as a mandate that most employers offer coverage to their workers or face penalties. The bill prevents insurance companies from denying coverage for pre-existing conditions, a key component of reform, Dr. Hayman said.

The $1.2 trillion bill would extend coverage to 96 percent of legal U.S. residents, according to the Congressional Budget Office.

Ken Ellinger, a political science professor at Dalton State College, said his “gut reaction” to the House bill’s passage is that it probably won’t speed things up too much in the Senate.

“The moderate Democrats in the Senate are probably scared of the overall scope and cost of the House bill, in addition to their almost-paranoid fear of the public option,” he said. “I would not characterize this House vote as historic because, unless it becomes law, it is nothing more than a meaningless footnote in history.”

One of the most controversial components of the bill is an amendment that would prohibit abortion coverage — except in some cases such as rape or incest — in insurance plans purchased with the help of government subsidies or in the government-run plan.

The amendment goes further than current law, which prohibits public funding of elective abortions, said Keri Adams, a vice president with Planned Parenthood of Middle and East Tennessee. Since private insurers likely would drop abortion coverage so they can cover people receiving federal subsidies, the provision would end up restricting women who are paying their premiums out-of-pocket, too, she said.

“We are not going to be able to support H.R. 3962 because of this amendment. It results in women losing health benefits that they currently have today,” she said.

Within the American Medical Association, mixed opinions abound on the House bill, even though the association endorsed it, said Chattanooga oncologist B.W. Ruffner, president of the Tennessee Medical Association.

Some members believe the bill is “so flawed and includes some issues physicians just can’t live with that they would prefer to see it fail,” he said.

“On other hand, the official position of AMA is there are enough good things in there to make it a starting point,” such as the broad expansion of coverage and a requirement that insurance companies must spend 85 percent of enrollees’ premiums on medical costs, he said.

The AMA’s hope is that some provisions — such as the inclusion of a public option — will be eliminated in a later version of the bill, he said.

Under the bill, small employers would receive tax subsidies to help pay for providing mandated coverage. Sherrie Gilchrist of the Tennessee Multicultural Chamber of Commerce said she would support a broad expansion of coverage so long as small businesses aren’t burdened.

Most small businesses struggle to afford skyrocketing costs of health insurance, though they want to provide coverage to their employees, she said.

“They know it’s a major impediment for them being able to hire qualified individuals,” she said.