Hurdles remain for reform of health care

Hurdles remain for reform of health care

December 22nd, 2009 by Emily Bregel and Matt Wilson in Health

Despite a key vote paving the way for passage of the Senate's health care reform bill, the real challenge in finalizing reform efforts still lies ahead, said some local health care professionals.

"The real question will be whether they can reconcile both the House and Senate bills, " said Dr. Ken Hayman, director of the emergency department at Parkridge Medical Center and president of Chattanooga and Hamilton County Medical Society.


The House and Senate health care bills are similar

* The bills cost about $1 trillion over 10 years, paid for by tax and fee increases and cuts in projected Medicare spending.

* Both bills set up new insurance marketplaces called exchanges where uninsured or self-employed people and small businesses can compare prices and plans designed to meet some basic requirements.

* Denying people coverage based on pre-existing conditions would be banned.

* Young adults could retain coverage longer under their parents' insurance plans.

Source: Associated Press


* U.S. Sen. Lamar Alexander, R-Tenn., called the Democrats' rush to pass the bill a "political kamikaze mission."

"The only reason we are literally voting in the middle of the night on a 2,700-page bill we received just yesterday is because Democrats want to pass this legislation before the American people find out what is in it," he said.

* U.S. Sen. Johnny Isakson, R-Ga., criticized the concessions given to holdout senators to secure their votes.

"This bill dissolved into a game of 'Let's Make a Deal,'" he said.

* In an appearance on CNBC Monday morning, Sen. Bob Corker, R-Tenn., said the bill "throws future generations under the bus."

Sen. Corker said it would be hard to see anything derailing the bill's passage in the Senate, however.

"For those that want to pass a health care bill that's full of trickery and budget gimmicks and is going to add tremendously to our budget deficit, for those that want to see that, last night was a big night," he said.

For example, senators "had to give up the public option, which many of the liberals in the House were quite supportive of," Dr. Hayman said.

Early Monday morning, the Senate's health care reform bill got the 60 votes needed to override a Republican filibuster, which would have delayed a vote on the bill. Although no Republicans voted for the bill, the vote brings Congress one step closer to passing broad health care reform.

The bill still faces several more procedural votes this week. The Senate is expected to take a final vote Thursday evening, and the bill would then have to be reconciled with a different House bill, which passed in November, before heading to President Barack Obama's desk.

Tony Garr, of the Tennessee Health Care Campaign, an advocacy group that is lobbying for health care reform, said more than 700,000 uninsured Tennesseans would get coverage under the Senate bill.

"Even though we had some misgivings about some parts of the bill, there's so much that's good in the bill that would really help Tennessee families that we could not say, 'Start over again,'" he said.

Republican legislators in Tennessee and Georgia opposed the bill, which Sen. Saxby Chambliss, R-Ga., said would leave millions of Americans uninsured.

"That's not what we've heard from Day One from the folks on the other side of the aisle about making sure that every single American was covered," he said.


The Senate bill creates new insurance marketplaces called exchanges in which competing plans must meet basic requirements in coverage. Insurers will no longer be able to deny coverage based on pre-existing conditions, the Associated Press reported.

Insurers also would have to spend 85 percent of premiums collected on medical care for large group plans and 80 percent for individual and small group plans.

Mary Thompson, spokeswoman for BlueCross BlueShield of Tennessee, said that services such as disease management and prevention and wellness programs would be limited by what she calls the "arbitrary" cap.

"While the expenses associated with these programs may be accounted for in administrative costs, they directly improve patients' health and ultimately, help reduce costs," she said in an e-mail interview.

But some leaders in the hospital industry are concerned that 24 million people would be left uninsured under the bill.

Hospitals agreed to give up billions in Medicare payments to help fund reform, so long as the vast majority of their patients would be insured after a reform bill passes, said Kevin Bloye, spokesman for the Georgia Hospital Association.

"We would like to see more Americans covered under the plan and, if we can't get that, we'd like to see some changes in the levels of reductions in hospital payments," he said.


On abortion, a compromise worked out over the weekend drew opposition from both sides of the issue.

The deal seeks to maintain a division between taxpayer money and private premium funds that would pay for abortion coverage. No health plan would be forced for offer abortion coverage and, for those that offer it, beneficiaries would have to pay for the coverage separately.

States could prohibit abortion coverage in plans offered in insurance exchanges, the AP reported.

Keri Adams of Planned Parenthood of Middle and East Tennessee said the compromise is no better than the hotly contested Stupak amendment included in the House bill. Under the amendment, private companies in insurance exchange could not offer plans covering abortion if they receive any federal subsidies, which would affect most plans in the exchange.

Most insurers likely will choose not to offer abortion coverage because of the "bureaucratic nightmare" that it would be to figure out the funding, she said.

Federal law already bars the use of taxpayer money to pay for abortion, except in certain cases such as to save the life of the mother.

Charles Wysong, president of the pro-life American Rights Coalition in Chattanooga, said he has not had a chance to read the new language on abortion, but he said even the stricter Stupak amendment in the House bill does not go far enough to limit abortions.

"I don't think their intention is to protect unborn children," he said.

The Associated Press contributed to this story.