Senate Bill May Provide Starting Point to Fix Health Care System

The Senate Finance Committee is considering legislation that could serve as the basis for major health care reform efforts during the next presidential administration, according to analysts interviewed by AAFP News Now.

In January 2007, Ron Wyden, D-Ore., introduced the Healthy Americans Act, S. 334, (at the THOMAS Web site, type "S. 334" in the search box after selecting "Bill Number") a bipartisan bill that reflects the values of both the Democratic and Republican parties, making it a viable vehicle for health care reform. That's according to Len Nichols, Ph.D, director of the health policy program for the New America Foundation, a think tank created to promote bipartisan solutions to problems.

"I will be the first to say this bill is not perfect," said Nichols. "It will not be the (health care reform) bill that actually passes in 2009 or 2010. But it is a perfect place to have a conversation."

The bill addresses key Democratic concerns by requiring adults to carry health insurance, thus promoting the Democratic goal of universal coverage. Under the legislation, adults without insurance would be required to enroll themselves and their children into Healthy Americans Private Insurance plans, which would provide beneficiaries with the same benefits members of Congress receive.

"(The bill) says coverage is going to be comprehensive and affordable," said Nichols in an interview with AAFP News Now. "It also protects the sick -- those with chronic conditions -- from being discriminated against in the insurance market, as they are today."

At the same time, the legislation relies on individual choices, market incentives and reforms to improve health care access, reduce costs and make the delivery system more efficient, thus appealing to congressional Republicans.

"The bill provides patient-driven health care through market forces by allowing more transparency and competition, which will result in insurance companies having to compete on price, benefits and quality," said Tara Hendershott, press secretary for Sen. Robert Bennett, R-Utah, Republican co-sponsor of the bill. "This emphasis on utilizing market forces is a key component that appeals to Republicans."

Other provisions also make the bill attractive to both Republicans and Democrats. For example, the bill encourages Medicare beneficiaries to choose a medical home, and it pays physician practices a fee for serving as a medical home. Medicare also would be required to create a chronic disease management program and to provide a chronic disease management payment to any physician who manages patients with any of the five most prevalent chronic diseases, as identified by the HHS secretary.

"I believe if everyone had a medical home, we could manage a lot of conditions medically and keep people out of the hospital," said Nichols. "We would, therefore, save money in the long run."

In the past 15 months, the bill has picked up 14 co-sponsors, including eight Republicans, who represent the "critical mass" needed to move the health care reform debate forward, Nichols said. He describes the Healthy Americans Act as the "first comprehensive reform bill that has ever been co-sponsored by both parties."

According to Nichols, two key factors will drive health care reform efforts during the next few years: cost considerations and international competition. During the past 20 years, health care costs have jumped dramatically, consuming an ever-increasing share of individual incomes and sparking an outcry from the nation's middle class for health care reform. In 1987, family insurance premiums comprised 7 percent of median family income; that number stands at 17 percent today, Nichols said.

In the meantime, the global economy has put tremendous pressure on American businesses, which are struggling to meet the health care costs of their workers.

"The global economy is here," said Nichols. "It is relentless, it is amoral, it is highly efficient … so fundamentally, we have to figure out how to get health care costs under control."

That is why, he added, business coalitions are "grabbing politicians by the lapels and saying, 'Quit the dance already, let's get this solved.'"

Nichols notes that during the past few years, Republicans and Democrats have undergone fundamental shifts in their respective thinking about health care reform. Democrats have "discovered markets -- they have figured out that the center of health reform needs to be markets and choices," said Nichols. Republicans, for their part, have "discovered that many people cannot afford health care," and have proposed ways to make health insurance more affordable and accessible.

In many ways, the Healthy Americans Act reflects the changing attitudes of both Democrats and Republicans on the issue of health care reform, said Nichols.