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Hardest work lies ahead on health care reform.

The hard work of health care reform lies in front of Congress as it headed back to work after its 5-week summer recess.

Over the next 2 months, Democrats and Republicans will have to figure out what to pare off the long wish lists put together by House and Senate committees, and, more importantly, take on the politically distasteful task of determining how to pay for what remains.

That job is the province primarily of the Senate Finance Committee, which at press time had yet to weigh in with a reform proposal. Reportedly, the committee set a mid-September deadline to complete its work.

The funding issue is thorny enough; achieving a bipartisan consensus is another hurdle, and Finance Committee Chairman Max Baucus (D-Mont.) seems more wedded to achieving that than the other committees with jurisdiction over health care.

Joe Antos, a scholar with the Washington-based American Enterprise Institute, said he expected Sen. Baucus to go to the mat to win a bipartisan agreement, largely because of his enduring friendship with the committee's ranking minority member Sen. Chuck Grassley (R-Iowa). And that could push any potential floor action in the House and Senate further into the fall, he said.

In press conferences and town hall meetings, President Obama has made it clear that he wants a health reform bill to sign before the end of the year. In a New Hampshire forum last month, he said, "If we let this moment pass--we will continue to see 14,000 Americans lose their health insurance every day." And he added, premiums would continue to "skyrocket," and the deficit would keep rising because of unsustainable growth in Medicare and Medicaid.

Republican lawmakers, on the other hand, have sought to slow the process. In a teleconference with reporters, Sen. John Cornyn (R-Tex.), who sits on the Senate Finance Committee, said, "One of my personal goals was to make sure we slowed this debate down so that we could have the time to analyze what's in the bills, and analyze the cost and effectiveness, and I think this has been a very important break in what's happening in Washington."

During the congressional recess, many senators and House members arrived home to find well-organized protests objecting to what protesters called "government-run health care." The administration scrambled to reassert its message amid the rising din, in part by launching a "Reality Check" Web page ( and hosting a national Webcast.

The Obama administration also appeared to paint the insurance industry as the poster child for everything wrong with the current system. At the New Hampshire event, President Obama said that under reform, "insurance companies will be prohibited from denying coverage because of a person's medical history," and that "they will not be able to water down your coverage when you need it."

But the industry has fought back. "Health plans last year proposed health insurance reform to make sure that no one is denied coverage because of a pre-existing condition," Karen Ignagni, CEO of America's Health Insurance Plans, said in a statement. "Our proposal includes new consumer protections and market rules to guarantee coverage for pre-existing conditions, discontinue basing premiums on a person's health status or gender, and get everyone covered through a personal coverage requirement."

Mr. Antos said that taking on the insurance business might make for good public relations, but that, "this tactic seems like an admission of defeat," by the administration. If the White House makes a villain out of insurers now, it might make it difficult to come back and negotiate with the industry this fall, he said.

The insurers' cooperation might be necessary to meet the president's goal of having a deficit-neutral reform package. The White House has gotten promises from the pharmaceutical industry and hospitals to cut costs over the next decade, but physicians are looking for a raise from Medicare--or at least a guarantee that their fees won't be cut. The substance of that final health care reform package is far from clear.

The Senate Health, Education, Labor, and Pensions Committee was first to produce a plan. After 60 hours of debate and changes, the bill passed on a pure party-line vote on July 15.

The three House committees with jurisdiction over health--Ways and Means, Energy and Commerce, and Education and Labor--combined forces and created a bill that, again, passed along party lines, with the last vote coming July 31 in the Energy and Commerce Committee.

There are some large philosophical differences between the House and Senate plans (see chart); the addition of the Finance Committee's proposal, when it comes, is likely to widen the gap.

Ultimately, the decision on what's in and what's out will come down to the conference committee established after the House and Senate pass their bills, noted Mr. Pollack of Families USA. If there's no bipartisan agreement, he said he expects the Senate leadership will move forward without the Republicans and put the whole package to the floor for a vote, likely through the complicated reconciliation process. Under that procedural maneuver, only 51 votes are required for passage.

That scenario looks increasingly likely, Mr. Pollack said. He said Senate Republican leaders, including John Kyl (RAriz.) and Mitch McConnell (RKy), "feel it's in the best interest of the Republican Party politically to defeat health care reform."

Joyce Frieden and Mary Ellen Schneider contributed to this report.
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Author:Ault, Alicia
Publication:Clinical Psychiatry News
Date:Sep 1, 2009
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