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Hillary Rodham Clinton takes the lead.

The Washington crowd expected scandal, expected change, expected Bill Clinton to maybe throw a few curves -- it did not expect the First Lady to emerge (and during the first month, at that) as the key player on one of the most crucially important issues facing the White House. Nevertheless, that is exactly the role that Hillary Rodham Clinton has accepted in chairing the White House Task on Health Care Reform.

The Task Force includes Secretary of Health and Human Services Donna Shalala, other members of the Cabinet with health care responsibilities, and Tipper Gore, wife of Vice President Al Gore. Hillary Rodham Clinton, formerly a partner of the largest law firm in Arkansas, has extensive experience in pediatric health care issues, in part from her service on the board of directors of the Children's Defense Fund. Tipper Gore also has extensive background on mental health and mental retardation issues. Over seventy experts from various health care fields have been tapped to provide position papers that will contribute to the deliberations of the Task Force.

In addition, members of the Task Force plan to attend several regional hearings on health care issues prior to formulation of final recommendations for health care financing reform. The first of these hearings took the form of a conference organized by U.S. Senator Harris Wofford (D-PA) on February 11. The conference participants tended to be middle-income individuals concerned that their existing insurance coverage was a fragile protection against major health care costs.

The problems of the uninsured, however, occupied less attention. Senator Wofford explained that fears that providing health care for the uninsured will add enormously to the federal deficit were unfounded because the poor already are being subsidized by insurance rate payers. "We are paying the costs for hospital care for the poor," he explained, though he noted that this approach is inefficient because it concentrates resources on the most expensive form of health care.

Although the Task Force is not expected to produce recommendations until May, its composition and plan of action have made several health care policy observers uncomfortable. The absence of health care professionals in a direct policymaking role is one reason why. As one prominent supporter of Clinton's election campaign in Louisiana put it, the absence of a pharmacist among the expert consultants serving the Task Force is disturbing, since pharmaceutical costs have obviously become a major target of reform. In fact, none of the Task Force members are clinicians, and most of the consultants are policy analysts and insurance experts.

One organization that apparently doesn't mind not being included is the American Health Care Association (AHCA), which has taken issue with the assumption that the problems of financing nursing home care should be addressed by major health care system reform. AHCA recently issued a statement claiming that expansion of private long-term care insurance should be a key goal, and that its limited use thus far is caused by lack of consumer awareness of its affordability. The AHCA statement urged that consumers be educated in the need to purchase private coverage before they need it, rather than waiting for a potential financial crisis in paying for nursing home care. Whether Hillary Rodham Clinton and her Task Force will buy that argument remains to be seen.

New Congress Brings Few Changes to Health Care Committees

Although the freshman class of newly-elected congressmen is the largest in four decades, the new legislators generally have not won seats on committees of' interest to the nursing home community. With the exception of Congressman Tom Downey, defeated for reelection by his Long Island, New York constituents, the principal leadership on health care issues on Capitol Hill remain in place.

Henry A. Waxman, the Los Angeles-based Democrat, continues to chair the House Subcommittee on Health and the Environment; Senator Edward Kennedy continues as chairman of the Senate Labor and Human Resources Committee. Senator Tom Harkin of Iowa and Congressman William H. Natcher of Kentucky, senior members of the Senate and House Appropriations Committees, remain the two most important voices on federal spending for health programs other than entitlements and the Veterans medical system.

Only one freshman congressman, Republican Jim Greenwood of Pennsylvania, joined Waxman's powerful Subcommittee on Health and the Environment. Two newly-elected Democratic congresswomen, Marjorie Margolies-Mazinsky of Pennsylvania and Blanche Lambert of Arkansas, have been appointed to the House Committee on Energy and Commerce, which approves all legislation passed by Waxman's subcommittee. A new Republican congressman from Idaho, Michael D. Crapo, also has been appointed to the full Energy and Commerce Committee.

The membership of the House Appropriations Subcommittee for Labor, Health and Human Services, and Education did not change at all. It remains one of the few committees whose membership "looks like America." Five of the 13 members of this key appropriations subcommittee are women, two are of Latin American descent, and one is African-American.

Senator Harris Wofford, whose surprise special election in 1991 catapulted health care to the top of the issue agenda, was appointed to the Senate Committee on Labor and Human Resources. No freshmen members of the Senate elected in 1992 were recruited for either the Senate Committee on Labor and Human Resources or for the subcommittee of the Senate Appropriations Committee that is responsible for federal health-related expenditures.

One explanation for the impasse on health policy during the past four years is that the congressional committees that focus on health issues tend to have members that are unusually liberal and more likely than average to favor government activism. According to this view, the committees frequently proposed relatively radical changes in health care policy that were not supported by the more conservative majorities in the Senate and House. This raises the question whether the lack of turnover in membership on these committees in 1993 will mean that this problem will continue in the new Congress.
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Title Annotation:View From Washington
Author:Stoil, Michael J.
Publication:Nursing Homes
Date:Mar 1, 1993
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