Baucus previews uninsured debate for next Congress

Washington -- Sen. Max Baucus (D, Mont.) will try to advance a major health system reform bill with bipartisan support next year. But the chair of the powerful Senate Finance Committee might consider using a budgetary tactic to force adoption of the measure with a simple majority vote if broad support does not materialize.

Baucus, speaking Sept. 23 at a U.S. News & World Report forum on the uninsured, said he plans to outline his measure later this year. The Senate Finance Committee -- a key stop for most health care legislation -- has held a series of hearings on health system reform in recent weeks to lay the groundwork for a major bill.

"This is going to be one of my top issues -- one of my very top issues -- next year," he said.

The measure will be based on a few major principles: Universal coverage, incentives for preventive care and wellness programs, and the concept of sharing the burden of health system reform.

Normally, bill backers require 60 Senate votes to end debate, but Baucus said he would consider using the process known as budget reconciliation to adopt the health care bill with a simple majority vote and limited amendments. That tactic has been used to pass several major measures in recent years, including the 2001 and 2003 tax cuts. Baucus could prevail if Democrats maintain control of the Senate next year.

The senator is starting out with a bipartisan approach. If lawmakers find common solutions for tackling the uninsured problem, for improving quality and for lowering costs, they might end up with widely supported legislation, he said. For example, paying physicians for aspects of patient care that are not currently compensated could persuade doctors to accept larger health system reform.

American Medical Association President Nancy H. Nielsen, MD, PhD, who introduced the forum's panelists, said policymakers need to do more than debate why the country has nearly 46 million uninsured people. "We must not just focus on the problem, but focus on getting to a solution," she said.

Many health care stakeholders are more motivated to reform the health system now than in previous decades because health care spending increases have outpaced inflation in recent years, said panelist Paul H. Keckley, PhD, executive director of the Deloitte Center for Health Solutions, a policy analysis group.

Baucus said many people might not be enthusiastic about the health system, but they do understand it. "So I think a lot of Americans want improvements, but they are concerned about changes that might disrupt what they currently have."

Health system reform is one of the top three issues voters want Congress and the White House to address, said panelist Mary R. Grealy, president of the Healthcare Leadership Council, a coalition of health care industry CEOs. "But we have to be very careful. It actually is working well for the vast majority of people. And if you threaten the coverage that they have, they don't like that threat of dislocation," she said.

But Baucus said many people might not realize how steady increases in health care spending threaten the economy. If left unchanged, health spending will grow to take up nearly half of the country's gross domestic product by 2082, according to the Congressional Budget Office.

"The problem is much worse than most Americans really know, because if this current trend continues, we are going to be in a very deep, deep hole that is going to be harder and harder for us to dig out of," he said.