Analysis compares competing health system reform plans

Washington -- An analysis of major federal health system reform legislation from the last two years has concluded only bills that fundamentally change the health system will cover a significant number of the nation's roughly 46 million uninsured.

The January report by the Commonwealth Fund, a nonpartisan research organization, and two other research groups examined 10 bills and one non-legislative proposal designed to expand health insurance coverage. The authors estimated the number of people the proposals would cover and how the legislation would affect national health spending.

The analysis is intended to be a guide to health care bills for members of Congress and other policy leaders, said Sara R. Collins, PhD, report co-author and assistant vice president at the Commonwealth Fund. The report grouped some similar legislation together and analyzed one bill in each group. But the study did not estimate how the measures' payment to physicians and others would affect access to care, she said.

The report found that two bills and one proposal from the last two years would leave none or only a few million uninsured. These include the Building Blocks plan written by the Commonwealth Fund that is similar to public-private proposals by President Obama and Sen. Max Baucus (D, Mont.). Also included is the AmeriCare proposal by Rep. Pete Stark (D, Calif.), which the report estimated would cover every uninsured person under new public health plans.

The Healthy Americans Act, sponsored by Sen. Ron Wyden (D, Ore.), would use an individual insurance mandate to cover all but about 3 million uninsured. "Bills that don't require everyone to have coverage tend not to get to near-universal coverage," Collins said.

Three other market reform or state-federal partnership measures, including those authored by Sens. Mike Enzi (R, Wyo.) and Richard Burr (R, N.C.), would cover roughly half of the uninsured, the report estimated. The remaining five bills in the report would target specific populations and would not increase coverage by more than a few million people.

Study authors estimated that one bill by Rep. Sam Johnson (R, Texas) actually would increase the number of uninsured by nearly 300,000. Letting business associations buy group coverage across state lines would enroll more healthy workers but force out less healthy or older people, the report concluded. Johnson's office did not respond to a request for comment.

Obama and Democrats in Congress have begun work on comprehensive health reform. Republicans, meanwhile, have yet to outline comprehensive proposals but likely are having closed-door discussions with Democrats on the issue, said Len Nichols, PhD, an economist and director of the Health Policy Program at the New America Foundation, a nonpartisan policy institute.

Republicans have limited time to determine what reforms they will back, said Robert Moffit, PhD, director of the Center for Health Policy Studies at the Heritage Foundation, a conservative think tank. "What's coming at them is coming like a freight train," Moffit said.

Some Republicans favor ending the tax exclusion for employer-sponsored health insurance, but during the election Obama criticized Sen. John McCain (R, Ariz.) for supporting an end to that exclusion, said John E. McManus, a former Republican staff director of the House Ways and Means health subcommittee. Conservatives are still developing an overall stance on reform, he said.

Congressional Republicans in safe seats aren't going to back reform proposals acceptable to Democrats, predicted Mark A. Peterson, PhD, professor of public policy and political science at the University of California, Los Angeles. GOP lawmakers "are going to have a perspective and a point of view which right now is just not going to be anywhere near the middle of the political spectrum." But Moffit said Rep. Tom Price, MD, (R, Ga.), an orthopedic surgeon, has more expertise than previous heads of the Republican Study Committee, a conservative House members' group.