Stakeholders start offering their own proposals for health reform

Washington -- The debate over health reform is taking shape as key players in the American health system embrace or reject some of the concepts outlined by President Obama and Democrats in Congress -- or offer their own.

The system reform plan Obama outlined during his campaign called for creating a national health insurance exchange linked with a public plan to serve as competition for private plans. He did not include a requirement for adults to have health insurance but did call for all children to have coverage. His plan rejected a large-scale restructuring of the employer-sponsored insurance system.

In recent weeks, health care stakeholders have begun offering more specific health reform ideas. Chairs of congressional committees with jurisdiction over health care have agreed to try offering comprehensive health legislation for consideration by the August recess.

The Health Reform Dialogue, a coalition of physicians, hospitals, nurses, employers, consumers, business owners, insurers and others, formed about six months ago to search for common ground on health reform. The group, which includes the American Medical Association, on March 27 released a five-page report. It states that although some issues continue to "elude consensus," the group has agreed to several principles. The report said legislation should have "all Americans purchase or otherwise obtain health insurance," reform the Medicare payment system to promote better prevention and care coordination, and mandate a minimum Medicaid eligibility for adults of 100% of the federal poverty level, among other provisions.

"Now more than ever before, all of us agree that fundamental reform of the nation's health care system is critical -- right now, this year -- and is essential for every sector of society," said American Hospital Assn. President and CEO Rich Umbdenstock. "The American people want bipartisan, responsible reform, and all of us do, too."

Insurers also stoked the debate by separately expanding a previous offer. America's Health Insurance Plans and the BlueCross BlueShield Assn. sent a March 24 letter to leaders in two Senate committees offering to stop using a person's health status to base individual premiums or to deny health insurance coverage. In return, the companies are calling on Congress to require everyone to have health insurance and abandon Obama's national public health plan idea.

"We believe the package of interrelated reforms will give the American people peace of mind and help the nation achieve universal coverage," states the letter, signed by AHIP President and CEO Karen Ignagni and BCBSA President and CEO Scott Serota.

While offering to take health status off the table, the insurers still would reserve the right to adjust premiums based on other factors, such as beneficiary age and geographic location.

Obama told an online town hall audience on March 26 that the health plans' offer was "progress in the sense that they've acknowledged that this preexisting condition situation is a real problem." But he said he was "skeptical of mandates only because my attitude was the reason people don't have health insurance is not because they don't want it, it's because they can't afford it."

Few leaders in Congress offered unsolicited public responses to the AHIP/BCBSA proposal. But when asked, a spokesperson for Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, said the insurance companies have "taken a large step in the right direction."

However, a spokesperson for Sen. Orrin Hatch (R, Utah), said the senator would prefer offering "positive incentives" for people to buy health insurance before mandating it.

Nick Simpson, a spokesman for Rep. Roy Blunt (R, Mo.), said Blunt agreed with the AHIP/BCBSA offer in that he believes "a government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan." Blunt is leading a group of House Republicans working on health reform.

AMA policy calls for requiring families earning more than 500% of the poverty level to have at least catastrophic coverage, with penalties for noncompliance assessed through the tax system. The AMA also supports expanding that mandate to lower-income groups once there is an established system of advanceable, refundable tax credits inversely related to income.

Some nurses, though, rejected the AHIP/BCBSA offer. "That's not a sign of flexibility at all -- it's blackmail," said Geri Jenkins, RN, the California Nurses Assn./National Nurses Organizing Committee co-president. Decisions on whether patients can receive health insurance should be based on need, not on how much profit insurers can make, Jenkins said. The nurses organizations support a government-run single-payer health system.

At the online town hall forum, Obama said he understands that some Americans want a single-payer system. He also agrees that America's public-private health system might not be the best, but he rejected the call to scrap it. "Rather, what I think we should do is to build on the system we have and fill some of these gaps."