New York Times Editorial: A Bill Well Worth Passing/Congress would do well to keep two key provisions in Senate health bill

New York Times Editorial: A Bill Well Worth Passing
Copyright by The New York Times
Published: December 21, 2009
http://www.nytimes.com/2009/12/22/opinion/22tue1.html?th&emc=th


The health care reform bill that Senate Democratic leaders have cobbled together to win support from all 60 members of their fractious caucus — the filibuster-proof majority needed to ensure passage — has drawn scornful attacks from a united Republican opposition. It is causing anguish among liberals who fear too much has been given away to a handful of conservatives.

The bill, which is moving toward a climactic vote this week, has some imperfections but is worthy of support from lawmakers who care about health care reform.

There is a lot to like in the bill. The Congressional Budget Office estimates that it would cover more than 30 million of the uninsured and would, by 2019, result in 94 percent of all citizens and legal residents below Medicare age having health insurance. That is a big improvement from the current 83 percent.

It also estimates that the bill would reduce deficits over the next decade by $132 billion and even more in the following decade. Despite all the exaggerated Republican rhetoric that the bill will lead to fiscal disaster, it has been carefully and responsibly drafted so that it is fully paid for without busting future budgets.

Important elements of the bill have been strengthened during the struggle. An independent board and other new entities would be given greater powers than previously planned to test and implement cost-saving measures free of political lobbying. Tax credits to help small businesses buy coverage have been expanded.

Insurance companies will be deterred from jacking up premiums just before the reforms take effect, prohibited from imposing lifetime limits on benefits and annual limits will be tightly restricted. Insurers will also be required to spend more on medical care and less on administrative costs and profits than they currently do.

The two big concessions that were made in the Senate were unfortunate, but not fatal. The original bill would have created a new public plan to compete with private ones. That was replaced with a likely weaker alternative: a couple of private plans that would be supervised by an obscure government agency that administers heath benefits for federal employees. The reform package should include a public plan, but the absence of one is not a good reason to vote against the bill.

The Senate flirted briefly with a proposal to allow people ages 55 to 64 to buy into the Medicare program to create competition to private plans on new insurance exchanges. The buy-in idea was intriguing, but it was never vetted carefully enough to analyze how it would work in conjunction with other reforms. Its elimination does not make the bill worth opposing.

In another concession, the Senate bill would allow states to ban the coverage of abortions by health plans sold on the new exchanges. Those exchanges will allow people who buy health insurance to choose from an array of private plans, with subsidies provided to help low- and middle-income people pay the premiums.

This amounts to deplorable interference by state governments into decisions that should be made by a woman and her doctor — and abortion rights groups are right to object. The implacable Republican opposition to reform, and obstruction from a handful of Democrats, have made this bill less effective and less fair than it might have been. Still, the United States Senate has a chance this week to get past the bickering and haggling that have robbed it of Americans’ trust and pass a historic piece of legislation.







Washington Post Editorial: Congress would do well to keep two key provisions in Senate health bill
Copyright by The Washington Post
Tuesday, December 22, 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/12/21/AR2009122102937.html


THE PARTY-LINE, early-morning Senate vote Monday to end the Republican filibuster of health reform all but assures Senate passage of the measure before Christmas. That is a welcome but worrisome outcome.

It is welcome because, as we said in a snowed-under editorial Sunday, the United States is the last developed country not to ensure affordable health care for its citizens. The Senate bill, like its House counterpart, would extend coverage to more than 30 million Americans who would otherwise be uninsured, with subsidies to those who cannot afford coverage on their own. It would change the rules -- and to some extent, the underlying incentives -- for insurance companies: No longer would they be able to exclude people or charge them higher prices because of preexisting conditions. And it would carve a toehold of cost control into the health-care system, potentially yielding both better results and lower spending. Rapidly rising health costs and an aging population make the status quo unacceptable. Controlling health-care costs is a necessary though insufficient step toward putting the country on a sustainable fiscal path.

Yet the grim fiscal picture is also the reason that the measure is worrisome. No one should contemplate without concern a vast new entitlement program when the federal debt has ballooned so dangerously. The measure is paid for, and more, on paper; President Obama was right to insist that it should be. But the tab is paid in large part with $500 billion in Medicare cuts to health-care providers, raising the question of whether future Congresses, beseeched to provide relief, will withstand entreaties to soften the hit. Likewise, with the new mandate that individuals obtain insurance, there will inevitably be a clamor for Congress to increase the subsidy amounts.

Those risks are one reason that, as the measure heads to a House-Senate conference, lawmakers must retain the Senate's approach on two key provisions: the excise tax on high-value insurance plans and the independent Medicare commission with power to get changes through Congress on a fast track.

The tax on high-value insurance plans, endorsed by health economists of every ideological stripe, would bring the dual benefit of helping pay for reform and imposing a brake on rising prices. It is far preferable to the surtax on high-income individuals contained in the House measure. Likewise, the Medicare commission, which is not part of the House bill, would bring rational decision making to health-care administration. This, too, is an essential element of the package. In fact, it was improved in the version of the bill that Senate Majority Leader Harry M. Reid (D-Nev.) brought to the floor -- leading the Congressional Budget Office to give the bill even more credit for reducing deficits in the second 10 years than the earlier version.

The outcome in the Senate seems foreordained. The final, critical hurdle will be the massaging of the two measures in conference committee. Given the exquisite difficulty Mr. Reid faced in cobbling together 60 Democratic votes for his manager's amendment, there does not appear to be much room for bargaining with the House; the Senate seems, once again, to have the upper hand. Given the important differences between the two measures, that is a good thing.