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Could some areas of health-reform consensus still move forward?

Though certain policy changes have wide support, the political dynamic is too poisoned right now, one expert suggests. Others see parts being salvaged.

Can you tell whether a Democrat or a Republican member of Congress wrote the following statements on health-care reform?

1. “We need to fix the Medicare reimbursement problems that punish states like Minnesota who provide high-quality, low-cost care.”

2. “Medicare’s outdated and unfair reimbursement system pays Minnesota doctors and hospitals at some of the country’s lowest rates, despite the fact they produce some of the country’s best patient outcomes. … The broken Medicare payment system threatens to undermine it in years to come.”

No. 1 comes from Republican Rep. Erik Paulsen’s “Plan for Comprehensive Health Reform.”

No. 2 comes from Democratic Rep. Betty McCollum’s statement issued before passage of the Affordable Health Care for America Act.

Granted, rehabilitating Medicare to reward Minnesota providers is a no-brainer for Republicans and Democrats in our congressional delegation. But there’s also been some broader agreement in both parties that Medicare’s costs are out of control and the fee-for-service system leaves a lot to be desired.

If McCollum and Paulsen found some common ground even though they’re at opposite ends of the political spectrum, is there any hope of salvaging other parts of national legislation where Democrats and Republicans appeared to come to consensus? What are those other parts? Could the parties and the White House craft a bipartisan solution at this stage?

I posed the questions to a few observers Wednesday, the day after Massachusetts’ election of a Republican to the Senate appeared to doom prospects for health-care reform legislation. Democrats will no longer have the 60 party-line votes needed to stop a GOP-led filibuster in the Senate, and Republicans are practically dancing in the streets.

‘Delusional, not possible …’
“The idea of health reform being redone in a bipartisan way for a scaled-down bill is delusional and is not possible in this Congress in this year,” said Larry Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota’s Humphrey Institute of Public Affairs. “We’re in an election year. Republicans had hoped that health reform would be Obama’s Waterloo. Pieces are falling into place for a Waterloo. They have no interest in helping the Democrats out.”

Larry Jacobs
Larry Jacobs

In the past, Jacobs was fairly animated about the prospects for the first major health-insurance reform in the nation. He has studied and written about health policy and its history and politics for 25 years. (Here’s my Q&A with him last fall.)
Wednesday, he seemed dejected.

“I do think that health reform is now less likely,” he said. “This election (in Massachusetts) is a debacle in a lot of different ways. Obviously, the Democrats … now are going to be subjected to the filibuster. It’s a debacle because it was unusually framed as a referendum on one piece of legislation — and that rarely happens. Now the message is delivered to Washington that health reform is a killer at the voting booth. The third part is the reassurance from the White House, that Barack Obama would save the day with voters, has been proven false.

“So, it’s a new day in Washington,” Jacobs said.

Sen.-elect Scott Brown
REUTERS/Adam Hunger
Sen.-elect Scott Brown

Still, it’s noteworthy that Massachusetts’ new senator, Scott Brown, is a supporter of the state’s individual mandate, even though he campaigned against national reform that calls for such a mandate, fearing its costs would work against his home state. Although some Republicans have challenged the constitutionality of an individual mandate, the late Republican President Richard Nixon proposed one in his era, Jacobs said.

This month, Democrats working on a merged bill crafted a compromise on taxing so-called Cadillac insurance plans to help pay for expanding health coverage to the uninsured. The tax was a key part of Republican John McCain’s health policy in the 2008 presidential campaign.

So, isn’t that a bit of consensus? Could our lawmakers work from there on crafting a smaller bipartisan bill?

‘Irreconcilable philosophical differences’
“It’s kind of like a marriage that doesn’t work and is heading for divorce,” said Jacobs. “The Democrats and Republicans have irreconcilable philosophical differences, so even though there are policy ideas that they both support, there’s such mutual animosity, and their constituents are wired for warfare, that it makes it impossible to pursue bipartisan legislation.”

It may be wishful thinking, but Jess McIntosh, a spokeswoman for Sen. Al Franken, D-Minn., doesn’t think partisanship belongs in a debate about health care for Americans.

“I’ve often heard Republicans say they agreed with us that insurance companies should not be able to drop or deny folks because of a pre-existing condition or because they reached an arbitrary lifetime cap,” she said in an email. “But the truth is that none of this debate should be a partisan issue. The health care situation in this country has reached crisis level and when families are going bankrupt because of a medical issue, they’re not thinking about political parties.”

Not ready to give up
Health policy analyst Lynn Blewett, director of the U’s State Health Access Data Assistance Center, isn’t ready to give up on the passage of reform yet.

Lynn Blewett
Lynn Blewett

“My hope is that the Medicaid expansions, or universal coverage for low-income Americans (up to 133 percent of the federal poverty level or about $14,400 for an individual), will be the center of the expansion proposal with federal funding at 100 percent for the first three to five years of the program,” said Blewett, who keeps track of the uninsured and studies consumer confidence in health care. “I imagine the moderate insurance reforms will also be maintained, including guaranteed issue (allowing access to health insurance without regard to pre-existing conditions) with limits on premium rates to keep premiums in check.”

Obama likely will need to make some concessions on the Senate bill, which “will be the vehicle that moves through the process,” she said. “The president must address the deficit and the looming bankruptcy of the Medicare program even if this is only in a study and recommendations for future consideration. Citizens want to hear about how the government will constrain federal health care spending and not on how much more the government is spending without regard to the deficit.”

Before Tuesday’s election, U of M health economist Stephen T. Parente, who was a volunteer on McCain’s health-policy team in 2008, proposed in an op-ed piece some corrections down the line.

Stephen T. Parente
Stephen T. Parente

Congressional elections in 2010 and 2012 will make it possible for a “more bipartisan Congress” to “fix the flaws” in the legislation. “With some basic edits to the current bill, we could achieve a fiscally responsible bill that would be a solution to many of the problems in the current health care system,” Parente writes.
Current bill ‘partisan, too costly’
“Although the congressional leadership and President Barack Obama are celebrating having reached a milestone, the end result is a bill that is partisan, too costly, and will not do much if anything to bend the cost curve down,” he writes. “In addition, it is hard to imagine a more partisan gambit.”

Parente suggests five fixes in his piece, including:

• Guaranteed issue and a modified community rating. “This would provide individuals who have a pre-existing condition with a fair price for a policy. … Those unable to afford the premium because of their health status and restricted personal finances could be rolled into a separate high-risk insurance pool,” an idea proposed by Obama and McCain in 2008, Parente writes. [Note: A national high-risk pool is proposed in both Senate and House bills.]

• Allow the purchase of insurance across state lines. “Large employers who self-insure have been able to do this since 1974 because of the ERISA law. It is time for others to enjoy this benefit. If the health program for federal employees can offer plans with a range of benefits that are not determined by idiosyncratic and premium-crushing state policies, why can’t other employers?” [Buying insurance across state lines is one of Republican Gov. Tim Pawlenty’s proposals for Minnesota.]

• Use the excise tax for employer-sponsored care to help pay for initiatives. “Congressional leaders have successfully repackaged for political purposes the highly repudiated McCain tax on employee health insurance as an excise tax on employer-sponsored insurance. … Putting an excise tax on employer-sponsored health coverage would remove a tax subsidy that every health economist will privately tell you is a massive drain of resources.”

So, could McCain or someone like him look at the big picture, that health care is in a crisis in the nation, and step up?

“Why?” Jacobs said. “McCain ran for president on the Republican Party ticket. Let me put it this way: Put yourself in the position of a Democrat during George W. Bush’s presidency and George Bush comes to you and says, ‘We need to double the number of troops in Afghanistan. I know it’s unpopular. I know I’m unpopular. But help me out because it’s important for the country.’ How many Democrats do you think would do that?”

Payment reforms, pilot projects
If lawmakers were so inclined, Jacobs said, the current legislation in Congress offers a number of places where Republicans and Democrats could find a meeting of the minds. Among them would be payment reforms and pilot projects to test some cost-saving ideas.

“The truth is that the headlines and the vitriolic, partisan debate on both sides, conservative and liberal, missed a lot of the guts of what this reform was about,” he said. “There were a lot of ideas here that have been talked about for a long time and for which you can find Democrats and Republicans supporting. And among the Republicans would be (former Massachusetts Gov.) Mitt Romney (who signed the individual mandate legislation), John McCain and Scott Brown. But the political animosity, the kind of Hatfield-McCoy dynamic in Washington, is not going to make that possible.”

Casey Selix, a news editor and staff writer for MinnPost[dot]com, can be reached at cselix[at] Follow her on Twitter.