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Congress is unlikely to pass a health-care reform plan before it adjourns in October. And the plan most likely to pass exists only in the minds of a bipartisan coalition of lawmakers.

Market reforms - including changes in insurance, antitrust and malpractice law - "could pass tomorrow" with strong bipartisan support. But Congress is bitterly divided on whether employers should be required to provide coverage. And the "political reality" is that "rather than a real debate on real reform, it is breaking down to a partisan debate," said Rep. Bill Orton, D-Utah.Orton held a news briefing on health-care reform at Pioneer Valley Hospital this week.

He said Democrats, who control the House, the Senate and the White House, "want to show they can govern. Republicans want to show they (the Democrats) can't."

He believes that Congress would approve a plan containing the president's market reforms, as long as there are no mandates. Instead, Orton said, such a plan would set a target goal for cost containment and coverage with phase-in over five to seven years.

Built-in "trigger mechanisms" would kick in if the goals were not reached.

If market forces fail, "government could intervene in a pre-agreed-upon way."

Just the threat of government intervention, combined with market forces would make it likely the goals would be met, Orton said.

Reform is needed, according to Orton, who cited a crisis in two specific areas: for people who are under- or uninsured; and regarding a "looming financial crisis for government and also for the health-care industry."

The fastest-growing portions of the federal budget are Medicaid and Medicare, interest on the national debt and Social Security, according to Orton. Administrative costs eat up 20 to 25 percent of health-care dollars, which account for one-seventh of the economy.

Paying for reform will be a major sticking point, he said. The budget, signed a month ago, requires health-care programs to meet pay-as-you-go standards.

"It's a possibility, but I believe it's at or below 50-50 that a health-care bill will pass" this year, he said.



A variety of ideas on health reform

The five congressional committees with jurisdiction over health reform have disparate ideas of what would work. Here's a thumbnail sketch, presented by Rep. Bill Orton, D-Utah:

- House Ways and Means would expand Medicare. The employer mandate allows a choice of Medicare Part C or private-sector insurance, with subsidies for small businesses and low-income consumers. People who use medical services without coverage would be assessed the Medicare premium on their tax returns. The cost is higher than the president's proposal and would be paid with a $1.25 tax on cigarettes, plus a 1 percent payroll tax. Benefits include prescriptions but not dental or vision care.

- House Energy and Commerce members are divided on a plan, which is expected to contain employer mandates.

- House Education and Labor is the only committee that has approved a plan. It is based on Clinton's plan, with major differences. Employers of more than 1,000 would sponsor their own insurance. State government replaces alliances. It provides more generous subsidies. Benefits include prevention, dental and mental health coverage.

- Senate Labor and Human Resources is trying, so far unsuccessfully, for bipartisan agreement. So far, they've agreed on a national health board and health-care alliances.

- Senate Finance is the "wild card." Members want bipartisan agreement that would cover 97 percent of people without including mandates.