Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the Senate, with the goal of being ready to go in January, according to advocates and policy watchers.
Many health policy analysts have compared and contrasted this election cycle with that of 1992, which sent Bill Clinton to the White House and launched the Clintons' health care reform efforts.
Both elections—1992 and 2008—feature a high level of public concern about access to health care and its costs, said Len Nichols, an analyst at the New America Foundation, a nonpartisan public policy institute.
For instance, a Harris Interactive survey conducted for the Commonwealth Fund in May found that 82% of Americans think the health care system should be fundamentally changed or completely rebuilt.
But the differences between the two elections are striking in a positive way, Mr. Nichols said in an interview.
First, the two major candidates themselves have acknowledged that cost is an overriding concern, he said. Also, a common theme is the use of private markets, which he called “evidence, I would say, of moderation” and, perhaps, the proposals' better legislative traction.
Both candidates—Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.)—have also learned that “no president is going to send [to Congress] a 1,400-page health bill written in a hotel room by 300 wonks,” Mr. Nichols said.
Instead, “Congress is going to own this [effort] far earlier and deeper than before,” he said, adding, “It's still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.”
Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee's ranking minority member.
The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she's a rising star and has impeccable liberal credentials,” Mr. Nichols said.
In a paper published in the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:689-92).
The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits.
It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage.
Sen. Wyden is likely to be front and center in crafting a bill, as he is a member of two of the committees of jurisdiction: finance and budget, said Mr. Nichols, adding that those committees, along with the Health, Education, Labor and Pensions (HELP) Committee, “will play very important roles.”
Ron Pollack, executive director of the advocacy group Families USA, said that although Sen. Wyden may play a part, “I have little doubt that Sen. Baucus is going to be as instrumental in the process as anyone.”
Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview.
Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow.
Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack, noting that Sen. Baucus and Sen. Grassley have worked closely on many bills.
The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, Mr. Pollack said.
“I think there's significant movement underway in anticipation of health care reform being a top domestic priority,” he said. But, “I don't think any of the proposals that have come out so far are going to be the proposals,” Mr. Pollack added.