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Former Senate Leaders' Health Reform Proposal Includes State Exchanges

Janice Simmons, for HealthLeaders Media, June 18, 2009

While their Capitol Hill days are now a memory, three former Senate majority leaders have become the latest voices to weigh in on what directions federal healthcare reform could take.

Two GOP senators—Howard Baker and Robert Dole—along with Democrat Thomas Daschle (with an earlier assist from George Mitchell) released their bipartisan proposal Wednesday that addresses delivery, cost, quality, coverage, and financing issues facing the healthcare system.

"We have no legislative writing authority, but that's an advantage in a way," said Baker. "It frees us to ascertain the points of agreement, to identify the areas of disagreement, and to suggest the boundaries of concern and the possibilities of accommodation."

While the men, working together as members of the advisory board of the nonprofit Bipartisan Policy Center, found many points to agree on, they did encounter one area of major disagreement: the public health insurance option.

"For many reasons, this is one of the most difficult issues we grappled with during our negotiations," Daschle said. "While I feel strongly that consumers should have a choice of a national Medicare-like plan, my colleagues do not and I understand where they are coming from."

"In the spirit of bipartisan effort," though, they decided to reach a consensus on the issue "to move it forward," Daschle said. The compromise: Build on the network of state and regionally-based insurance exchanges and allow states to establish plans—similar to those many already operating as part of their employee benefit programs.

"We decided that we weren't going to let two or three issues derail our total effort," Dole said. "We're just citizens. We don't have power. We don't have anything where we can march up and tell the leadership in the House and the Senate . . . but we do have the experience."

The Senate leaders' proposal, called "Cross Our Lines: Working Together to Reform the U.S. Healthcare System," reflects a series of forums that took place in 2008 that were hosted by each of them. The events addressed four key topics, or "pillars," of healthcare reform:

  • Promoting high quality, high value care
  • Making health insurance available, meaningful and affordable
  • Emphasizing and supporting personal responsibility and healthy choices
  • Developing a workable, sustainable approach to healthcare financing.

Among the issues that their budget-neutral plan calls for are:

  • A personal responsibility requirement for all individuals to purchase their own health insurance
  • Refundable tax credits that limit premium contributions to a percentage of income
  • Tax credits for small businesses that offer coverage
  • Limited fees for employers not offering or paying for health benefits
  • Establishment of an independent healthcare council to promote coordination among federal healthcare programs

The report also proposes placing greater emphasis on prevention, wellness, and care coordination, plus the need for stronger insurance reforms; elimination of medical underwriting for pre existing conditions and rating limitations; addressing Medicare's Sustainable Growth Rate formula for physicians; and financial assistance through Medicaid and tax credits.

The senators have sent their recommendations to Capitol Hill. Sen. Max Baucus (D-MT), chairman of the Finance Committee, said he saw many similarities with the legislation that his committee is now discussing behind closed doors. "The plan shows us bipartisan consensus is within reach," he said in a statement.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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