With the House of Representatives' narrow approval of its health reform bill Saturday, the next stop for the health reform train is the Senate, which will soon begin debating its own plan that was approved by the Senate Finance Committee.
If the Senate's bill is approved—which is probable, but not a slam dunk—the two houses on Capitol Hill will come together to create the final health reform law. (If you need a reminder of the process, Bill can tell you all about it.)
The House passage was praised by many as a landmark achievement, but we're still a long way off. During the next few weeks (or months), legislators will battle for pet reforms while stripping away others.
Here is my prediction for three health reform ideas that will stay and three that will go:
Three that will stay
- Medicaid expansion.
The final health reform plan will make it easier for poor and lower middle-class Americans to get insurance through Medicaid.
The House bill would allow individuals and families with incomes at or below 150% of the federal poverty level to be eligible for Medicaid. The Senate will probably come up with a not-as-generous level, but the two sides will develop a plan that will allow thousands of new Medicaid beneficiaries.
This will somewhat satisfy those who decry healthcare system access, but won't please doctors, hospitals, or states.
The feds will provide funding in the transition, which may increase Medicaid reimbursement in the near term, but doctors and hospitals will not like having more of its patients covered under state Medicaid programs.
- More insurance regulations coupled with a watered down individual mandate.
President Barack Obama has made it clear health reform will target health insurance. Obama and the Democrats want more health insurance regulation, including not allowing rejections because of pre-existing conditions or charging higher rates to women (who insurers say cost more to insure than men), or those who are in worse health.
Insurers are OK with those added regulations as long as health reform requires all or most Americans to buy health insurance. The insurance industry wants the mandate because they know it will flood the market with young adults who are historically not interested in health insurance. These new, low-cost members will help pay for the new, sicker members.
- Insurance exchanges that will allow consumers to compare health plans online.
An insurance exchange will be seen as a compromise to a public plan. The federal government will likely seed billions to states to help them create Web sites, public outreach, and staffing so residents will have an easy one-stop shopping experience for health insurance.
This will likely resemble the Massachusetts Connector Web site, which I wrote about in September.
These Web sites will give states control while satisfying Republicans and conservative Democrats, who will see the exchanges as a way to help consumers buy insurance rather than expanding government-run healthcare.
Three that will go
- A public plan.
For the past few months, I have predicted that a public plan will not be part of the final health reform package and I have not been convinced otherwise.
In the final analysis, I don't think the federal government wants to create another program that could cost more than expected. The Senate will likely discuss a compromise public option, such as Sen. Olympia Snowe's trigger plan, but I think the feds will pass the issue onto the states through expanding Medicaid eligibility.
- A powerful individual mandate.
The good news for insurers is that health reform will likely include an individual mandate. The bad news is that I don't think it will have much teeth.
Many members of Congress are against an individual mandate with a heavy fine for those who don't buy insurance. Opponents of the idea don't want the government telling Americans what to do and/or don't want to place financial burdens on individuals who choose to not buy health insurance, particularly those who can't afford it.
This opposition is coming from both sides of the political spectrum, so I think ultimately Congress will pass a wishy-washy individual mandate that will sway many, but not all, of the 47 uninsured Americans to acquire health insurance.
- Taking away health insurers anti-trust exemption.
Democrats added this idea to the health reform debate shortly after America's Health Insurance Plans released a study that charged current reform proposals would cost Americans more money.
From the start, taking away the exemption has been used as a weapon and bargaining tool against the health insurance industry.
It's not going to be part of the final health reform bill.
If my predictions come true, you can see that health insurers will dodge a bullet with health reform. Yes, there will be more regulations, which aren't ideal for insurers, but there will be avenues to bring in new, younger, and healthier members, such as insurance exchanges, a limited individual mandate, and Medicaid expansion.