Analysis: Obama Reforms Require Sacrifice

Helen Darling, president of the National Business Group on Health, told The News Hour with Jim Lehrer on Thursday that determining coverage levels and the affordability of any universal health plan would be problematic. "Someone will have to decide whether or not the package of coverage that is going to be offered and paid for is going to be very rich, or adequate and good but not totally comprehensive," she says. "The hardest decision for the people who want universal coverage is to say, 'We may not be able to immediately afford everything for everybody the first year out.' The packages right now in this country, unless somebody is going to give up some income, cost a family about $15,000. Coming up with that for families, and to finance that, particularly all the ones who will need subsidies, especially now, is going to be very hard."

Let Congress Write it.
Roper supports Obama's decision to let Congress write the bill. "The president and his team are wise to say they are going to articulate a set of principles and leave it to Congress to shape specific legislation. That is a far more promising way of going about it than the Clinton administration did 15 years ago," Roper says.

Brandon Edwards, president/COO of Davies Public Affairs, which focuses on three industries including healthcare, says Tom Daschle's withdrawal as the nominee at Health and Human Services has left many observers with a sense of uncertainty. The general belief was that Obama supported Daschle's plan. In the case of current, Kansas Gov. Kathleen Sebelius, there are questions about what she supports.

As a result, Edwards says, Sens. Max Baucus and Ted Kennedy are rushing to get their own reform proposal through Capitol Hill. "I think most people, including me, assume that this is a horserace between Baucus' plan and Kennedy's plan and who can get to [Arlen] Specter, [Susan] Collins, and [Olympia] Snowe first," says Edwards, referring to three moderate Republican Senators, who may support a major healthcare reform package.

Edwards says the toughest issue policymakers have to tackle is creating a standard benefit design. The feds can't mandate everyone have insurance and move the 47 million uninsured into existing commercial health plans because each state has its own required coverage mandates that require insurers provide certain services, such as maternity or cancer care.

Though state leaders have created the mandates as a way to assure residents are covered for such services as maternity and cancer care, the health insurance industry rails against mandates because it adds costs onto plans. Meanwhile, some states, including Florida, have created "mandate-lite" policies. These health plans limit the mandated services, which cuts costs and provides more affordable health insurance options for those uninsured.

To get the support of state delegations, such as New York and California, reform supporters will have to develop a richer standard benefit design, but that will also increase plan costs and raise the ire of those who oppose coverage mandates.

"I think this is their biggest challenge," says Edwards.