For anyone who thought there would be much agreement on health care reform had quite a shock this week, when Republicans began to release their own outlines of health reform and tried to stall the reforms sought by the Democrats. To see how far apart some of the positions are, one need only looks at the plans envisioned this week by two separate groups.
The House Republican Health Care Solutions Group would like the following to happen:
--An "above the line" deduction that is equal to the cost of an individual's or family's insurance premiums.
--Incentives for individuals to build health savings accounts and IRC Sec. 125 flexible spending accounts.
--An option for Medicaid beneficiaries to "transfer" the value of their coverage to a private insurer.
--Allowing youths up to age 25 to remain on their parents insurance policies.
--Limits on malpractice lawsuits.
--Insurance pools that would encourage states, small businesses and others to share risk in low-cost plans.
The other group is led by three former Senate majority leaders who have published a health care reform package that would tax health benefits and includes individual and employer mandates. Tom Daschle, Bob Dole, and Howard Baker outlined their plan in a document titled Crossing Our Lines: Working Together To Reform The U.S. Health System, which included the following major elements:
--expand comparative effectiveness research (CER) relevant to patient decisions;
--reform medical liability laws;
--reform health insurance markets;
--create a network of state or regional-level health insurance exchanges;
--implement a federal fallback if states or regions do not create exchanges in a timely manner;
--provide for competing state plan options;
--establish minimum creditable coverage standards for health insurance;
--set additional standards for options available through insurance exchanges;
--limit out-of-pocket premiums to no more than 15% of income for a minimum benefit package;
--offer enhanced protections for Americans under 400% of the federal poverty level;
--create new tax credits for small businesses to purchase coverage for their employees;
--ensure low-income families have coverage through the Medicaid program;
--expect individual responsibility for obtaining basic health insurance: all Americans must demonstrate that they have health insurance coverage that meets minimum creditable coverage requirements;
--link the tax exclusion to the value of benefits received by members of Congress; and
--institute a fee for certain employers not offering or paying for health benefits.
Not much in common here—a bit of tinkering from the Health Care Solutions Group and some fairly dramatic changes envisioned by the former Senate majority leaders. Thus, while the possibilities for compromise may be dimming, at least it is now much easier to get off the fence and agree with one side or the other—the choices are clear.