Washington Update: President-Elect Obama Faces Opportunities and Challenges in Reforming Healthcare

 President-Elect Obama Faces Opportunities and Challenges in Reforming Healthcare

A changing political and economic landscape could present President-Elect Barack Obama with obstacles and opportunities to effect healthcare reforms, pundits began predicting just hours after his historic victory. Democrats solidified their majorities in both the Senate and House in the November 4 election, better positioning the Obama Administration. But how the new balance of power in Washington, coming amidst global economic turmoil—a floundering world economy, a record federal deficit, a $700 billion Wall Street bailout, and the likely need for further bailouts and stimulus efforts—will affect the particulars of healthcare reform remains to be seen.

According to some, the Obama Administration will have to limit or postpone any big new spending programs—such as those to expand healthcare—given fiscal uncertainties.

According to others, including Rep. Rahm Emanuel (D-IL), who will serve as the new president’s Chief of Staff, the economic crisis will create opportunities for reform. “No crisis should go to waste,” he has said.

Shortly after the election, PriceWaterhouseCoopers estimated that the healthcare reforms the President-Elect outlined on the campaign trail (see “2008 Presidential Candidates Propose Differing Plans for U.S. Healthcare System” in the October issue of Annals of Long-Term Care for an overview of Mr. Obama’s healthcare reform proposal) would total roughly $75 million the first year. The reforms would, however, cover 95% of Americans, the firm’s analysis notes. Roughly 15% of Americans now lack health coverage.

According to a PriceWaterhouseCoopers analyst, the current economic crisis could “unleash more market forces to drive the (healthcare) system toward more value,” trimming waste and ushering in more cost-effective, and effective, system. For these and other reasons, say advocates of speedy reform, tackling healthcare sooner rather than later could strengthen the economy and aid recovery.

Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, is among those sharing this view. Giving a boost to reform efforts in mid-November—shortly before this issue of Annals of Long-Term Care went to press—he released a comprehensive plan aimed at providing quality, cost-effective care for all Americans. He also urged President-Elect Obama to effect reform within his first six months in office.

The American Geriatrics Society (AGS) applauds the Senator’s efforts to encourage timely reform aimed at ensuring all Americans, regardless of age, access to high-quality, affordable care. AGS also strongly supports many of the recommendations in the 89-page plan.

“We are heartened by Sen. Baucus’ proposal, his dedication to ensure that healthcare reform is swift and comprehensive and benefits the young and old alike, and his willingness to work in a bipartisan manner to effect needed reforms,” said AGS President John B. Murphy, professor of medicine and family medicine at Brown University’s Warren Alpert Medical School and Chief Physician Officer at Rhode Island Hospital. “Sen. Baucus’ call for universal access to affordable, quality health coverage and expansion of care to enhance the prevention and treatment of chronic diseases will improve the quality of life for millions of Americans of all ages, especially our most vulnerable older adults.”

Sen. Baucus has said he is committed to working with Mr. Obama and other lawmakers on healthcare reform. “Much of what’s here dovetails with the President-Elect’s own health plan,” he told The Washington Post. “And where we differ, I have committed to work with him to find a consensus.” President-Elect Obama, who praised Sen. Baucus’ efforts, likewise signaled his desire to work closely with the Senator and other legislators “to make quality, affordable healthcare a reality for all Americans.”

In many ways, Sen. Baucus’ plan parallels the President-Elect’s campaign proposals for overhauling healthcare. But there are differences. The Baucus plan calls for mandated healthcare coverage, something the President-Elect did not support during the campaign.

Like Mr. Obama, Sen. Baucus has proposed a national health insurance “exchange” or “marketplace,” through which individuals and businesses could buy affordable health coverage—choosing among both private and public policies. The Senator’s plan would create a new public health insurance plan, and expand eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP). Large employers would have to either offer health coverage to employees or contribute to a fund to cover the uninsured. Certain small businesses would be exempt from the requirement or qualify for tax credits, however, and the plan would also provide subsidies to individuals in need. Sen. Baucus estimates it would take three years to fully implement the provisions in his plan and ensure all Americans access to quality, affordable health coverage. In the interim, the plan would temporarily allow adults age 55 to 64 to buy into Medicare. Once affordable quality coverage is universally available, all Americans would be required to have health coverage and this requirement “would be enforced, possibly through the tax system,” the Baucus plan notes.

The AGS strongly supports several proposals in the Senator’s reform plan. Among other things, the plan calls for efforts to promote care coordination. The plan also recommends further consideration of the benefits of geriatric assessments to determine necessary elements of care and identify patients requiring care coordination. The AGS has long supported legislation (S. 1340, proposed by Sen. Blanche Lincoln [D-AR] and H.R. 2244, proposed by Rep. Gene Green [D-TX]) that would fill a gap in traditional Medicare by covering both comprehensive geriatric assessments and care coordination services for beneficiaries with multiple chronic conditions.

The AGS also supports Sen. Baucus’ proposals to:

• Prohibit insurers from denying coverage to those who are or have been sick, and limit insurers’ ability to charge higher premiums based on age or prior illness.
• Bring about meaningful reform of payment systems, including Medicare’s, which, by neglecting to cover geriatric assessment, care coordination, and additional key elements of care tailored to older patients’ needs, undervalues primary (or comprehensive geriatrics) care provided to beneficiaries by geriatrics health professionals. The financial disincentives this creates are leading contributors to the growing nationwide shortage of geriatricians and other geriatrics healthcare providers.
• Support long-term care services, particularly services provided in the home and community.

At the same time that Sen. Baucus announced his plan, major advocacy groups representing business, labor, and retirees announced the start of a campaign to press President-Elect Obama to enact comprehensive healthcare reform without delay. The Business Roundtable, the National Federation of Independent Businesses, AARP, and the Service Employees International Union urged the President-Elect in November to tackle healthcare reform in his first 100 days. According to The Los Angeles Times, the groups plan to spend nearly $1 million on newspaper and television advertising pressing Washington to pursue reform aggressively.

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