The Debate Gets Serious

The Wall Street Journal * SEPTEMBER 6, 2009

Excerpts from:
Health Care: What's on the Table, What's Ahead

By JILIAN MINCER

It's been a summer of discontent . And when Congress reconvenes this week it has its work cut out.

A possible overhaul has been hotly debated in town-hall meetings and bogged down in committees. So President Barack Obama is expected to lay out new details of the administration's proposal.

Four of the congressional committees responsible for health-care legislation approved proposals. The three House committees still have to merge those bills for a House vote. The Senate has one committee bill proposed.

Much of the debate is over how to pay the estimated $1 trillion price tag. There also is disagreement over a public option for coverage.

Despite the confusion and contentious atmosphere, there are some issues that most sides appear to agree on.

Lawmakers agree there need to be subsidies to help families pay for health coverage if it's not available at work.

Mr. Altman says there is consensus that the legislation should include provisions ensuring that insurers don't deny anyone coverage or charge significantly higher rates because of pre-existing medical conditions.

Insurers already have agreed to many of these changes, as long as the legislation requires that all people have coverage.

"If you're in the employer system, there wouldn't be much change" to your insurance, says Kathryn Bakich, a senior vice president at consulting firm Segal. "But in the individual market or [small-business] market would see significant changes in their ability to get insurance, how much it would cost"

Mike Langan, a principal at consulting firm Towers Perrin, says, "I don't see the legislation having a negative impact on the quality of care." That's because the majority of Americans still get their health insurance from their employers.

Who Gets the Bill?

A big area of disagreement is how to foot the bill. President Obama and congressional leaders don't want the health-reform plan to add to the deficit over a 10-year period. The largest potential cost would be the subsidies to the uninsured, according to the Kaiser Family Foundation.

The House has proposed that the additional revenue come from cuts to certain Medicare services and additional taxes on affluent families.

There also is a lot of disagreement over whether to include a public plan as an insurance option for those who need to get coverage. Some groups oppose the idea because they say it would destabilize employer coverage.

Mr. Langan of Towers Perrin thinks that in the end there will be a law this year. But he warns that "it will take several years to implement."

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