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Lines In The Sand: A Big Week For Health Reform

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opednews.com Headlined to H2 9/9/09

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Coming back from the long Labor Day weekend, health reform has not taken a vacation. Indeed, the August recess is now officially over, and no one--least of all Sen. Max Baucus or President Obama--is taking their time to get the ball rolling again.

Multiple sources
reported on Monday that Baucus has finally drafted a reform plan in the Senate Finance Committee. By putting something down on paper, Baucus has drawn the first line in the sand, and his less than cooperative colleagues Sens. Grassley and Enzi will finally face an ultimatum on Tuesday: Work to find a compromise around the plan, or walk away from talks completely.

I haven't seen a draft (if you happen to have an electronic copy, I'd love for you to share), but these are the basics:
  • The $900 billion plan is budget neutral
  • Raises funds by levying fees on private insurers
  • No public option
  • Health insurance co-operatives
  • Health insurance exchange to increase transparency for consumers
  • Subsidies and benefits less generous (up to 300% FPL) than House bill
  • Expansion of Medicaid eligibility to 133% of FPL
  • No pre-existing condition exclusions or dropping coverage for illness
  • Shift in provider reimbursement from focus on quantity to quality

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Meanwhile, as I reported last week, President Obama is getting ready to show his hand on Wednesday night. That's this week's other line in the sand. There's a great deal of speculation swirling around about just what the President will have to say. Will he insist on a public option or will he support something less than that (e.g., co-ops, or the trigger option)? What other specifics is he likely to nail down?

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The White House has been so aloof during most of the debate thus far, that it's fairly hard to be certain one way or another. Perhaps that was intentional. Let Congress come up with it's several versions of reform, and let the August town halls serve as the ultimate "idea floater" -- find out how the public feels about various pieces of reform before committing to a specific approach. The problem is, there wasn't ever a rational debate on the issues. So I'm not sure how much the President and his health care team were able to surmise.

Either way, it's uncertain just how meaningful any line drawn in the sand really is. After all, Robert Gibbs suggests that it is highly unlikely that Obama will threaten use of the veto during his address to Congress. All that's certain is this: Obama is increasingly betting it all on the issue of health reform. I can't imagine that he'd make such a poorly calculated political move as to risk defining his presidency as a failure. And so, I continue to hold onto the hope that when the President shows his cards to the nation Wednesday night, should his hand be less than stellar, he may secretly have an ace in the hole.
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Brad Wright is a doctoral student in health policy and management at the University of North Carolina.

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