Health-care negotiations focus on affordability
Updated 5:27 p.m.
By Shailagh Murray
As House and Senate negotiators start writing a final health-care bill, one concern looms above all others: whether Americans will be able to afford the coverage that the legislation would require them to buy.
In a series of meetings this week, including two sessions on Wednesday, Democratic leaders and White House officials combed through the House and Senate versions of the legislation to identify differences and debate compromise provisions. Their aim is to strike a final deal before President Obama delivers his State of the Union address, either in late January or early February.
But for all the individual issues that must be addressed, a broader challenge has emerged -- how to whittle down the bill's potential cost to consumers. As the legislation moves closer to the finish line, Democrats are increasingly wary of imposing an additional financial burden on millions of uninsured people, many of whom have chosen to forgo health coverage because it is too expensive.
"We want to make sure we get it right," said Rep. Chris Van Hollen (D-Md.), a member of the Democratic leadership, after a House negotiating session on Wednesday. "And that's why the affordability piece is so essential."
House Speaker Nancy Pelosi (Calif.) and key House committee chairmen spent two hours huddling with Obama at the White House on Wednesday afternoon, reviewing areas of conflict. But Pelosi played down the differences between the two bills, telling reporters after the meeting, "I think we're very close to reconciliation, respectful of the challenges -- policy and otherwise -- in the House and in the Senate."
One open question is the size of the subsidy for individuals who do not have access to affordable coverage through their employers, and who will purchase plans on new insurance exchanges. The House bill would provide more generous assistance to most of these individuals, through lower premiums and out-of-pocket expenses. But the total value of the House subsidies is estimated at $602 billion over 10 years, compared to $436 billion in the Senate bill.
Whether the new exchanges are organized nationally or by state could translate into a cost difference, Van Hollen said, depending on the number of insurers the new marketplaces attract. The House bill proposes a national exchange, while the Senate would limit this authority to individual states. Obama favors the House approach, senior Democratic aides have said.
The House has not formally agreed to give up a government insurance option, Van Hollen noted, and many of his Democratic colleagues remain convinced that a public option is the best way to guarantee affordability. But negotiators are examining ways to tighten insurance regulations and impose greater oversight of the industry, to keep premium costs in check. "What we cannot allow is consumers to be held hostage by the insurance industry," Van Hollen said.
January 6, 2010; 3:16 PM ET
Categories: 44 The Obama Presidency , Health Care
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