Managed Healthcare Executive - March 2009 - (Page 8) { POLITICS AND POLICY } ate Majority Whip Richard Durbin (D-Ill.) has joined with House leaders in sponsoring legislation that permits Medicare to operate a low-cost plan that would bene t from government negotiated drug prices. The stated Many agree a public plan option should aim of consumer advocates is to force out pribe linked with a coverage mandate vate plans and end the competitive approach to reach a reasonable price point to providing the Medicare drug bene t. Insurers, hospitals and payers fear that a BY JILL WECHSLER government-sponsored plan would have authority to set negotiated prices for providers and thus could reduce its costs much more leading Democratic strategy for than private plans. Similar to the Medicare achieving universal coverage is to program, the public plan also might not o er consumers access to a publicly have to account for administrative costs or sponsored health plan through a national maintain reserves, giving it important adhealth insurance exchange. During last vantages over private insurers. year’s election campaign, President Obama One way to level the playing eld is to called for a public plan option, and Congres- o er the public plan through an adminissional leaders have been insisting this aptered market system. The federal governproach is critical for providing low-cost cov- ment or national board would set parameters erage to consumers and small businesses. for bene ts and premiums, and insurers Insurers and employers, however, are would bid on the product. That approach, leery about competing with a subsidized similar to the federal health insurance propublic program. They fear that healthy congram for government employees, would be sumers eventually would opt for the less-ex- very di erent from the government-run pensive public plan and further the shift to a plan envisioned by most Democrats. government-run healthcare system. There is agreement that any public plan Jill Wechsler, a veteran option should be linked to an individual reporter, has been PROVIDING CHOICE mandate on coverage. Stark said at a Decovering Capitol Hill since 1994. The Obama administration is considering cember brie ng that to have a reasonably a public plan option as an e cient way to priced plan, “everyone has to be in the pool expand the safety net provided by Medicare and pay.” Insurers similarly acknowledge and Medicaid, according to White House that universal coverage is necessary to elimihealth policy advisor Jeanne Lambrew. “We nate exclusions for pre-existing conditions. ought to give people the choice” of such Congressional Republicans say they will coverage, she said at the AcademyHealth ght any proposal that puts everyone in a conference last month. Medicare-type program, which would evolve Rep. Pete Stark (D-Calif.), chairman of into a “super-HMO” able to dictate care. the House Ways & Means Health subcomDemocrats maintain that the public option mittee, is a lead proponent of the public plan is critical to any agreement on health reform. option, maintaining that it would help trim Rep. Henry Waxman (D-Calif.), chairman spending on healthcare and make coverage of the House Energy & Commerce Commitmore a ordable. tee, described the public plan as an alternative Congressional Democrats also want to to a single-payer system, and that increased establish a government-run Medicare drug “creative tension” between public and private plan that would compete with private plans plans can be bene cial. But, he noted, o ering Part D pharmaceutical bene ts. Sen- nancing and coverage are critical. MHE Public plan pitched as alternative to single payer A 8 MARCH 2009
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