Managed Care - June 2008 - (Page 20)

LEGISLATION & REGULATION If that new plan is rolled out in 2011, says the CBO, it would be budget-neutral in three years. With the presidential contest in full swing now, there’s no shortage of universal coverage plans. However, Wyden’s bill not only survived considerable scrutiny, it attracted the support of seven Democrats and seven Republicans in the Senate even before the CBO gave the bill the stamp of budget neutrality, something that would be a big boost for any bill. Bipartisan “I regard the Wyden Senate bill as a serious example of individuals who are centrist in their own parties, pulling together equal numbers of Democrats and Republicans,” says Gail Wilensky, a senior fellow at Project HOPE and administrator of the Medicare and Medicaid programs during the George H.W. Bush administration. “It’s a very important example of a seriously bipartisan bill.” “This is a serious proposal,” agrees Paul Ginsburg, PhD, president of the nonpartisan Center for Studying Health System Change. Ginsburg has long been skeptical about trying to shift the system from an employer-based approach to an individual market, fearing that the way premiums are adjusted by age and medical history would price many people who now have insurance out of the market. Wyden’s bill goes a long way to avoid that disaster, he says, by pooling people in statewide markets. “This is a bill that has been getting people to think more broadly about the reform of health care financing,” Ginsburg adds. Because Wyden and Bennett aren’t running for president, they may have the freedom to think more carefully about solving the thorny issue of universal coverage. You can expect plenty of open rebellion among some key Republican lawmakers. “If you really like the compassion of the IRS and the efficiency of the Department of Homeland Security after Katrina . . . you’ll love a government health care program,” Oklahoma Sen. Tom Coburn said of Wyden’s bill recently. “If you like working for an HMO,” he told doctors, “you’ll love Ron Wyden’s bill.” It’s hard to find anyone in the insurance side of the market who openly takes issue with the Wyden bill, but probe behind the public tranquility and you’ll find real dismay over the prospect that it could become law. Moving from an employer-based system that pays the bulk of the cost of insurance to an individual market where each person selects a plan managed by a state HHA is a recipe for disaster, says one industry lobbyist only willing to speak on condition of anonymity. First, you’d have to create a massive HHA bureaucracy to manage large numbers of individual policies. Are people who lose their company-subsidized benefit really going to sign up for insurance and pay a thousand dollars a month out of their own pockets for family coverage, even if they’re making a six-figure income? “If you listen to the dialogue, we question whether you would have a mandate,” says the lobbyist. “You can say all this on paper, but is there a realistic expectation you would actually enforce it? Look at noncompliance on taxes.” Opposition likely The notion that the tax system would be responsible for gathering premiums adds another element of government control that is likely to ignite fierce opposition in an industry well versed in combating any proposal for a government-orchestrated insurance system. “Workers really want to keep what they have,” says Sheils. “They’re not crazy about dropping what they have and going into another plan. The bill was changed last summer so that employers had the option of continuing to provide coverage, so the employer is back in the game if that is what the employer wants to do. But getting out of the business of offering insurance is an attractive option.” MC MCO dismay So far, there’s been only muted response from the managed care industry. A spokesman for America’s Health Insurance Plans says that the trade group has not taken a position on the bill, noting that the industry has been marshaling its forces to back its own approach to universal coverage. 20 MANAGED CARE / JUNE 2008

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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