Managed Care - October 2008 - (Page 16) The new president will first have to deal with the country’s biggest economic crisis since the Great Depression, an unsettled foreign policy arena, and an annual budget deficit that is steamrolling its way to $500 billion or more. That won’t leave much room for a controversial health care reform bill in the first 100 days of any new administration. “While health care reform is still on the tongues of the candidates and a lot of people out there, I have to tell you that other issues are more dominant and will be confronting the next president and the next Congress,” says Hoagland. “While health care comes in there, it’s not going to be the first thing on the list in terms of comprehensive proposals.” “There isn’t much chance of any major reform,” equalizing the program’s payment rates with traditional Medicare. “As states see the federal government stepping aside from comprehensive reform, they are likely to come up with new regulations of their own,” says Hoagland. Pay-or-play laws like the one in Massachusetts, in which companies must either provide health coverage or pay a tax, may well spur a state assault on federal ERISA exemptions, a serious issue for health plans that cater to big employers. Under ERISA, self-insured employers are exempt from state regulations. And if the federal government won’t reform the system, says Hoagland, then states are more likely to insist on regulating all companies. “You can’t come up with the $100 billion you need for a new health care plan when you’re looking at a $500 billion deficit,” says Bob Laszewski, a longtime health policy analyst. agrees Bob Laszewski, president of Health Policy & Strategy Associates and a longtime analyst and blogger. “There’s no chance of major regulation of the health insurance market dealing with the uninsured. So I don’t look for any major or sweeping reform.” With Congress unable to pay for ambitious reforms, Hoagland adds, federal and state lawmakers and appointed officials are likely to turn to new regulations to alter the way the market works if they cannot agree on legislation that makes revolutionary change. “And I see that coming particularly through the states,” says Hoagland. If the focus switches to regulatory controls, even Hoagland’s list of possible incremental steps could usher in significant changes for the health insurance market. The incoming Congress, which many expect to have more Democrats than the present Congress, will have to deal swiftly with the unresolved issues surrounding SCHIP expansion and a looming 20 percent cut in Medicare’s payment rate to physicians. That growing majority of Democrats in both the House and Senate will have its hands on the legislative process, looking to impose new regulations on the industry. The Democrats’ growing influence is likely to threaten private fee-for-service Medicare plans by “Everyone’s calling for change, but they’re not putting anything on the table the other guy can vote for,” says Laszewski. “If you look at every major group, no one is willing to sacrifice anything. You can’t come up with the $100 billion you need for a new health care plan when you’re looking at a $500 billion deficit.” He ticks off a series of huge new federal burdens, from the takeover of Fannie Mae and Freddie Mac to tax cut proposals from both McCain and Obama. Laszewski sums it up: “You can’t talk about health care reform unless in the same breath you talk about America’s fiscal situation.” The nonpartisan reformers, though, aren’t about to let a crisis interfere with their efforts. They want serious change in the first 100 days of a new administration. Several players are coming together now to do just that. First 100 days “Quietly and confidentially,” representatives of many of the political odd-bedfellows club now aligned in common cause for generic reform are reaching for a set of common policy initiatives, says Ron Pollack, who heads the influential Families USA, another supporter of Harry and Louise’s new marketing campaign. “There’s really been a material change in the attitude of groups irrespective of ideology,” says Pol- 16 MANAGED CARE / OCTOBER 2008
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