Dollars before details in health reform

By Christine Ferguson

Senior Advisor

Tuesday was a significant step forward in the health reform debate for Democrats in the House. To get three very forceful Committee Chairmen to agree on a proposal was an important achievement as lawmakers continue to wrangle over details of a massive effort to provide insurance coverage for everyone in America. The main issue remains how to pay for it and it doesn’t appear likely that the Senate will embrace the payment mechanisms proposed by the House.

According to published reports, House Democrats want to raise taxes by 5.4 percent on millionaires, make cuts in Medicare and Medicaid and require employers to offer, and individuals to get, health insurance coverage or pay a penalty.

But detailed cost estimates for the tax increases and program cuts weren’t part of the fine print unveiled Tuesday. And discontent amid both parties persists. As is so often the case, agreement on how to pay for health reform will be its biggest barrier and the issue that is focused most on by the Press and the general public. However, the bill is over 1,000 pages long – there are some critical provisions that will encourage major changes in how health care is delivered and data is used to support more effective decision making. While everyone else is focused on the mega tax and spend issues, pay close attention to the details in these important areas because history tells us that even if a big health reform bill is not enacted, many of its most important provisions are included in later legislation. So, even if massive reform falls apart, profound changes could still come through in piecemeal legislation.

Either way, everyone needs to keep paying attention.

Christine C. Ferguson, JD serves as Senior Advisor for NSI’s Health Care sector providing expertise and strategic insight to NSI’s health care clients. In addition to her senior advisory role with NSI, Ms. Ferguson currently serves as a research professor at the George Washington School of Public Health and Health Services.