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Advocates, Lawmakers Begin Preparations for Comprehensive Overhaul of U.S. Health System

By Leah Nylen, CQ Staff

November 6, 2008 -- Democrats plan to advance a single, comprehensive bill to revamp the health care system, but will follow President-elect Barack Obama's blueprint for a health care overhaul, according to health care advocates and a congressional aide who spoke at a Families USA briefing Thursday.

Sen. Edward M. Kennedy, D-Mass., and his Senate Health, Education, Labor and Pensions Committee staff have already begun to craft a comprehensive overhaul that includes changes to coverage, cost, and quality, said Michael Myers, the committee's staff director.

"With the Obama victory, the question is no longer whether we will pursue comprehensive health reform, but when and what form," Myers said.

Myers said Kennedy instructed the staff to begin discussions with stakeholders this summer. Since then, they have held a number of roundtables and HELP committee staff have begun consulting with staff on the Senate Finance Committee, which has jurisdiction over the Medicare and Medicaid programs. Myers said the discussions have mostly involved Democrats in the House and Senate, but they plan to begin consulting with Republicans now that the election is over.

Separately Thursday, health care analysts appearing at another post-election forum played down the likelihood that the new administration and Congress would pursue a comprehensive bill.

"The bottom line is, the vast majority of people who vote have health insurance," said Robert Laszewski, a 20-year veteran of the health insurance industry who is president of the firm Health Policy and Strategy Associates. "People don't want it enough." He also said composing a comprehensive bill would be contentious, even among Democrats, and that the looming fiscal crisis—"a $1 trillion budget deficit this year"—would prove too large an obstacle.

Instead, he urged Obama and his congressional allies to pass piecemeal legislation that would extend the State Children's Health Insurance Program (SCHIP), prevent physicians from facing a Medicare payment cut next December, and potentially provide a tax credit to small businesses, among other things, calling it "a fairly good starter package" that would be "bipartisan all the way."

Laszewski also warned Obama of overreach. "Harry and Louise are alive and well," he said, referring to the industry ads that helped marshal public opinion against President Clinton's health care overhaul in 1993. The forum where Laszewski appeared was sponsored by Congressional Quarterly and the Public Affairs Council.

Myers said they have not yet begun drafting the legislative language, nor have they finalized particular aspects of an overhaul, although Democrats hope to expand coverage, reduce premium costs, and improve the quality of care. Although Myers said the Democrats plan to use Obama's health care plan as a model, he declined to provide more specifics, such as whether it would include the mandate on health coverage for children.

The "one-bill" approach is a crucial part of Kennedy's strategy for getting an overhaul passed. According to Myers, Kennedy plans to work on the bill in the full committee to allow all the members a chance for input.

"There's a growing recognition that the best way, maybe the only way, if for Democrats to unite around one bill," Myers said.

House Energy and Commerce Chairman John D. Dingell, D-Mich., recuperating from knee surgery, spoke briefly via conference call. He called the current system "broken and inadequate" and said he backed a comprehensive overhaul that would help the uninsured get coverage. Later Thursday, in a letter to House Democrats, Dingell said he supported a broad overhaul "so that nearly 50 million Americans without health insurance can get the care they need, and that those Americans with health insurance can continue to afford it in times of economic distress such as now."

Health care advocates from several organizations said they plan to aggressively push for an overhaul. Dennis Rivera, chairman of SEIU Healthcare, said his organization plans to hire 5,000 people to travel the country and drum up support for an overhaul.

Ron Pollack, executive director of Families USA, said they will advocate for getting an overhaul on the table within the first 100 days of the new administration.

He noted that in 1993 President Clinton's health care overhaul did not come until the fall, after Clinton had expended significant political capital on the North America Free Trade Agreement, the budget, and an initiative on gays in the military.

We have "a better shot if health care reform is early on the agenda," Pollack said.

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