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From the CQ Newsroom: House Panel Starts to 'Lay the Groundwork' for Health Care Overhaul

By Alex Wayne

April 15, 2008 -- Uninsured and under-insured people by the millions are racking up huge medical bills or forgoing life-saving care in a broken health system, health experts said at a hearing Tuesday.

The hearing, by the Ways and Means Subcommittee on Health, was intended to "lay the groundwork" for an expected attempt next year to overhaul the health insurance system, said panel Chairman Pete Stark, D-Calif. Congress has not seriously discussed a broad health care overhaul since the ill-fated Clinton administration health plan of 1993.

"It's time to revisit it," Stark said.

Health care is an oft-mentioned topic on the presidential campaign trail this year. An estimated 47 Americans are uninsured, and millions more are under-insured, meaning that their coverage isn't sufficient to cover catastrophic problems like cancer. Both Democratic presidential candidates—Sens. Barack Obama of Illinois and Hillary Rodham Clinton of New York—have produced detailed health overhaul plans. Republican Sen. John McCain of Arizona has not produced his own detailed plan but says he will work to reduce health care costs.

Stark says he supports including an individual mandate in any universal coverage plan.

"I don't see how it can be done without a mandate," he said. But he said he does not necessarily prefer Clinton's health plan—which includes a mandate—over Obama's, which does not.

Experts at Stark's hearing said Congress could start to nibble at the problem now by doing things like changing the way the nation pays for long-term care and allowing health workers to cross state lines to volunteer at free clinics.

Most people now pay for long-term care, whether at home or in nursing homes, in one of two ways: out of their own pockets, or by impoverishing themselves and qualifying for Medicaid, the health entitlement for the poor. While private long-term care insurance is available, it is costly and not widely used. Former Sen. Dave Durenberger, R-Minn (1977–1994), who was until recently a member of the Medicare Payment Advisory Commission, told the subcommittee that creating a combination public- and private-insurance program to cover long-term care would be a first step toward an "income security policy" for the nation.

He also said he did not believe states would be able to achieve universal health insurance coverage on their own without federal direction. Massachusetts is trying to implement a state-level universal coverage program, and other states—notably California—have discussed the idea.

Other experts told rending stories of uninsured and under-insured people struggling to pay health bills. Stephen Finan, associate director of policy for the American Cancer Society, told the subcommittee that the society "had to enter the broader national debate about access to care" because of repeated stories about cancer patients going broke fighting their disease, or forgoing treatment because they couldn't afford it.

"Please think about this for a moment: These are people who have stopped treatment for a deadly disease because they cannot afford to pay," he told the subcommittee.

The subcommittee also watched a "60 Minutes" segment about the Remote Area Medical (RAM) Volunteer Corp, which organizes free health clinics in rural areas, focusing on dental and vision care, that attract thousands of uninsured patients. RAM founder Stan Brock suggested that Congress should pass a law allowing health workers to volunteer their services outside their own states, and protect volunteers from "frivolous" malpractice lawsuits.

Tennessee, where RAM is based, has passed a state law allowing health workers from other states to volunteer there, Brock said.

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