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GOP Advisors Emphasize Affordable Coverage as Health Overhaul Goal

By John Reichard, CQ HealthBeat Editor

October 25, 2007 -- Advisors to GOP presidential hopefuls played up affordable health insurance as the goal of their bosses' health overhaul plans at a Washington forum Thursday, with none spontaneously volunteering universal coverage as a priority.

Lanhee J. Chen, domestic policy director for the campaign of Mitt Romney, did say in response to a question about 90 minutes into the event that the former Massachusetts governor would like to cover every American during his presidency, but advisors to Arizona Sen. John McCain and former New York Mayor Rudolph Giuliani focused on cost control and tax code changes as priorities. They did say, however, that every American should have access to affordable coverage.

The remarks at Congressional Quarterly's Presidential Forum, sponsored by the Partnership to Fight Chronic Disease, contrasted with those made earlier in the week by Democratic presidential advisors, who were much more apt to name universal coverage as a goal. But there were some areas of overlap, with advisors on both sides of the aisle saying that competition among insurers would help restrain rising costs and that tax revisions would help pay for coverage.

But Giuliani advisor Don Moran said there is a bright line dividing the parties, with Democrats favoring centralized governmental solutions and Republicans urging market-based solutions. Giuliani's goal is to "reinvigorate the role of private insurance markets in health care," said Moran, a consultant who served as executive associate director for budget and legislation at the White House Office of Management and Budget from 1982 to 1985.

Democrats espouse the use of new or existing insurance "exchanges" or "marts" as the arena for competition, with tight regulations to ensure that people with costly illnesses have access to affordable insurance. GOP advisors at the forum acknowledged the need for regulatory changes, but were more vague about what they should be. Nevertheless, they rejected the Democratic charge that Republicans just want to give the uninsured tax deductions or credits to buy coverage on the "individual" market without making regulatory changes that would allow people with costly medical conditions to actually find affordable coverage. In the individual market, a single person or family buys coverage alone and not as part of a larger pool.

"There's nothing about the current insurance market that everybody should embrace and love," said McCain advisor Douglas Holtz-Eakin, former director of the Congressional Budget Office. "The current individual market is not a good place to live."

Added Chen: "We recognize the market is broken."

The advisors said insurance could be made more affordable with regulatory changes that would make it easier for Americans in one state to shop for better insurance deals in another state, using the Internet, for example. However, they conceded that doing so might require a new way to conduct regulatory oversight of such sales. "You're going to have greater federal involvement—there's no way around that," said Holtz-Eakin. But both Moran and Chen expressed reservations about a greater federal role.

Holtz-Eakin wasn't skittish about downplaying coverage as the needed focus of a major health care overhaul. It's more important to tackle the issue of rising costs, he said, by changing payments to reward higher quality and lower cost care and better management of chronic diseases. "The focus has to be on changing the practice of medicine in the U.S.," he said. "John McCain has decided to take this as the premier problem" in domestic politics, Holtz-Eakin added.

Part of tackling the cost problem should be reining in the costs of Medicare, in part by scaling back the Medicare prescription drug benefit to target it to low-income people, he said. Holtz-Eakin suggested that coverage can be a greater focus once costs are under better control. He added that a healthy dose of individual responsibility is also needed, with McCain favoring stronger messages to people to take better charge of their own health.

Chen emphasized the importance of coverage more than his fellow panelists. As governor of Massachusetts, Romney developed a track record on health care, reforming insurance markets to expand access to care, Chen said. "I'm just glad to see on the Republican side that we're all embracing the notion of expanding access to health insurance," Chen said. He suggested that without insurance coverage, people are less likely to get access to medical advice emphasizing the importance of exercise and preventive care.

But Chen joined his colleagues in arguing for a less centralized approach to overhauling health. He said states should lead the way in widening coverage and lowering costs, and be given regulatory flexibility and greater control over Medicaid in order to do so.

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