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Looking Back, Looking Ahead, with Jeanne Lambrew

By John Reichard, CQ HealthBeat Editor

FEBRUARY 2, 2009 -- Whither the Obama health overhaul? Hundreds of health policy researchers were all ears Monday when senior Obama health adviser Jeanne Lambrew took the stage to speak at the National Health Policy Conference. She confined her remarks to explaining what the administration health team has done so far while offering only a murky description of the future&8212;Lambrew said she'd have a lot more to say in "a few short weeks."

What seemed clear however was that President Obama will be pushing hard for a public plan option in a reworked system. It also appears that his team may be having a challenging time of late carving out time for working on a long term overhaul of the health care system.

Lambrew, deputy director of the White House Office of Health Reform, suggested that Obama strongly supports giving creating a public program option in a system leading toward universal coverage. "If you really believe in competition why not give the public plan a chance," she asked. The issue is heating up as a potential source of gridlock in the health overhaul debate, with the White House and many House Democrats favoring it and many congressional Republicans likely to be firmly opposed. She said one potential model for a public option would be a state employees health benefits plan in which the government pays private health plans to provide coverage.

Lambrew also said that Obama's team got an "enormous" response to its pre-inaugural plea to citizens to organize local meetings on health changes and that it is preparing a report for Obama on what average Americans want changed. Lambrew said the call for meetings led to as many as 9,000 gatherings around the country and 4,500 reports on those meetings containing recommendations on changing the system.

But "a lot of our work got overwhelmed by the rapidity in the decline of the economy," she told the Washington, D.C. conference, an annual event sponsored by the policy journal Health Affairs and AcademyHealth, an association of health services researchers. That decline contributed to the addition of numerous health-related provisions in economic stimulus legislation.

In addition, the team also has been focusing on other "unfinished business" from the last session of Congress, specifically reauthorization of the State Children's Health Insurance Program. It wasn't easy to figure out a plan to extend the program after its March 31 expiration because the costs of doing so have risen and because of differences over whether to allow states to end the five-year waiting period for coverage of the children of legal immigrants. The Senate has passed a different version of the reauthorization than the House, and the White House is hoping the House will clear the Senate version and send it to Obama this week for his signature.

Might Lambrew have been trying to lower expectations for rapid action on a health overhaul? On the one hand, she described action on the issue as an undiminished priority for the president as it confronts a deepening recession. On the other hand, when asked about whether a health overhaul is on a 2009 timetable she said Health and Human Services Secretary nominee Tom Daschle would likely say that FDR and LBJ moved quickly to pass major legislation early in their administrations and that Obama considers a health overhaul a top priority. As for Daschle's nomination woes, Lambrew made it clear to reporters after her remarks that she wouldn't answer questions on the subject.

Lambrew devoted much of her speech to explaining the thinking behind economic stimulus provisions supported by the administration. She described as "protection provisions" elements of the stimulus that would provide states $87 billion over a two-year period in the form of a temporary federal increase in the share of Medicaid outlays borne by the U.S. government, plus language approved by the House allowing a Medicaid "buy-in" and paying 65 percent of the premium costs for 12 months for laid-off workers qualifying for coverage under "COBRA," the federal law that gives certain workers continued access to group rates for 18 months after they lose their jobs.

Lambrew noted findings by the Commonwealth Fund that 38 percent of low-income unemployed workers lack access to COBRA protections in explaining the rationale for the Medicaid buy-in, which would be available to laid-off workers without access to COBRA.

Other elements of the stimulus would pave the way for an overhaul in several ways, she said. Stimulus language includes job creation provisions that would help build up the primary care workforce in anticipation of sharply increased demand for that type of care in a system covering millions more uninsured. Health information technology provisions would boost adoption of the technology by an estimated 85 percent of doctors and 50 percent of hospitals by 2014, she said. Stimulus language would provide for "historical investments" in wellness and disease prevention programs, and comparative effectiveness funding of $1.1 billion would provide another tool to lay the foundation for lower cost growth, she indicated.

The final shape of stimulus legislation is unclear however, with the Senate taking up the legislation over the next several days.

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