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Change Will Be Incremental: Democrats Will Push a Health Care Agenda, But Bush Still Stands in the Way

Pete Stark

By Rep. Pete Stark (D–Calif.),chairman of the House Ways and Means health subcommittee

In the 110th Congress, new leadership will bring new priorities. However, we have to be realistic: President Bush will continue to occupy the White House for two more years.

Instead of working toward quality health care for everyone, President Bush wants to dismantle the parts of our health care system that work—Medicare, Medicaid and the coverage that most of us receive through our jobs. We can't expect too much from a president who ignores the overwhelming majority of Americans who support lifesaving stem-cell therapy.

That doesn't mean Congress will be at a standstill on health care. On the contrary, we will be working to make much-needed improvements in our health system, helping to control rising costs and slow the loss of insurance coverage. But for the next two years, our efforts will be more incremental than some of us, me included, would prefer.

Initially Congress will focus on Speaker Nancy Pelosi's (D-Calif.) "Six for '06" agenda, which includes two important healthcare items: fixing the Medicare prescription drug program so that the HHS secretary negotiates drug discounts for Medicare beneficiaries and passing legislation to promote real stem-cell research. The House of Representatives will pass these two initiatives in January, setting the stage for meaningful action on healthcare in the months to come:

  • Restoring Medicare's board of directors. Once we've completed the Six for '06 agenda, my focus will turn to oversight and management of Medicare. It is my intent to return the Ways and Means health subcommittee to its traditional role as, in effect, Medicare's "board of directors." For the past six years, Republicans in Congress have conducted almost no oversight of the Administration's activities. Instead, they choreographed cheerleading sessions to compliment each other on the great work they were doing to bring "choice" to Medicare, all the while dismantling the traditional program through design and neglect.

    Their focus has been to maximize the choices of private health insurance plans available to Medicare beneficiaries, rather than choice of physicians and hospitals—the choices that truly matter to patients. As a result, Republicans have placed Medicare on a path toward destruction. We need to reverse the march toward privatization and once again put Medicare on solid footing.

    One way Republicans have made private plans in Medicare more attractive is by paying private plans 12 percent more than it pays fee-for-service. Equalizing payments between plans and fee-for-service would save upward of $50 billion over 10 years and would be a good place to begin.

    Republicans also subjected Medicare to a budget gimmick—called the 45 percent trigger—designed to indicate the sky is falling with regard to the program's financing and hasten its demise.

    Further endangering Medicare, Republicans allowed a defective physician payment formula to be in effect far too long, forcing physicians and other providers to annually beg Congress to override the cuts the formula would have forced. Making providers angry at Medicare further aids Republican efforts to privatize it.

    In addition to these topics, there are many other issues on which oversight is overdue—everything from ensuring that beneficiaries are receiving the benefits they are eligible for through the Medicare prescription drug program to reviewing quality improvement programs to ensure that taxpayer resources are being carefully stewarded. We could fill the next two years in this arena alone. These efforts are necessary to guarantee that Medicare remains a high-quality program for generations to come.

    A healthy, functioning Medicare program that pays adequately is an asset to healthcare providers working in a country where more and more people are uninsured—and from whom payment is not necessarily possible. Improving Medicare should be a bipartisan commitment. Again, I will work to restore that philosophy in the new Congress.

  • Expanding coverage for kids: One major healthcare imperative in the 110th Congress is to reauthorize the State Children's Health Insurance Program (SCHIP). SCHIP is a combined federal and state program designed to provide coverage to uninsured children above Medicaid eligibility, but in families with incomes below 200 percent of poverty (higher in some states). Even with this program in place, we saw the number of uninsured children in America increase to 8.3 million in 2005 from 7.9 million in 2004.

    Reauthorizing this program provides the opportunity to improve it as well. Ideally, I would expand SCHIP to all children, and parents who provided coverage for their children elsewhere could opt out. Otherwise, anyone who takes a child as a deduction on their tax return would be assessed an annual SCHIP premium. Subsidies would be available for lower-income families on a sliding-scale basis. I don't know how much bipartisan support we could obtain for such a proposal, but I would happily dare the president to veto children's health insurance.

  • Bipartisanship: While expanding government-funded healthcare might not be a bipartisan success, there are still plenty of opportunities for bipartisan cooperation. When I chaired the health subcommittee from 1985 to 1994, Bill Gradison of Ohio served as my Republican counterpart. Together, we wrote plenty of good Medicare legislation. In 10 years, my subcommittee never sent a bill to the House floor that was not co-sponsored by both Gradison and me. I intend to pursue a similarly bipartisan course this Congress.

    All of these are important improvements to our healthcare system. If we can move forward in these arenas in the 110th Congress, we will enter the 2008 presidential election cycle, in which I expect healthcare to be a major issue. Then, we can turn to the pressing need to follow the rest of the world in guaranteeing that everyone in our nation has affordable health care.

The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

Publication Details



P. Stark, Change Will Be Incremental: Democrats Will Push a Health Care Agenda, But Bush Still Stands in the Way, Modern Healthcare and The Commonwealth Fund, January 2007