Baucus Plan Gives A Nod To GOP Ideas

Republicans denounced the Democrats’ latest health care proposal-even though some elements of their ideas are embedded in the plan.

The Senate Finance Committee bill unveiled Wednesday by chairman Max Baucus, D-Mont., contains several provisions that were inspired by Republicans, including testing new ways to handle medical malpractice cases, creating avenues for consumers to cross state lines to buy insurance and immediately launching a high-risk pool that would cover people with pre-existing medical conditions.

Moreover, the bill’s overall scope and cost have been whittled down — the Congressional Budget Office put the price tag at $774 billion over 10 years, less than other Democratic proposals that Republicans said were too expensive. Also, the plan doesn’t include a public insurance option, a proposal favored by President Barack Obama and liberal lawmakers but rejected by most Republicans and many conservative and moderate Democrats. Rather, it would spend $6 billion to help create nonprofit cooperatives that would sell insurance to individuals and small businesses.

“This isn’t everything Republicans wanted, but it isn’t everything Democrats wanted either,” said Elizabeth Carpenter, associate policy director at the centrist New America Foundation in Washington. “You can see the negotiation process here, a bipartisan process in this bill.”

Many of the GOP-inspired provisions are more modest than Republicans wanted. Still, their inclusion suggest that the gap between the two parties on health care overhaul might be a little narrower than the heated rhetoric indicates. Not much attention has been paid to the fact that three comprehensive health care bills introduced by Republicans in the Senate and House have a few key elements in common with all the Democratic bills: they create health insurance exchanges to help the uninsured and small businesses find affordable coverage, provide subsidies to people who need them to buy policies and impose new regulations on insurers. (See related story.)

But Republicans say the differences remain large. None of the three Finance Committee Republicans who spent months negotiating with Baucus — Sens. Charles Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine  – signed on Wednesday to the Baucus bill. “The proposal released today still spends too much, and it does too little to cut health care costs for those with health insurance,” Enzi said in a statement. The others echoed his cost concerns.

Narrowing the gap?

Baucus insisted the legislation will still get Republican support but others are skeptical. The Republican gains in the bill “are second- and third-tier items,” said  Robert Laszewski, president of Health Policy and Strategy Associates, a consulting firm in Alexandria, Va. “What they were successful in doing is getting Democrats to round the edges of some of the elements, but not enough to please any significant number of Republicans.”

By including some Republican ideas, Democratic leaders might be preparing to make the case that they made concessions to the GOP even as its leaders refused to negotiate. Obama has been saying that, with or without Republican votes, many elements of the final Democratic plan would reflect at least some Republican thinking. 

That flies in the face of criticism from Republicans that they have been shut out of substantive talks for months. “There has  been absolutely no effort whatsoever on the part of the White House to reach out and, if they really do want our participation, to just say come on in,” House Republican Minority Whip Eric Cantor told KHN last week. “None. Nor any on the Hill.”

Some of the Republican-inspired provisions include:

Cross-state sale of insurance to individuals and small businesses: The Baucus bill  would allow two or more states to form “compacts” that would allow individuals to buy policies from insurers in states that agree to the compact. Insurers would be subject only to the laws and regulations of the state where the policy is written. In a separate measure, insurers could create national policies with uniform, federally set benefits that could be sold in any state where the companies are licensed. The polices would be exempt from state benefit rules.

– Medical malpractice: The legislation says Congress should consider creating state demonstration programs to evaluate alternatives to the current litigation system. Republicans had called for the creation of special malpractice courts and limits on damage awards.

– High-risk pool for people with pre-existing medical conditions: Within a year of the enactment of the legislation, a high-risk pool would be set up for people with pre-existing medical conditions.  The pool would continue until 2015, when new state insurance exchanges would be up and running and insurers would be required to sell policies to all who apply, regardless of their medical conditions.

– Prevention and wellness incentives: Medicare beneficiaries would become eligible for annual “wellness visits” with their doctors, paid for by the government program.  They would also no longer have to pay out of pocket for certain tests and treatments, such as flu vaccinations or diabetes screening. Financial incentives would also be offered to beneficiaries who complete certain “healthy lifestyle” programs targeting such risk factors as high cholesterol, diabetes or smoking. This is not just from the Republicans; Democrats embrace the idea as well.