Battle at Blair House

As Congressional leaders from both parties prepare to meet ahead of this week’s Healthcare Summit at Blair House – the official guest house of the President across the street from the White House – speculation is rampant on whether or not the meeting will be substantive or political theater.  Guess which party thinks what result?  On Thursday, the Obama Administration upped the ante by announcing they would put forward their own comprehensive healthcare legislation ahead of the meeting.  Long criticized for not being specific enough in their goals for healthcare reform, the White House’s decision to release such a plan puts President Obama front and center on the healthcare reform issue as one of his top domestic priorities.

The President will post his proposal Monday on the White House Web site.  It appears that the President’s proposal will be a reconciliation bill that can be written as an attachment to the FY 2011 budget. Though neither Democrats nor any members of the House or Senate have yet to see the White House proposal, Administration officials have confirmed that it would insure more than 30 million Americans by 2019 with an estimated cost of $900 billion.  Additionally, the bill will require most of us to purchase insurance or suffer a financial penalty, ban insurers from denying coverage based on a pre-existing condition, and provide tax subsidies for the middle-class to help cover the cost of healthcare coverage. In terms of how to pay for the measures, the White House plan will likely mirror the Senate’s proposed “Cadillac Tax” on expensive insurance policies while exempting union members from the policy.  There are several wildcards that remain unresolved.  Abortion policy is one of those issues.  Many Blue Dog Democrats remain skeptical of any plan that includes funding for abortion.  And, Republicans as a whole are almost uniformly opposed to the President’s healthcare reform plan.  So, despite the possible dialogue at the Summit, the tug and pull over healthcare reform continues.  Though it seems that reconciliation is the option which Congress is now pursuing, many Members remain wary of the approach – especially with the 2010 midterm elections just around the corner.

Aside from the highly political issues of abortion and fractured dialogue between the Democrats and Republicans, two other issues will also impact Congress’ healthcare reform effort.  First, there is growing sentiment among Senate Democrats that the final bill should include some aspect of a publically-funded insurance plan. An option that was long thought to be dead, it is now regaining momentum. Pushed by the Progressive Change Campaign Committee, 17 Senate Democrats signed a letter calling for Senate Majority Leader Harry Reid (D-NV) to include a public option. Though it is unclear what the results of the effort will have on the final bill, it comes at a time of impasse and makes for interesting politics.

Second, a recent decision by the Commonwealth of Virginia to make the mandatory purchase of health insurance illegal creates a set-up for healthcare reform to move from the Congress to the courts if and when it passes.  The policy passed the Virginia Senate where the Democrats are in control.  So again, interesting politics.  Many predict that in a court battle between the federal and state governments on this issue that the feds will prevail due to precedents.  Still, the Virginia position illustrates the distaste many Americans have for the Congressional healthcare plan. As a swing-state in the last presidential election, Virginia’s move could be a harbinger of things to come in the country’s reform debate.

So, full circle back to the President’s Healthcare Summit.  It is an intriguing event and will require all sides to lay out their ideas.  Whether or not it is groundbreaking is unknown at this point, but it’s unlikely.  Obama is clearly pressing the proverbial “reset button” on stalled negotiations.  If we see more of what we’ve already seen from both sides, don’t expect much.  If we see more middle of the road proposals, all bets are off and healthcare reform might survive its sudden cardiac arrest following the Massachusetts election. 

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.