Back on the burner Featured

10:00am EDT July 22, 2002

Now that our long national nightmare—i.e., the Clinton-Lewinsky scandal—is moving from center stage to the sidelines of the 106th Congress, business groups can start worrying about health reform again.

“The [106th] Congress is once again going to be the sounding board for future, more sweeping health care reform,” says Todd McCracken, president of National Small Business United in Washington, D.C.

The way McCracken sees it, a presidential re-election, three congressional elections and retreat of ultra-conservatives since the original Clinton reform plan crashed and burned, combined with renewed upward pressure on insurance premiums and lingering anxiety about 40-some million uninsured Americans, will make the political landscape once again habitable for some proponents of national health care reform.

One sigh of relief for business, according to Chip Kahn, new president of the Health Insurance Association of America, is that employer mandates are off the table. A veteran of 15 years as a staffer on Capitol Hill, Kahn believes the final nail was driven into that coffin during the waning days of the doomed Clinton initiative. Concerns about an employer mandate’s impact on a nervous economy will likely keep the idea buried.

Still, there are the uninsured—but in most cases, gainfully employed—Americans, whose numbers in part motivated the last reform drive, and whose ranks have since increased. “The health insurance industry can provide coverage for everyone,” Kahn says. “But there’s no free lunch.” The association plans to announce its proposal some time this spring for alternative funding to cover the uninsured.

In another corner, the so-called Patients Bill of Rights is stirring back to life. Smothered by the Lewinsky shenanigans and a Gingrich-led scheme to divert the issue through a House Republican “working group,” Georgia Republican Rep. Charles Norwood’s PARCA bill will be reintroduced to Congress early this session. “The job won’t be done until we have passed this bill into law,” pledges Norwood spokesman John Stone.

The Patient Access to Responsible Care Act won 234 co-sponsors (more than any other single piece of legislation in the 105th), and Stone thinks its reincarnation this year will come close to that number. But Democrats have their own patients rights bills, and some Democrat PARCA co-sponsors may abandon the GOP bill for their own.

Kahn believes PARCA and similar proposals will expose employers to potential lawsuits by employees denied coverage for certain conditions. Stone rejects that claim, saying language included to protect employers while allowing managed care companies to be sued will be strengthened this session. Kahn counters that he doesn’t think any patients rights language can completely protect employers. And PARCA-type legislation would raise premiums, he adds, notwithstanding employer protections.

Elsewhere, McCracken and others suspect Congress will extend a federal pilot program on the feasibility of medical savings accounts. The program ends this year, with disappointing enrollment. McCracken thinks that’s because Congress placed too many conditions on participation and business hesitated to participate in anticipation of an enrollment rush that never materialized, then backed further away when the pilot’s expiration date loomed.

NSBU will also push again to speed up 100 percent tax deductibility of health insurance premiums for the self-employed. “We’ve always advocated for 100 percent [deductibility] right now,” McCracken says.

The American Health Quality Association, representing physician groups that monitor quality of care, wants Congress to extend federal monitoring of Medicare and Medicaid quality to standardize private quality controls and share information. “Quality is going from being perceived as being a proprietary advantage to being a community good,” says AHQA president Dr. William E. Golden.