Even though there’s nothing shocking about the health care reform bill currently under debate on the Senate floor, say
The
While Kopperud has “little doubt” that reform will pass this year, the final shape of the bill is “very much up in the air.” Specifically, it “needs clarification regarding the role of brokers in state exchanges on several fronts — particularly defined compensation models and the role we would play as exchange navigators,” he says.
Obstacles to the bill passing the Senate include highly contentious abortion and immigration language, “sideshows” that Kopperud hopes will fade in favor of a real discussion over the issue of cost containment, which he’d like to see “re-emerge as the primary driver of the legislation.”
The Senate bill met the expectation of the
Skeptical of the Congressional Budget Office’s estimate that the bill would cost $849 billion over 10 years to cover 31 million uninsured and reduce the federal budget deficit by $127 billion, Dave Lapka, president of logistics consulting company D360, believes it disguises taxpayer costs rather than clarifies them. “Realistically, even federal budgets are done on a yearly basis, this scoring involves 10 years of taxpayer funding but only seven years of service provision,” he says. “I'd like to see annual breakouts of cost versus benefit payout. That will be the reality of this bill's impact.”
Director of the
Also citing the initial Medicare cost projections against actual expenditures as “a picture of what this reform could do to our country,” Tom Schuetz, co-president of Iowa’s Group Services, calls the legislation “a very subtle march toward government control of health care.”
However, as a supporter of universal health care, Kris Marohn, administrator with Texas-based
Kopperud agrees that the individual mandate needs improvement. “The mandate was weakened in the legislative process to ensure that working class citizens were not unduly penalized for not purchasing unaffordable plans,” he says. “Rather than weakening the penalty, the focus ought to be on increasing affordability. This is achieved by widening the age-based premium variation cap to a 5:1 ratio rather than the 2:1 ratio.”
Although the bill is a “terrific work of consolidation,” it does not adequately address systemic issues of lack of coordinated care, engagement and management, says Cyndy Nayer, president of the Center for Health Value Innovation. Nor does it focus enough on outcomes, she adds. With the year coming to a close, Nayer believes it will be “well into the second quarter of next year” before President Barack Obama has a bill to sign, citing his State of the Union address and February financial indicators as potential obstacles.
This story has been reprinted with permission from