By Janet Hook, With a virtual civil war raging over parts of President Obama’s healthcare agenda, the smoke of battle has obscured a surprising fact:
Democrats and Republicans actually agree on a bundle of proposals that could make medical insurance better for millions of Americans.
The consensus proposals include such popular ideas as barring insurance companies from denying coverage to people with preexisting injuries and illnesses, cutting insurance coverage off when a policyholder gets sick and imposing a lifetime cap on benefits.
The “reforms are quite possibly the least controversial of all the issues in health reform — and among the most important,” said Drew Altman, president of the Henry J. Kaiser Family Foundation, a nonpartisan research group.
Now, lawmakers from both parties are increasingly eyeing the areas of agreement as a possible fallback if Obama’s more ambitious approach collapses.
In the current political climate, there are steep new obstacles to that kind of strategic retreat. Insurance companies are poised to fight even harder against new policy mandates if they are not part of a broader overhaul of the payment system.
And the poisonous mistrust between Republicans and Democrats makes it harder to find productive common ground.
Nonetheless, in light of huge new budget deficit projections — a $9-trillion increase over 10 years — and growing criticism of Obama’s broad approach to revamping healthcare, some lawmakers have warmed to the strategy of scaling back their aspirations.
A key question when lawmakers return from their long hot August recess dominated by criticism of Obama’s plan is whether to shift their focus from massive overhaul to incremental changes.
“There is no reason we have to do it all now, but we do have to get it started,” Sen. Joe Lieberman (I-Conn.), who is generally supportive of Obama, said in a recent television interview. “I’m afraid we’ve got to think about putting a lot of that off until the economy’s out of recession.”
Sen. Charles E. Grassley of Iowa, one of the few influential Republicans who has been open to compromise, said Tuesday that he was less optimistic now than he was before visiting with his constituents this month.
“If other members of Congress are hearing what I’m hearing, they’re saying, ‘Slow it down. Do it a little more carefully. Make sure you know what you’re doing. And maybe do it even a little more incrementally,’ ” Grassley said in a conference call with reporters.
Passing a major healthcare overhaul also became tougher with the death Tuesday of Sen. Edward M. Kennedy (D-Mass.), a driving force behind reform and a master of eking out bipartisan compromises.
While Kennedy devoted much of his career to seeking a comprehensive overhaul of healthcare, he was also a monument to how much could be accomplished by passing incremental changes when grand plans failed.
“Kennedy was exceptionally gifted at focusing on what was essential and could be built upon later as a way of compromise,” said John Rother, legislative director of AARP, the senior citizens’ lobby.
As it happens, the health insurance proposals that enjoy the broadest support would have a far more direct effect on the majority of Americans than the lightning rod issues that have dominated debate, such as the establishment of a public insurance option and a provision allowing Medicare to pay doctors who counsel patients about end-of-life care planning.
Some of the ideas that enjoy bipartisan support are expanding coverage for preventive medicine, providing new incentives for small businesses to offer insurance to their workers and making it easier for individuals to comparison-shop for policies.
“Such reforms directly address some of the biggest insecurities people have about healthcare, particularly in the current economy,” Altman said.
There are, however, practical problems with seeking incremental change in an area as complex and interconnected as healthcare, even on an idea as politically uncontroversial as guaranteeing coverage for preexisting conditions.
Insurance companies have long insisted those limits are a legitimate way to deter people from getting insurance only after they get sick or injured. Industry spokesmen have said they are willing to drop such limits, but only if Congress requires everyone to have health insurance.
A mandate for universal coverage would ease industry concerns that their costs would soar if people who were sick or likely to become sick got insurance while healthy people did not.
But if Congress were to enact a mandate that everyone have insurance, it probably also would have to provide premium subsidies for lower- and middle-income people for it to be affordable and realistic.
Then Congress would have to include tax hikes or spending cuts to pay for the subsidies, and the bill would start looking less incremental.
“You can’t just do half the bill,” said Rother of AARP. “It’s an interconnected set of policies.”
Despite such objections, some lawmakers think ways might be found to make the incremental approach work.
When President Clinton’s effort to enact a broad healthcare plan collapsed in 1994, most lawmakers saw little prospect for salvaging any parts of it.
But Kennedy identified achievable goals in the wreckage: He teamed with Republican Sen. Nancy Kassebaum of Kansas on a 1996 law to make it easier for workers to change jobs without losing coverage because of preexisting medical conditions.
Then he sponsored a bipartisan law authorizing states to create insurance programs for children of poor working families and led the way to an expansion of it after Obama was elected.
Congress is far more partisan than it was 15 years ago, making compromise more difficult even on scaled-back measures.
There are fewer moderate Republicans like Kassebaum who are willing to cut deals. And there are fewer Democrats who, like Kennedy, are willing to look for a Plan B that will make progress without undermining the long-term goal of universal healthcare.
“It is hard to look at the Senate and see anyone who has that same ability to conceptualize the big picture,” Rother said. “But we hope someone will step forward and take that role.”