Sen. Edward M. Kennedy (D-Massachusetts), who is battling life-threatening brain cancer, intends to have health care legislation drafted by Inauguration Day. (Photo: Brendan Smialowski / The New York Times)
Two of the Senate's most influential leaders are working separately behind the scenes on legislation that would dramatically alter the way Americans get health care, hoping their early efforts -- including the release today of a position paper -- will push President-elect Barack Obama to move rapidly on the issue and spare the incoming administration some of the missteps that killed Bill Clinton's health reform initiative in 1994.
Senate Finance Committee Chairman Max Baucus (D-Mont.) is unveiling a 104-page blueprint today that serves as the opening move in a fierce competition in the Senate to frame the debate. Sen. Edward M. Kennedy (D-Mass.), who is battling a life-threatening brain cancer, has directed aides over the past several months to convene negotiating sessions with a diverse group of stakeholders, including physicians, patient advocates, small-business owners and insurers. He intends to have legislation drafted by Inauguration Day.
The first promise Obama made as a presidential candidate was to enact a universal health-care plan by the end of his first term, but since his victory a week ago, he has focused on repairing the economy. Health reform advocates fear that just as Clinton was sidetracked in early 1993 by debates over the North American Free Trade Agreement and gays in the military, Obama's urgency about taking on health care may wane.
"President Clinton came in determined to do something significant on health-care reform" but did not submit a bill until 10 months after taking office, noted Ron Pollack, executive director of the pro-consumer health group Families USA. "A president's leadership is most effective before he expends much of his political capital."
The Senate maneuvering, combined with an unprecedented level of post-election lobbying by outside interest groups, is intended to hold Obama to his pledge.
Yesterday, Divided We Fail, a coalition of business executives, consumer advocates and unions with 53 million members, announced a $1 million ad campaign to keep the pressure on Obama.
In a letter, the group offered the president-elect a deal: "If you will commit to taking action on this critical issue early in your administration, we will commit to engaging our members by hosting a health care reform summit, working with you to develop a proposal as part of your agenda for the first 100 days and educating our members about the challenges and trade-offs reform entails." A similar coalition led by Families USA is preparing its own ad blitz.
Though not as public, Kennedy's efforts will carry enormous weight, given his lifelong focus on the issue, his early endorsement of Obama over Sen. Hillary Rodham Clinton (D-N.Y.) and his own health status.
"We're doing all we can today to unite Congress around a single, unified bill for early action next year," he said through an aide.
The release of Baucus's white paper, entitled "Call to Action, Health Reform 2009," is striking in both its timing and scope. Rarely, if ever, has a lawmaker with his clout moved so early -- eight days after the election of a new president -- to press for such an enormous undertaking.
"We're at one of those rare moments that come every 15 years when you have a chance" to accomplish major change, said Drew E. Altman, president of the nonprofit Henry J. Kaiser Family Foundation, which researches health policy issues. "But a lot of things have to break right for it to happen."
The Baucus plan outlines an ambitious path for providing health coverage to every American in less than 10 years. Eventually, his approach would impose a mandate on every individual and large employer to participate in the system.
"I'm very serious about this," Baucus said in an interview. "Doing nothing will be a lot more costly."
Aides have refused to indicate what direction Kennedy will pursue but have made it clear he does not intend to cede his longtime leadership role on health policy. They expect to get valuable assistance next month when Peter R. Orszag, head of the independent Congressional Budget Office, releases a two-volume report on the need for health reform and a set of policy actions that could achieve measurable savings.
Baucus shares several ideas with the Obama campaign. Most notably, he proposes a Health Insurance Exchange, which would connect individuals and employers to insurance providers. Baucus would prohibit insurers from denying coverage of preexisting conditions, and he would offer government subsidies to low-income families to afford coverage.
In the paper, Baucus calls for expanding three government health programs -- Medicare, Medicaid and the State Children's Health Insurance Program -- as well as opening Medicare to people ages 55 to 64. He also outlines new tax breaks for individuals and small businesses to offset the costs of insurance.
Baucus also discussed several possible funding sources. He argues, as many experts do, that ideas such as eliminating waste and fraud, focusing on prevention and using sophisticated data to identify the most cost-effective therapies will save money over the long term. In the short term, he advocates eliminating what Democrats have long criticized as "overpayments" to insurance companies that sell managed care plans to Medicare recipients.
The most controversial idea is Baucus's suggestion to revisit the current tax treatment of employer-sponsored health insurance. American workers today do not pay income taxes on the value of insurance paid for by their employers, a benefit valued at $245 billion annually. The tax break is considered regressive because higher-paid workers and those employed by large businesses are the primary beneficiaries.
During the campaign, Obama sharply criticized Sen. John McCain (R-Ariz.) for touting a plan to eliminate that tax exclusion and instead give individuals the tax break, a move that would have extended the benefits to more uninsured or lower-income workers. A similar approach is outlined in bipartisan legislation sponsored by Sens. Ron Wyden (D-Ore.) and Robert F. Bennett (R-Utah.), though their bill goes further than McCain in creating opportunities for individuals to buy coverage.
Baucus's plan encourages Congress to consider a middle road given the large sum of money at stake.
Wyden realizes he may be outgunned by colleagues such as Kennedy and Baucus but said his ability to collect eight Democratic sponsors and nine Republicans illustrates the salience of the issue.
"This shows it is possible to move in a bipartisan way," he said.