State has muscle to flex over health care

U.S. Sentator Maria Cantwell (D) gives a talk on health care reform during a visit to the Marshall Center Wednesday morning April 8, 2009 in Vancouver, Washington. (The Columbian/Troy Wayrynen)

Gov. Chris Gregoire

The battle over the shape of national health care reform is heating up, both in Washington, D.C., and in Washington state.

President Barack Obama said last week that 2009 is the year Congress must pass a comprehensive bill that brings down the cost of health care, covers the uninsured and pays for itself without increasing the federal deficit.

Senate and House committees are scrambling to produce such bills before the August recess.

And Washington's top elected officials — Gov. Chris Gregoire and Sens. Patty Murray and Maria Cantwell — have key roles in the national debate.

Gregoire was among five governors who met with President Obama Wednesday to discuss the states' perspective on health care reform. She said later that she advocated "a hard look" at a government-run plan, but suggested that it could be run by the individual states — with the federal government footing the bill.

Cantwell and Murray serve on the two committees that are writing the Senate bill. Both will be in the state this week to talk health care with constituents.

Though Rep. Brian Baird does not serve on any House health care committee, he has a long-standing interest in the issue. In 2007, he introduced legislation that would de-link health coverage from employment and provide private health insurance coverage for every uninsured American.

All have offered measured support for creation of a government-run "public option" that would compete with private insurance plans, by far the most contentious issue in the health care debate.

Both Cantwell and Baird have come under fire from advocates of a public option for failing to take a stronger stand.

Because Congress has not yet produced a public option plan, no one can say how it would be structured. Discussion has centered on a plan that would cover the uninsured and those who can't afford or want to change their employer-provided plans.

However, U.S. Health and Human Services Secretary Kathleen Sebelius told reporters Friday that in her view, "it would be for people who don't have coverage … or are underinsured at this point."

Every plan under consideration would let people keep their private insurance if they are satisfied with it.

One public option under consideration would simply extend the Medicare system to those under 65. Medicare enrollees pay premiums to the federal government and the federal government in turn pays their medical bills, minus co-pays and deductibles.

Other proposals would create a health care "exchange," a large pool of enrollees that would allow the government to negotiate with doctors, hospitals and drug companies for lower-cost health care.

Supporters say a public option would lower the cost of coverage by removing the profit motive and pressure private insurers to lower their rates while filling the coverage void.

Unlike most private health insurance, a government-run plan would not deny coverage for pre-existing conditions, and it would be portable, allowing enrollees to take their insurance with them when they change jobs.

Congressional opponents of a public option, including virtually all Republican lawmakers and some Democrats, warn that a government-run program would undermine the private insurance industry, limit choice and open the door to a single-payer system.

On the other side, advocates for a single-payer system say the only way to provide efficient, universal health insurance is to cut out the private insurers entirely.

That's not going to happen this year, said Sen. Murray's spokeswoman, Alex Glass.

"People who are in favor of single-payer have put a lot of their time and effort into it." she said. "They have worked very, very hard. (Murray) absolutely wants to get to the same end result they do, which is to make sure all Americans have health care coverage. But she also feels we have a moment in history right now where moving ahead on health care reform is viable, and for those who don't have health care, who are worried about losing health care, we have to focus on what is doable. And right now, in Washington, D.C., single-payer is going to be politically untenable, which is why she is supportive of a strong public option."

National health care reform is about more than extending coverage to the uninsured, however.

It's about controlling skyrocketing medical costs, delivering services more efficiently, improving quality and reining in Medicare and Medicaid costs. It's also about giving medical students incentives to become primary care physicians instead of higher-paid specialists, encouraging people to live health-conscious lifestyles and focusing on preventive care.

Here's how Southwest Washington's representatives in Congress stand on national health care as the nation wades into what could be the most important domestic policy debate of the Obama administration:

• Murray serves on the Health, Education, Labor and Pension Committee, which is drafting the policy portion of the health care reform bill. She is one of five committee members tapped by the ailing Sen. Edward Kennedy, D-Mass., to draft the bill. Her assignment: To develop federal policy that will build a health care workforce for the future.
  
  Under that policy, approved by the committee last week, the federal government would offer scholarships, low-interest loans and other incentives to students who choose to become primary care physicians, pediatricians, and "allied health professionals" such as X-ray technicians and emergency medical technicians.
  
  A passionate reform advocate, Murray told a news conference in Washington, D.C., last week, "Our system is horribly broken, and we have got to fix it."
  
  She is on record as saying that she wants a strong public option, "something that competes with private insurance so we make sure there is a level playing field," Glass said.
  
  Glass declined, however, to say whether a public option is a deal-breaker for Murray.
  
  "The thing we want to make people aware of is, we are so much at the beginning of the process here. The conversation is ongoing. All the options are on the table."
  
  
• Cantwell serves on the Senate Finance Committee, which has the task of figuring out how to pay for reform.
  
  She told The Columbian that she supports a government-sponsored plan — with qualifications. "I think there can be a bill with a public option that can pass," Cantwell said.
  
  But that's not her highest priority.
  
  "I want quality care, I want total access, and I want cost control," she said. "This reform has to have some ability to clamp down on costs. We've been driving up costs and not delivering outcomes. If we create this new plan, I want to make sure we do a good job and focus on outcomes."
  
  Cantwell has introduced several bills that she hopes will be included in the final reform legislation. One would revamp the Medicare reimbursement formula to make it more fair to Washington, which is penalized under the current formula for operating a highly efficient Medicare program.
  
  Others would address the shortage of primary care physicians and help the infirm elderly find alternatives to expensive nursing home care, a major driver of escalating Medicaid costs.
  
  Cantwell believes the efficiencies she and others have proposed could save enough over time to cover a significant share of the estimated $1 trillion cost of national health care reform over 10 years.
  
  "I think we could come up with maybe half of what we need," she said. "The issue is in the transformation. It's hard to see those savings in a five-year window," the period covered by the legislation. "I think we can see them in 10 years. Having said that, I think we will come up with a bill that is revenue-neutral."
  
  
• Baird will be just one vote among 435 when health care reform reaches the House floor. His priorities are improving the quality of health care and controlling the cost.
  
  "I'd like to see responsible reforms to medical liability, medical records, and evidence-based practices," he said.
  
  Regarding a government-sponsored plan, Baird said, "I would be less likely to support a health care reform bill without a public option." But he said a government plan would have to compete with private insurance plans on a level playing field and not receive unfair taxpayer subsidies to get his support.
  
  "The way it would compete would be because presumably the public option would not be paying its CEO millions of dollars," he said. "If a public option can provide more effective, more efficient health care, why deprive consumers of that choice?"