Photo by Dave Ranney
U.S. Rep. Jerry Moran, a Hays Republican, fields questions from reporters at a recent health reform roundtable discussion in Topeka. Moran, like most of the state's congressional delegation, said the White House is moving too fast on its plan to reform the nation's health care system.
Kansas Congressman Jerry Moran says the nation’s health care system is broken and that it needs to be fixed.
But the 1st District Republican thinks that President Obama and Democratic leaders are moving too fast on their proposed version of the fix.
“I think the debate about reforming the health care system is long overdue, but I want us to take a sufficient amount of time to do it as well as we can,” Moran said during a recent interview. “Slow and methodical to me is better than what I’m reading about in the Senate.”
Two Senate committees are pushing to have a health reform legislation passed by the end of the summer. The Health, Education, Labor and Pensions Committee is scheduled to begin deliberations on a 651-page bill this week.
But like Moran, U.S. Sen. Pat Roberts, R-Kan., a member of the HELP committee, is urging a slower pace. In a letter last week to the Democratic leaders of the panel, Ted Kennedy and Chris Dodd, Roberts asked that members be given detailed cost estimates and a proposal for how the bill will be paid for before beginning deliberations.
“I see no reason why the Senate should shove through a bill that has this much at stake,” Roberts said, explaining why he sent the letter. “Time out. Slow down. Give us the details. That’s all we’re asking for.”
Public plan debate
But more time isn’t all that Republicans are asking for. They’re demanding that some key elements of the reform bill be eliminated or at the very least substantially modified. They have concerns about the mandates in the legislation that would require businesses provide and individuals purchase health insurance. They also have worries about how comparative effectiveness research might be used. That research has the ostensible goal of determining best treatments and thereby helping contain soaring medical costs.
But the proposed reform that has drawn the most vocal opposition from Republicans is the one that would create a government insurance program to compete with private plans.
President Obama, stumping for health reform late last week in Green Bay, Wis., said that a so-called “public plan” is essential because having it compete with private insurance companies “will keep them honest and help keep prices down.”
But Roberts and other Republicans on the key health reform committees see it differently. In a June 5 letter to the president they said that “forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition.”
The GOP senators said they feared that over time a government insurance program would lead to “a federal takeover of our healthcare system.”
That concern is shared by all of the Republican members of the Kansas Congressional delegation.
Moran expressed it after meeting in Topeka recently with representatives of several provider organizations and insurance companies, including the Kansas Hospital Association, the Kansas Medical Society and Blue Cross Blue Shield of Kansas.
“There is a real dilemma about what role government should play in the future of our health care delivery system,” Moran said. “Republicans and Democrats generally have different ideas about the size and scope of government.”
Lynn Jenkins, a Republican serving her first term representing the state’s 2nd District, said in a recent column that the proposed public plan was “a creative name for a government takeover of our health care system.”
And during recent questioning of Health and Human Services Secretary Kathleen Sebelius, 4th District Republican Todd Tiahrt said, “one of the biggest concerns with government interference in the healthcare delivery system is that it will limit innovation, choices and access.”
Tiahrt is running against Moran in the Republican primary for the U.S. Senate seat being vacated by Sen. Sam Brownback, who is returning to Kansas to run for governor.
Congressman Dennis Moore is the only member of the Kansas delegation who supports a public plan. The 3rd District Democrat said in a recent interview despite concerns about the cost of health reform he’s prepared to support a plan that includes a public option.
“We’ve got to be ready to run with this. We cannot repeat what happened before when everything fell through,” Moore said, referring to the failed attempt by President Clinton to reform the health care system.
As for predictions that a government insurance plan competing with private plans would ultimately lead to a federal takeover of the health care system, Moore said, “I know you will find this hard to believe, but there are some here who are not above using scare tactics to get what they want.”
Room for compromise
Len Nichols is playing the role of diplomat in the health reform debate. As the health policy director for the New America Foundation, a nonpartisan public policy institute, Nichols is working privately with Democrats and Republicans to craft a compromise on the public plan.
Nichols said it’s clear to him that most members of Congress want a bipartisan health reform bill. But he said there is a risk that the ideological debate over the public plan could prevent that happening.
“Unfortunately, the positions (on the public plan) were hardened before other alternatives were in the public domain,” Nichols said during a recent telephone interview as he made his way to Capitol Hill for another work session.
But other options are beginning to emerge and Nichols said he remains hopeful compromise is still possible.
“There are technical solutions if there is enough trust,” he said. “And that’s why bipartisan conversation is so important.”
Late last week, members of the Senate Finance Committee, on which Roberts serves, began discussing an idea promoted by Sen. Kent Conrad, a conservative Democrat from North Dakota. He is proposing creation of government-run, health care cooperatives that would be modeled after rural farming, electricity and telephone cooperatives that are owned and organized by members. The cooperatives would negotiate rates with providers and would have to meet the same licensing and regulatory requirements as private companies.
Sen. Charles Grassley of Iowa, the ranking Republican on the finance panel, said the idea had compromise potential, saying in the Washington Post that it could “increase the level of competition if done, if it were done right.”
Nichols said a public plan could be designed so that it doesn’t have a competitive advantage over private plans. Key to doing that, he said, would be requiring that all the rules of the marketplace — benefit package requirements, risk adjustment processes and other insurance regulations — apply equally to the public plan and its private competitors.
“The objections to the public plan can all be met with provisions that are designed to guarantee a level playing field,” Nichols said.
Health and Human Services Secretary Kathleen Sebelius said Sunday that public and private plans compete fairly in many state employee benefit programs as well as in State Children’s Health Programs.
“This notion that somehow this public plan can’t work and it will drive the private insurance market out of business is just not very accurate,” the former Kansas governor said on ABC’s This Week with George Stephanopoulos.
Asked if Conrad’s health cooperatives idea was a feasible compromise, Sebelius said, “I think Sen. Conrad has come forward with a creative idea, recognizing that choice and competition are good in a marketplace.”
Moran said he was hopeful that a bipartisan compromise emerges because he acknowledges that doing nothing is not an option.
“The system we have today is unsustainable,” he said.
-Jim McLean is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at jmclean@khi.org or at 785-233-5443, ext. 110.