Health Care

Currently, 50% of all health care in this country is either paid for or provided through the federal government. That includes Medicare, Medicaid, the Children's Health Insurance Program, Tricare Standard, Tricare for Life, Veterans Health Care, Military Health Care, Indian Health Care, the Public Health Service, and the Federal Employees Benefit Program.

Our health care system is in need of reform, but we need to be wary of the cost and complexity, and we should choose among the best proposals in the House, Senate, and White House. Over the last several weeks, I have supported a slow-down, because I think we need a longer period to search for better, more affordable solutions.

We have the best health care in the world, bar none, but it is also the most costly, and access is not assured to the 46 million who lack insurance coverage. I believe we should close that gap, but I recognize the cost and complexity. That's why I supported not voting until after the August recess. I want to see reform done right.

Because of the complexity, neither the House nor the Senate has come forth with a final draft, and major differences separate the two. For instance, the House draft contains an employer mandate, requiring the employer either to pay a percentage of the employee's premium cost or pay 8% of an employee's wage into a health insurance fund. In the Senate bill, employer contributions are much smaller. I lean toward a lower-cost alternative.

Both bills call for an insurance exchange, where individuals and smaller businesses have the advantage of competition. But the House bill contains a public insurance plan as one option in the insurance exchange. The purpose of the public option is to offer an alternative to private insurance and to have a yardstick to compare cost and coverage. Insurance companies oppose the public plan. They claim that it will be impossible to compete if the government subsidizes the public insurance policy. Sponsors say subsidies will be excluded. A public policy enacted as a backup, which is triggered into being only if the cost of private coverage escalates beyond certain benchmarks, may be a compromise.

The Office of Management and Budget has proposed a Super-MedPac with rate-making and regulatory authority over Medicare and Medicaid. One of its purposes is to save money in these programs to pay for coverage of the uninsured. I understand the need for strong administration, and one empowered to hold costs in line when Congress will not, but I think the Super-MedPac may be a bit too powerful.

When we wrote the budget resolution for fiscal year 2010, we required that the cost be deficit-neutral, so that every dollar spent is offset by a dollar saved. While the House proposal will be fully offset, a little more than half of the House proposal would be offset by savings in the existing health care program. I want to see even more of the cost offset by savings in the health care system.

The House and Senate are moving toward passage of health reform legislation, and the differences in the bills will have to be worked out in conference. So, health care reform is very much a work in progress.