Health care overhaul set to miss key goal

Washington: As a key Senate committee yesterday prepared to pass its plan to overhaul the nation's health care system, senior Democrats acknowledged that it might be impossible to provide coverage to all Americans — a central goal of President Barack Obama and his congressional allies.

That is fuelling alarm among hospitals and insurance companies, which have made universal coverage a condition of their support.

On Monday, the insurance industry stepped up its warnings that leaving a large segment of the population without coverage would accelerate the rise in premiums for everyone else. The bill that has emerged from the Senate Finance Committee would leave some 17 million people uninsured.

However, leading Democrats are standing behind a series of compromises worked out by the committee that are designed to control the cost of government subsidies for consumers forced to buy insurance.

They say the approach — which would keep the cost of the legislation under its 10-year target of $900 billion (Dh3.3 trillion) — is necessary to attract the moderate and conservative votes vital for passage.

"I'd like more [insurance coverage]," said Senator Christopher J. Dodd, who over the summer shepherded a version of the bill proposed by the late Sen. Edward M. Kennedy, through the Senate Health Committee.

"But that's a pretty good start... Senator Kennedy was a great advocate of the idea that you do the best that you can."

The bill that comes out of the Finance committee must be reconciled with the health panel's version before the legislation can be brought to the full chamber for a vote. A similar effort is under way in the House.

Congressman Henry A. Waxman, the House Energy and Commerce Committee chairman and a leading author of that chamber's health care bill, also said that compromises over how many Americans and legal immigrants would be covered may be necessary. There are 40 million without insurance, excluding illegal immigrants.

"The effort to reform health care is a balancing act," Waxman said on Monday. "And we are limited in how much money we can spend."

Senator Charles E. Schumer, a leading member of the Finance committee, said Senate Democrats shared the concern about federal spending.

"We're focused on the budget number," he said. "That's the most important number right now."

Liberal lawmakers and consumer groups long have nurtured dreams of covering all Americans. More recently, universal coverage emerged as a key goal of insurance companies and health care providers, who would gain tens of millions of customers. And hospitals would benefit as the number of uninsured patients receiving free care diminished.

Limiting costs

Industry leaders and health care experts also consider universal coverage as important to making other changes to the health care system — such as prohibiting insurers from denying coverage for pre-existing medical conditions and restraining the cost of premiums.

"The larger the insurance pool, the better able you are to spread risk," said Peter Harbage, a health care consultant who has advised Democrats in Washington.

"If you have universal coverage, you will have the most efficient system and best achieve affordable coverage."

Congressional Democrats have agreed on a series of steps to expand coverage, including a mandate requiring most Americans to obtain insurance and billions of dollars in federal subsidies to help low-income and moderate-income people pay premiums.

Elements of the bill

• Creates separate state-based exchanges for individuals and small businesses, with up to 50 employees, to shop for insurance.
• Four categories of minimum benefits would be offered.
• A policy offering catastrophic coverage for young adults, a "young invincible" plan, would be offered.
• Starting July 1, 2013, insurance companies would no longer be able to exclude people from coverage based on pre-existing conditions. Limited-benefit plans and lifetime limits on coverage would be barred.

Measures

• Beginning in 2013, most US citizens and legal residents would be required to obtain health coverage.
• Provides a sliding scale of tax subsidies for people with incomes up to 400 per cent of poverty to help buy insurance.
• Limits deductibles and out-of-pocket expenses. Limits put on a sliding scale based on incomes.
• Exemption allowed for those who cannot afford coverage if costs exceed eight per cent of income.
• Penalties for failure to purchase insurance would be phased in starting with $200 (Dh734.6) per adult in 2014. By 2017, the penalty would be $750 per adult.