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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Incremental Health Care Reform

In all the obsessive focus over the economic stimulus package, somewhat lost in the shuffle has been Barack Obama’s plan to overhaul the health care system. The CW is that the budgetary resources and political capital necessary to pass the stimulus bill are so large that any steps towards Universal Health Coverage (UHC) must be delayed until some indefinite point in the future.
In TNR’s new health care policy blog, The Treatment, Jonathan Cohn assesses the CW and suggests that a major health care system reform proposal could still arrive later this year:

[E]verything I’ve heard from both the transition team and Capitol Hill suggests nobody is backing off major reform yet. Staff and advisers are proceeding under the assumption that it remains a “year one” priority for Obama. That means they are continuing to do what they’ve been doing for the last few months: Crunching numbers, consulting experts, meeting with interested parties–all in the name of fleshing out a plan that Congress could formally consider sometime before year’s end.

Whether or not that’s accurate–and it will all probably depend on the economic and political situation a few months down the road–it’s worth noting that incremental steps towards UHC are actually moving along. The stimulus package itself includes a Medicaid “super-match” that will encourage states to maintain and in some cases actually increase coverage for low-income citizens. It also includes a provision allowing unemployed people over 55 to continue COBRA coverage (with new federal subsidies) until they are eligible for Medicare, which could affect a sizable group of the newly uninsured. Health care IT investments considered integral to UHC are included. And on a separate track, earlier this week the House passed the SCHIP eligibility expansion that Bush vetoed.
Cohn regards these steps as potentially representing a more cautious UHC strategy for Obama:

One thing to keep in mind, as the debate moves forward: Obama and his allies may well decide they need to address health care affordability sequentially. The “down payments” could then take the form of institutional changes (like setting up an institute to study the effectiveness of new treatments) and significant coverage expansions (starting with Medicaid and the State Children’s Health Insurance Program) that might still fall well short of universal coverage. The idea, then, could be to return later on–maybe in 2010 or 2011–with additional legislation, backed by additional funding, designed to finish the job.

At a minimum, it’s clear that Obama is determined to avoid actual reductions in health care coverage due to loss of employer-based insurance or state budgetary decisions. Beyond that, it’s hard to say whether steps he’s taking now represent a return to an incremental strategy for achieving UHC, or a foundation for a big UHC proposal in the near-term future.

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