August 02, 2009
The Portsmouth Herald

Despite a persistent push from President Obama, Congress will not meet his deadlines called for earlier this year for full votes in the House and Senate on reform of the country's $2.5 trillion health care industry before they adjourn for the summer recess Aug. 7.

Despite the fact no one single bill or approach has emerged yet — or that reform is subject to multiple definitions — the consensus among Maine and New Hampshire congressional delegations is there has been progress to achieve goals of broadening access to health care coverage, cutting health care costs and paying for it without adding to the budget deficit.

But getting there will require patience, breaking through political stalemate (between Democrats and Republicans and within the Democratic caucus itself) and educating the public.

"If it was easy, it would have been done already," said Sen. Jeanne Shaheen, D-NH.

"Honestly, I think in the end we will get a bill. With something this important, it takes a lot of hard work and longer than we hoped," said Rep. Chellie Pingree, D-Maine. Pingree, a freshman who represents Maine's 1st District, admitted to frustration about what she considers the "stalemate" spurred by well-funded special interests and misinformation about the goals of reform.

"This is number one on the president's agenda and for most of us in Congress," said Pingree, who said she has become a "pest" among her fellow freshmen for pushing a fast pace on health care reform. "This isn't something you can walk away from because it's getting more expensive and complicated every day."

Sen. Judd Gregg, R-NH, said he shares Obama's goals of access to health care for all Americans, medical cost control and health insurance affordability but he thinks the Senate is taking these goals far more seriously than the House.

"Unfortunately, the two House bills that have been approved don't accomplish those goals," said Greg. He estimates those bills would "increase costs dramatically" and would cost taxpayers $2 trillion over 10 years and $3 trillion over the second decade.

The main reason for Gregg's cost rise estimate is the so-called public option plan — designed to provide competition to private health insurers and to give an option for those unable to afford private insurance or unable to get employer-based coverage — which he opposes.

Gregg believes the Senate Finance Committee — one of two in the Senate with jurisdiction over reform — is leading the way for bipartisan consensus by dropping the public option which he said would lead employers to drop coverage and open the door to government-run systems like those in Canada.

The public option "would lead to a rationing of care and a lack of robust (medical) research," he said.

Rep. Carol Shea-Porter, D-NH, serves on one of the House Education and Labor Committees, one of three House committees overseeing reform legislation. She was part of a marathon 21 ½ hour committee session considering reform in mid-July. She said negotiations are taking place everywhere at the Capitol to garner support and that includes incorporating the fiscal concerns of the so-called Blue Dog Democrats and talking with industry stakeholders.

"It's a big bill and it's going to take time," said Shea-Porter, who supports a public option as a necessary cost-control measure. "It needs to be there as a competitive measure and for people who lose their health insurance. They get health care in the emergency room and the rest of us with insurance pay for it."

She said there's no shortage of misinformation about how reform will be paid for and who will benefit. One of her top concerns is to set the record straight, for example, on how small businesses might be impacted.

"We need reform to help small businesses. It's simply not true that small businesses will be hurt. They will be helped a lot," she said. "It's important for people to pay very close attention and sort out fact from fiction. The opponents are trying to frighten people away from this but they didn't like Medicare either. A lot of this debate is about change and fear of the unknown."

Reform change on this scale is why Republican Sen. Olympia Snowe of Maine said it was important to find the right solutions at the right speed.

"I am confident that we share the goal of providing universal, affordable health care this year," Snowe said recently. "But the task before us dwarfs any previous undertaking in health and we must calibrate the speed of our action on this monumental issue to the necessity to get this right."

Shaheen supports a public option and said with health care costs continuing to rise, everyone is searching for answers on a number of difficult issues. Shaheen thinks the stakes for the economy and health care are too high for a consensus not to be reached.

"One positive development this time is that we still have those folks at the table," Shaheen said about the involvement of the public and major stakeholders such as the health insurance, pharmaceutical and medical communities. "They all know the need for reform and how best to address these issues. There's a lot at play and the bills we will eventually debate haven't even been finalized but I think the bottom line is that we will get a bill passed."

As an example of the major issues at play, Shaheen is working with Maine's Republican Sen. Susan Collins on a bill to address skyrocketing Medicare costs for patients returning for hospitalization within 90 days of surgery. Shaheen said not enough is being done to follow up to cut down on the need for multiple hospital stays.

"Many have not seen a doctor in that (90-day) period," Shaheen said. "We need to do a better job and we think this will save about $5,000 per Medicare patient, or about $17 billion a year."

Like many in Congress, Shaheen is hearing from constituents expressing support, opposition and confusion about the reform effort. She said the current system has become a serious drag that threatens not only to leave more people without health care but it's hurting economic growth with health care costs rising to become 1/3 of the country's GDP by 2045.

"I was recently at the Amoskeag business incubator (in Manchester). Almost all of these businesses have fewer than 10 employees and they are the real entrepreneurs that new Hampshire and the country are relying on to help the economic recovery," Shaheen said. "None of them have health care for themselves or their employees. They can't afford it."