I strongly believe there is a need for health care reform and I have offered my own proposal for how this should be accomplished. The bill before the House is a result of thousands of hours of effort put in by members of Congress and their staff, plus the unprecedented input from the public on all sides of this issue. Clearly, people care about how we deliver and pay for health care in this country and there is a need and opportunity for change.
In comparison to the initial draft of H.R. 3200, a number of improvements have been made. To name just a few, the current bill would allow negotiations for prescription drugs under Medicare D, promote alternatives to malpractice litigation, and allow for cross state agreements to purchase cross state insurance (something especially relevant to border districts such as my own). There are also elements that could at long last correct the Medicare payment disparities that disadvantage our state, and the bill would end the anti-trust exemption long enjoyed by insurance companies.
All of those changes are commendable, but there are still reasons for concern. The most important of these is the simple fact that we do not yet have reliable estimates of how this legislation will impact the premiums paid by people who already have insurance.
This week I spoke with Nancy-Ann DeParle, the President's chief health advisor and Doug Elmendorf, the director of the Congressional Budget Office (CBO). Although some prominent economists have asserted that premiums on average may go down relative to what they would be without this bill, the CBO has yet to complete its analysis of the issue. Furthermore, just yesterday, the chief actuary for the Centers for Medicare and Medicaid Services (CMS) said he did not think a cost estimate of the House bill would be available before the scheduled vote.
This is no small matter. To insist that members vote on this legislation without having cost estimates of Medicare and Medicaid impacts by CMS or an estimate of premium impacts from the CBO seems premature and unwise.
Precisely because this matter is so important, it is critical that we do things right, and know what we are doing. At present, unfortunately, I do not believe we have answers to fundamental questions.
Another troubling matter is how the legislation will be brought to a vote. As of this writing, only one amendment will be allowed from the Republican side. No other amendments, by either the majority or minority members, will be allowed. I believe that is a mistake. For a matter of this importance, and on which reasonable people can and do disagree, there ought to be more opportunity granted for amendments on both sides.
For these reasons, until more information is available on premium estimates and Medicare impacts, I will vote against the legislation in its current form. I will wait to make a decision on final legislation until this critical information becomes available and when the House and Senate together produce one bill.