Benefits still years away, even if health care passes

Sixty years is how long Democrats contend they’ve been pushing for legislation that provides health care access for all Americans. They’ll have to wait a little longer if President Barack Obama gets a bill to sign this year.

Under the Democratic bills, federal tax credits
to help make health insurance affordable for millions of low- and middle-income households won’t start flowing until 2013 — after the next presidential election. But Medicare cuts and a sizable chunk of the tax
increases to pay for the overhaul kick in as soon as it is enacted.

The eat-your-vegetables-first approach is causing heartburn for some Democrats. They worry that opponents could capitalize on misgivings about the complex legislation to undo what would be a signature achievement for Obama. Democrats, however, say the lag time is needed to properly set up the program.

“The real danger is that health reform could be vulnerable to what we see with the stimulus package,” said Democratic health policy consultant Peter Harbage, referring to criticism that Obama’s $787 billion economic plan hasn’t stemmed rising unemployment.

Said Judy Feder, a senior health official in President Bill Clinton’s administration: “Just as we are fending off ideological attacks to get the bill passed, we will be fending them off as we implement the law.”

The House of Representatives is inching closer to voting on a comprehensive health care bill, even as the chamber appears so divided that the measure may not attract a single Republican supporter. House debate is expected this week.

Officials and Democratic lawmakers said setting up insurance marketplaces, writing consumer protection rules and reconfiguring the bureaucracy would take years. President George W. Bush’s administration took two years to phase in the Medicare prescription benefit, a more modest undertaking.

Another reason is to make the costs of the plan seem more manageable under congressional budgeting rules.

Lawmakers use a 10-year accounting window to assess new programs. Starting the Medicare cuts and some of the taxes in the early years — and pushing the bulk of new spending into the latter years — helps keep the cost of the health care overhaul within Obama’s $900 billion limit. Bush used the same kind of maneuver to push the Medicare benefit through Congress.

Senate Finance Committee Chairman Max Baucus addressed the concerns in a recent news release captioned “What You Get Right Away.”

Among the major short-term improvements in his bill would be a benefit for people on Medicare. Starting in 2010, those who fall into the Medicare prescription plan’s coverage gap would get a 50 percent discount off the price of brand-name drugs.

In 2011 and 2012, certain small employers with fewer than 25 workers could get a tax credit for up to 35 percent of what they contribute toward the cost of employee coverage. This could encourage companies that don’t offer coverage to do so, but it’s more likely to shore up those who do.