Sen. Baucus, CBO Director Orszag Discuss Independent Health Policy Board
Senate Finance Committee Chair Max Baucus (D-Mont.) at a hearing on Tuesday expressed interest in a federal health board that could make controversial health policy decisions without interference from special interests, CQ HealthBeat reports. The hearing, which focused on the fiscal impact of rising health care costs, came one day after a bipartisan health summit hosted by Baucus' committee. After the hearing, Baucus said that "we need some cohesion, some discipline, some organized way to deal with most, if not all, the component parts of health care." He added that an appropriate approach would reduce "the direct interest group influence on Congress on matters that we in some respects are not competent to address, like minute Medicare reimbursement questions."Congressional Budget Office Director Peter Orszag said Baucus could ask CBO and the Government Accountability Office to study the possibility of such a board. Orszag, who did not necessarily endorse the creation of an independent board, said Congress could "delegate some degree of authority to create a professional and insulated body that can make decisions" on important health policy matters such as those related to coverage and reimbursement. He also said the commission could resemble the Medicare Payment Advisory Commission but "have the power to go beyond just recommending" to "actually implement the policy." In addition, Orszag said a federal health board could play a role in reducing regional variations in health care services, which could save billions of federal dollars without impacting quality.
Sen. John Rockefeller (D-W.Va.) "didn't immediately embrace the idea of a board," according to CQ HealthBeat, noting he would oppose any cuts to vital health services provided by Medicare and Medicaid as a way of increasing efficiency. He also "challenged the notion that Congress itself couldn't tackle reimbursement and coverage decisions," CQ HealthBeat reports. However, Rockefeller suggested that lawmakers needed more information on what has been effective in health care before they can make such decisions. Orszag said improved and expanded use of information technology could provide more information, adding that the best way to encourage providers to adopt health IT "overnight" is to exclude those who do not adopt the technology from participating in Medicare (Reichard, CQ HealthBeat, 6/17).
State Plans
On Monday, a group of health care experts who testified at a health summit session on state-based initiatives said the federal government might need to give up some of its control over health care to allow states to overhaul their health systems and serve as testing grounds for different approaches. Gary Claxton, a Kaiser Family Foundation vice president and director of the Foundation's Health Care Marketplace Project, said, "If it is a federal objective to encourage state experimentation and learn from state innovation, the federal government may need to provide states with more control over how health care is financed and delivered." He said programs and policies -- such as the Employee Retirement Income Security Act, which limits states' ability to legislate changes to employer-sponsored health plans -- make it difficult for states to "influence the scope or administration of health benefits for a large portion of employees and dependents residing in the state." He also said tax laws and federal health programs might also present barriers to states' ability to overhaul their health systems.
William Lindsay, chair of the Colorado Blue Ribbon Commission for Healthcare Reform, said the federal government should invest in state plans, noting that initiatives cannot be successful without such support. Massachusetts Commonwealth Health Insurance Connector Authority Executive Director Jon Kingsdale said the Massachusetts health insurance law is an example of a successful health plan, despite criticism that it has surpassed expected costs. "The program is a victim of its own success in outreach and enrollment," Kingsdale said.
Len Nichols, director of the Health Policy Program at the New America Foundation, said California's attempt to expand health coverage to all residents, although unsuccessful, did achieve bipartisan participation, coalition building and public support. Sen. Blanche Lincoln (D-Ark.), who moderated the panel, said, "We must continue our bipartisan coordination on all fronts. We won't get there unless we work together" (Wyckoff, CQ HealthBeat, 6/17).
