Washington Post Examines HHS, Health Care Reform Efforts After Daschle’s Withdrawal

The HHS secretary vacancy and no one yet nominated after former Senate Majority Leader Tom Daschle (D-S.D.) recently decided to withdraw his nomination has "left a gaping hole in President Obama's leadership team, one that health care advocates say has stalled what they hoped would be speedy action on high-priority measures," the Washington Post reports.

Douglas Kamerow, a former assistant surgeon general who served in the U.S. Public Health Service for 20 years, said, "Without a person with Daschle's stature, it really delays and complicates the effort on health reform." Kevin Frost, CEO of the Foundation for AIDS Research, added, "The health agenda isn't being addressed, and the health agenda was certainly a big part of the campaign and a big part of the transition."

White House spokesperson Dan Pfeiffer cited the recent passage of an economic stimulus package that includes a number of health care provisions and an expansion of CHIP as indicators of a continued focus on health care despite the lack of an HHS secretary. "We've seen more progress toward expanding access and improving health care in three weeks than we've seen in a long time," he said.

Obama administration advisers have not publicly discussed possible replacements for Daschle or when Obama might make a nomination. In addition, Obama has not nominated heads for CDC, CMS, FDA or NIH. According to the Post, while "[v]eteran bureaucrats are accustomed to the between-presidents interregnum that occurs every four or eight years ... there are limits to what they can do."

The "stimulus legislation also spotlights the potential gaps and pitfalls to negotiating a major bill without a top-ranking health official," as the package included limited funds for prevention and no funds for bioterrorism preparedness, according to observers, the Post reports. Observers added that food safety issues raised by the recent salmonella outbreak also highlight the need for an HHS secretary (Connolly, Washington Post, 2/16).

Divided We Fail Issues
Members of Divided We Fail -- a coalition led by AARP that includes the Business Roundtable, the National Federation of Independent Businesses and the Service Employees International Union and seeks to promote health care reform -- have become "divided over key elements of how to fix health care" as they "get down to the specifics," the AP/Boston Globe reports. According to the AP/Globe, although members "agree that something should be done to revamp health care in the United States" and have reached a "consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient," they "differ over important details, including what roles the government and private businesses should play."

Labor unions and advocacy groups seek a health insurance system in which a public health plan competes with private plans, all residents receive benefits similar to those provided to federal employees and employers offer coverage or pay into a federal fund. However, business groups favor a health insurance system based on the private market and oppose new requirements for employers.

The "emerging rifts highlight how difficult it will be for Obama and the Democrat-run Congress to deliver what they say they are committed to: a health care overhaul that would guarantee everyone affordable coverage," the AP/Globe reports. In addition, the differences "illustrate the limits of one of lobbyists' favorite tactics: banding together with partners to try to build support for a top priority," according to the AP/Globe (Hirschfeld Davis, AP/Boston Globe, 2/17).

Wyden Bill Receives Support From Republicans
The ability of Sen. Ron Wyden (D-Ore.) to "attract the support of staunch Republicans" for his health care reform bill (S 391) "assures that the plan will get plenty of publicity," CQ HealthBeat reports. The legislation -- co-sponsored by seven Democrats, five Republicans and one independent -- effectively would replace the employer-sponsored health insurance system with a system in which individuals purchase private coverage through pools administered by states.

The bill has "more than enough" support from Republicans to "allow the measure to cross the magic 60-vote threshold needed to get legislation to the floor in the Senate and get it passed, assuming all Democrats and independents back the Wyden measure," CQ HealthBeat reports. According to CQ HealthBeat, the legislation likely has received support from Republicans because "it is a way to get to universal coverage without driving up the federal deficit," based on an analysis conducted last year by the Congressional Budget Office.

However, a "number of analysts see enormous obstacles to the plan despite its favorable scoring and ability to attract Democrats and Republicans," CQ HealthBeat reports. Joseph Antos, a resident scholar at the American Enterprise Institute, said, "It is not really bipartisan ... and I don't think it represents a consensus view," adding, "It can't be the base plan from which you begin to deviate because it is way far out there in too many ways."

Other analysts have raised concerns that the legislation would change Medicaid and CHIP into "supplemental coverage plans that would wrap around private coverage obtained through the state-run pools," CQ HealthBeat reports (Reichard, CQ HealthBeat, 2/13).

Opinion Piece
As a result of Daschle's decision to withdraw his nomination as HHS secretary, "it looks less likely now that the Obama administration is going to be able to put together a health insurance program and pass something resembling it through Congress anytime soon," columnist Michael Barone writes in a U.S. News & World Report opinion piece. "Getting 218 votes in the House for any Democratic plan will be easy," he writes, adding, "Getting 60 votes in a Senate that currently has only 58 Democrats (and will have 59 if Minnesota's Al Franken is seated) will be much harder."

In addition, "there's another problem when you tackle health care" -- the U.S. "does not have one health care and health care finance system; it has many health care and health care finance systems," Barone writes. As a result, "different states and different regions have players with different interests," he adds (Barone, U.S. News & World Report, 2/11).