After dominating the headlines in 2008, the debate over health care culminated in the House and Senate each passing sweeping reform measures. In January, House and Senate negotiators plan to hammer out a final version for the president’s signature.
Congressional leaders and President Obama have so much invested in the issue that a version acceptable to both houses is almost certain to emerge. The bills as passed diverge from each other in several aspects, but their many areas of agreement provide a snapshot of the myriad ways they will reshape the health insurance system and Medicare.
“I think a lot of people were expecting this bill to do two things, one of them was to expand coverage, and the other was to control costs,” said William Harmon, MD, director of pediatric nephrology at Children’s Hospital Boston and a member of the American Society of Nephrology’s Public Policy Board. “It is clear that what seems to be coming out is going to expand coverage. The jury is out on whether it is actually going to contain costs.”
The nonpartisan Congressional Budget Office (CBO) estimates that the House bill would insure an additional 36 million people, resulting in coverage for 96 percent of legal residents under 65, and the Senate plan would cover an additional 31 million, or about 94 percent of those under 65, compared with 83 percent now.
Aside from the coverage expansion, Harmon and Thomas Hotstetter, MD, chief of the nephrology division at Albert Einstein College of Medicine in New York City and chair of the ASN Public Policy Board, pointed out two provisions in the bills of particular interest to nephrologists: Medicare payment related to end stage renal disease (ESRD) and increased funding for comparative effectiveness research. The reform momentum is likely to also lead to another key action within the next two months—a reconfiguration of the Medicare reimbursement scheme that avoids scheduled cuts.