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Managing Expectations for Federal Health Reform

Posted Feb 03 2009 12:44am

One of the challenges facing health reform legislation are the expectations of different stakeholder groups - many of whom were strong supporters of the Barack Obama’s campaign.  Although the new Administration has only been in office a week and a day, a number of signs point to the fact that health reform legislation will not be quickly formed and passed - including an article in today’s Boston Globe titled, “Some fear window is narrow for healthcare overhaul.”

But not rushing health reform was both predictable and a good thing.  First, the reasons why it won’t happen quickly:

  • It takes time for the new Administration and Congress to get organized - and they are rightly prioritizing actions to address the economic “situation”
  • The US system of government is designed to be deliberative and not speedily make major decisions
  • For reasons that are not fully apparent, the Senate is taking longer to confirm Tom Daschle as Secretary of HHS - although there are no signs that this won’t happen soon
  • Senator Kennedy’s health has been a question mark, but his staff has been working diligently to prepare legislative framework and language in conjunction with other Congressional offices such as the Finance Committee
  • Congressman Waxman’s taking over the Chairmanship of the Energy and Commerce Committee will likely mean some staff turnover in that Committee which also takes time - particularly since Congressman Waxman is known for getting some of the best and brightest staff in Congress

And second, not rushing health reform legislation through the process may be a good thing because no matter what scope and details the legislation eventually includes, getting more groups comfortable with its goals, priorities and specifics will make it more likely to succeed.  Some might argue that getting it done quickly will prevent any opposition from building up steam to defeat or derail it, but I believe that any interest groups seeking to do that will be more organized and quicker to the trigger than many others who would support it but might need more time to understand the legislation and rally their forces in its favor.

In addition, no matter how quickly legislation is written, passed by Congress, (and presumably signed by President Obama), it will still take a long time to implement.  For example:  Regulations will have to be written, published for comment, revised, and published in final form; Government programs will have to be revised or created - which entails moving people around or hiring new staff, and creating new forms and procedures for individuals and companies to report information to the government about their health benefit, etc.; Private companies will have to submit proposals for participating or providing services to the government for any new health programs (i.e. health insurance exchange, or new insurance plans).

All these things take time, so that actual substantive changes in how people get or pay for health insurance, how companies pay for employees benefits, or how the government regulates or provides health insurance will likely not occur for months or years after new laws are signed.  The exception to that process of course are modifications or expansions to existing programs - which is why the stimulus bill is looking at providing financial relief to states for their Medicaid and SCHIP programs to prevent or minimize cut-backs in those health insurance options for low-income individuals.

The bottom line is that health reform will be a long roller-coaster ride.  So pull down the safety bar until it locks in place, buckle your seat belt, keep your arms inside the car, don’t throw anything that could hurt your fellow riders or onlookers, and if you begin to feel ill, remember that everyone’s on the same ride, there will be dips and calm periods amidst the twists and turns, and this time it will most likely get done - eventually.

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