What If Health Reform Passes?

My column this week looks at the evolution of impressions of the Medicare prescription drug benefit among seniors in the years following its passage as a way to anticipate how public opinion toward health care reform might evolve should Congress pass a bill this year. Seniors were initially skeptical of the new benefit, and struggled with its complexity during the initial enrollment period, but grew much more positive as they started to experience the program's full benefits. The big lesson from that experience is that the timing of the initial benefits or initial costs will matter a great deal.

After filing the column on Friday, my colleague Ron Brownstein alerted me to a portion of panel discussion he moderated that covered this topic.  The panel was hosted two weeks ago by the Bipartisan Policy Center. In the second video segment, a question comes up at about the 12:00 minute mark i(transcription that follows is mine):

Q: Assuming something does pass... next year when the Democrats are up for reelection, what the things they can point to in this bill that are will mean something to people since so much of the discussion is about things that will take years to accomplish?

Ron Pollack (Executive Director, Families USA): That's a critical question because as you correctly indicated, 2013 is essentially the implementation date for so many of these things. I was telling an anecdote before we got up here. My sister-in-law called last night. She's moved and she's trying to purchase individual coverage and because she's had a health problem, she's tried to get coverage on the individual market and because she's had some health problems, she's been turned down. So she said, "I'm really rooting for health care reform to happen so I can get my coverage this year," and I said, "sorry, it's not going to happen." I think the legislation will pass, but so much of health reform is not going to be implemented until 2013.

Note: The current draft of the Senate Finance Committee bill includes a provision to create a high-risk pool in 2010 to help provide coverage to those denied it due to pre-existing conditions.  Pollack continues:

One of [the] things we've counseled to folks on the Hill and the White House is you've got to line up a number of things that are concrete that people can actually feel and touch with respect to what happens between now and 2010 and its difficult to do that because of the fiscal constraints. You can't put a whole new regimen that's going to spend a lot of money, but there are going to be, I think, a number of things that are going to be improvements. Take one example: Billy [Tauzin] and PhRMA worked out arrangements in terms of helping seniors with respect to the [Medicare drug benefit] donut hole. At least they're going to get discounts for brand name drugs that will subsidize fifty percent of the cost in the donut hole. That's a significant thing that I think is going to be very helpful to seniors.

I think there will be some efforts at insurance market reforms such as prohibiting rescissions of policies. I think you're going to see, as this bill goes to conference, much greater attention given to what can we do that's implemented in 2010 so that when people go to the polls in 2010 then can feel some concrete benefit.

John Rother (Executive Vice President, Policy and Strategy, AARP): All of us know, after the prescription drug benefit was enacted, which was by the way an exact parallel, politically, to this debate except for the parties switched, we did enact a discount card that people could use immediately before the full program went into effect precisely to offer people something tangible of benefit before they could realize the full program. So I'm hoping we can do something similar.

Billy Tauzin (President and CEO, PhRMA): That was a six hundred dollar per senior benefit, twelve hundred dollars in a couple, that was available immediately, and not everybody took advantage of that. I think it was about an eighteen percent take, but it was there immediately to help people in the interim before implementation. We're going to need probably to look at that as we get through this process. Where are those points were we can do something immediately.

Of course, that initial benefit did not eliminate seniors' suspicions about the program. More had unfavorable impressions than favorable on the Kaiser Family Foundation tracking until enrollment in the full program ramped up in late 2006. See the column for full details.