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JANUARY 20, 2009 -- Obama is President!

President Barack Obama vowed during his campaign to expand access to health insurance and reform health care. Early indications now suggest that, despite an ailing economy -- or perhaps because of it -- he is resolved to keep his promise. In the weeks leading up to the swearing-in ceremony, the 44th president began setting the stage for health reform.

Many health policy leaders praised his nomination of former South Dakota Sen. Tom Daschle to serve as Secretary of Health and Human Services. Daschle, who is also leading the Obama administration's newly created White House Office of Health Reform, is thought to have a solid grasp of health policy, having outlined his vision for reform in the 2008 book Critical: What We Can Do About The Health-Care Crisis.

Earlier this month, Obama laid out an economic stimulus plan that positions health care as a cornerstone of financial growth and recovery. During his campaign, he identified health reform as a top priority, along with economic recovery and energy independence. "The thing that's intriguing to me is, this seems to be a nice recognition of how big and how important health care is as part of the economy," said R. Paul Duncan, professor and chairman of the department of health services research, management and policy at the University of Florida in Gainesville. "There seems to be a notion that if we do good things in health care, they will not simply cost us, but in addition, they are likely to produce economic benefit."

A new national survey by the Kaiser Family Foundation and the Harvard School of Public Health suggests that Americans would also like to see action on health reform. While economic recovery is far-and-away their top concern (73 percent), 43 percent said reforming health care reform should be a top priority, after fighting terrorism (48 percent).

Experts in health care policy are also advocating systemic change. According to a recent survey of "health care opinion leaders," conducted by the nonprofit Commonwealth Fund, 92 percent of experts favor or strongly favor allowing Americans who can't get insurance through employer plans or Medicaid/SCHIP to purchase insurance through a national health insurance exchange, as Obama has suggested. "There really is an historic wind of opportunity for health reform," Kaiser Family Foundation President and Chief Executive Officer Drew Altman said at a press briefing on the Kaiser/Harvard survey results. In part, that opportunity is brought about by the public's concerns about paying for health care and health insurance amid a deep recession, he noted.

However, the survey also revealed wide divisions in public opinion, with roughly half (49 percent) saying they are not willing to pay more to expand access to health insurance and 47 percent saying they are. Such underlying tensions in public opinion could be exploited, "especially if there is a protracted debate," Altman conceded.

Under Obama's plan, medium and large employers that don't offer employee health benefits would pay a tax to help fund coverage -- a so-called "play-or-pay" mandate. He also pledged to expand eligibility under Medicaid and the State Children's Health Insurance Program (SCHIP). And he would create a plan much like the Federal Employee Health Benefits Program to help individuals who don't have job-based coverage or don't quality for other public programs.

The House of Representatives, acting on one leg of that plan last week, voted to reauthorize and expand SCHIP. The measure would add 4 million children to the federal-state program over the next four and a half years. The Senate Finance committee approved a similar measure, which heads to the full Senate. Other health reform measures Obama has proposed are aimed at reducing wasteful spending and improving health-care quality. Some of these are tucked into the $825 billion economy stimulus package unveiled by House Democrats earlier this month. The measure sets aside $20 billion to help the nation's doctors and hospitals computerize patient medical records, for example, and $3 billion for preventive care.

Another $87 billion would go to shore up state Medicaid programs that are reeling amid heightened demand for services. "I think that is a hugely positive acknowledgement of reality, and it's a big enough number of dollars that it should ultimately help states and their Medicaid enrollees," Duncan said.

Obama's resolve, along with bipartisan leadership on health reform among key Congressional committees, has fueled hope that the new administration might make headway where previous administrations have failed.

 

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