Incremental approach eyed on insurance

Mcclatchy newspapers

WASHINGTON — With a virtual civil war raging over parts of President Barack Obama’s health-care agenda, the smoke of battle has obscured a surprising fact: Democrats and Republicans actually agree on a bundle of proposals that could make medical insurance better for millions of Americans.

And with the loss of Sen. Edward M. Kennedy, D-Mass., and his storied ability to eke out bipartisan compromises, lawmakers are eyeing those consensus proposals — including a ban on lifetime benefit caps and barring denial of coverage because of pre-existing conditions — as a possible fall-back if Obama’s more ambitious approach collapses.

In fact, though Kennedy devoted much of his career to seeking a comprehensive overhaul of health care, he also showed how much could be accomplished by passing incremental changes when grand plans failed.

He long ago concluded that his dream of a “single payer” government insurance system was a nonstarter politically, so he found piecemeal ways to expand medical coverage for children, workers who changed jobs and others.

In the current political climate, there are steep new obstacles to that kind of strategic retreat.

Insurance companies are poised to fight even harder against new policy mandates if they are not part of a broader overhaul of the payment system.

And the mistrust between Republicans and Democrats makes it harder to find productive common ground, especially in the absence of a legislative craftsman such as Kennedy.

“Kennedy was exceptionally gifted at focusing on what was essential and could be built upon later as a way of compromise,” said John Rother, legislative director of AARP, the senior citizens’ lobby.

Nonetheless, in light of huge new budget-deficit projections and growing criticism of Obama’s approach, some lawmakers have warmed to the idea of scaling back their aspirations.

A key question for lawmakers when they return from their August recess dominated by criticism of Obama’s plan is whether to shift their focus from massive overhaul to incremental changes.

“There is no reason we have to do it all now, but we do have to get it started,” Sen. Joseph Lieberman of Connecticut, an independent who is generally supportive of Obama, said in a recent television interview. “I’m afraid we’ve got to think about putting a lot of that off until the economy’s out of recession.”

Sen. Charles Grassley, R-Iowa, one of the few influential Republicans who have been open to compromise, said this past week that he was less optimistic now after meeting his constituents this month.

Drew Altman, president of the Henry J. Kaiser Family Foundation, a nonpartisan research group, cites a range of proposals that enjoy bipartisan support, including barring insurance companies from denying coverage to people with “pre-existing injuries and illnesses,” from cutting off insurance coverage when a policyholder gets sick, or from imposing a lifetime cap on benefits.