With the imminent change in presidential administration, there will be multiple (and perhaps conflicting) legislative proposals for major reforms in how health care is provided and financed. Stakeholder debate on all facets of any proposal is expected to be both wide-ranging and deep, and will overlap with other issues facing the Obama administration such as economic recovery. A key congressional research arm, the Congressional Budget Office (CBO), is already doing its homework and preparing for a robust debate by issuing two background reports designed to provide members of Congress with tools to analyze the forthcoming proposals. These timely reports, issued on December 18, 2008, provide background context for the specific proposals that will likely be forthcoming. The reports, or at least their introductory summary chapters, are recommended reading for all who need a better understanding of the complexities of health care reform.
The reports, entitled Key Issues in Analyzing Major Health Insurance Proposals and Budget Options, Volume I: Health Care, provide a comprehensive overview of the numerous policy challenges and tradeoffs that Congress and the Obama team will need to tackle when crafting viable legislative proposals. According to CBO, the reports are “intended to assist the Congress as it contemplates possible changes — both large and small — to federal health programs and the nation’s health insurance and health care systems.” CBO is a well-respected impartial voice on Capitol Hill, and its findings are routinely cited by members of both parties during policy discussions. While neither report makes recommendations as to which options Congress should consider or enact, CBO does draw conclusions regarding the current state of the health care system and the impact of the various options considered.
The first report, Key Issues in Analyzing Major Health Insurance Proposals (Key Issues), provides extensive background information regarding the current state of the health care system, broadly describes the numerous issues that could arise should Congress seek to enact major changes in that system, and explains how CBO would analyze those issues. The report does not analyze specific proposals; rather, it provides an overview of CBO’s approach to major questions and issues that would likely arise in the context of health care reform legislation.
Key Issues frames the major issues in the upcoming health care debate by drawing the following “main conclusions”:
The second report, Budget Options, Volume I: Health Care (Budget Options), is much more specific and focuses on discrete potential changes in health care policy. Budget Options presents 115 specific options, addressing a broad array of issues related to the financing and delivery of health care. The report includes some options that would reduce spending and others that would increase it as well as changes that would reduce or raise revenues.
CBO organizes the 115 options in the report by thematic chapters as follows:
Budget Options presents CBO’s estimates of year-by-year costs or savings for five years as well as a 10-year total for the various options. It notes, however, that the options are “not additive” and that “a package of multiple options would, in many cases, have a budgetary effect that differs from the sum of the individual effects because of interactions among them.” Moreover, the report warns that subsequent cost estimates by CBO or revenue estimates by the Joint Committee on Taxation may differ from these option estimates, “either because the policy proposal differs from the option as described, or because of additional data and analysis.”
The two reports collectively provide a compendium of the major problems with the current health care system facing Congress, the solutions Congress will likely consider, and how CBO, as a key congressional advisor, will analyze those solutions. The reports, or at least their introductory summary chapters, are important reading for anyone who wants a crash course in the complexity of these issues, or who plans to participate in the upcoming discussions. Stakeholders should begin now to anticipate which provisions may be proposed for discussion and the impact those proposals will have on their future operations.
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Robert C. Geist, Jr.
Philip G. Kiko
San Diego/Del Mar, California
Lawrence W. Vernaglia
Judith A. Waltz
San Francisco, California