Obama appeals to Congress for action on healthcare reform proposals

September 10, 2009

After a month of discord over proposed terms for comprehensive healthcare reform, President Barack Obama attempted to get his legislative initiative back on track with promises of wide-ranging insurance reform and expanded access paid for mainly through cost savings from Medicare.

After a month of discord over proposed terms for comprehensive healthcare reform, President Barack Obama attempted to get his legislative initiative back on track with promises of wide-ranging insurance reform and expanded access paid for mainly through cost savings from Medicare.

Obama alternately played the role of historian, educator, disciplinarian, and philosopher while calling for political moderation in an address before a joint session of Congress Wednesday night. He rejected calls from the political left for a single-payer system and advised the Republican right that people who are satisfied with their current health insurance will be able to keep their current plans.

"It makes more sense to build on what works than discard what doesn't," he said.

Overall, the 60-minute speech, which was carried live nationally by most broadcast networks, was long on details describing health insurance reforms and short on specifics covering how the federal government pay for the estimated $900 billion cost of reforms over the next 10 years without adding to the national deficit.

Medical imaging was not addressed specifically but would be directly affected by an offer from the president on malpractice reform, mandated insurance coverage for mammography and colon cancer screening, and Medicare cost-cutting efforts to pay for the plan.

Obama made no mention of expected cost savings from federal incentives for electronic medical records and comparative-effectiveness research on medical applications. The two strategies shared the limelight with the public health insurance option touted by candidate Obama during his 2008 drive for the presidency.

Pending legislation would ban insurers from denying coverage because of preexisting medical conditions. They would no longer have the right to drop coverage when a beneficiary becomes ill or is injured. Arbitrary annual and lifetime caps on coverage would be outlawed and a limit would be placed on beneficiaries' out-of-pocket expenses. And, in a provision with implications for medical imaging, insurers would be required to cover routine wellness and preventive care, including screening mammography and colonoscopy.

Obama couched reforms aimed at extending coverage to more than 40 million uninsured Americans in terms of shared responsibility. All individuals would be required to participate in a healthcare plan, and all businesses would face a mandate to provide their employees with healthcare benefits.

"Companies that refuse to offer their employees a plan would have an unfair advantage over their competition," he said.

Obama said that private insurance would become more affordable when sold through new state-level insurance exchanges. They would be placed under additional pressure to bargain in good faith by competing with a federal healthcare option that Obama promised would ultimately cover less than 5% of the population.

He stressed that a nonprofit public option would return competition to health insurance markets now dominated by a few insurers. He noted that 75% of the market is controlled by five or fewer insurers in 34 states. In Alabama, the market is controlled by a single company, he said.

"I don't want to push insurers out of business. I just want to hold them accountable," Obama said.

The proposed public option would be required to be financially self-sufficient and would provide a "good deal for the insured" by avoiding the high administrative overhead of many private insurers, according to the president. Tax breaks and targeted exemptions would help pay for individual coverage and employer-sponsored plans for startup firms and small companies.

While anticipating strong opposition from Republicans and conservative Blue Dog Democrats, Obama left the door open for modifying the public option possibly through nonprofit insurance cooperatives or regulatory triggers tied to competition that would lead implementation of a public plan.

While admonishing opponents for using scare tactics in an attempt to scuttle the plan, Obama also emphasized what the legislation proposal would not do. He characterized claims that the reform plan would fund bureaucratic death panels for the chronically ill and elderly "as a lie, plain and simple." He stressed that illegal immigrants would be excluded from participation and that federal funds would not subsidize abortion. He promised to "call out" opponents who intentionally misrepresent the plan.

"The time for bickering is over. The time for games has passed. Now is the season for action," Obama said. "Now is when we must bring the best ideas of both parties together and show the American people that we can still do what we were sent here to do."

The president anticipated that most of the $100 billion annual cost of reforms could be covered by eliminating inefficiencies in Medicare. He promised to save hundreds of millions of dollars by eliminating Medicare and Medicaid waste and fraud. Federal subsidies for private insurer participation in Medicare programs would be eliminated and penalties would be exacted from top-of-the-line fee-for-service plans marketed to wealthy Americans.

Citing terms that may not bode well for medical imaging, the president said more Medicare cuts will be made if the reform effort threatens to increase the federal deficit.

In a bipartisan gesture, especially popular with radiologists and other physicians, Obama reversed his longstanding opposition to tort reform. At a minimum, he promised to support a proposal initially backed by former president George W. Bush to sponsor demonstration projects to explore new options for malpractice reform.

To conclude, Obama evoked the memory of the late Sen. Ted Kennedy and his bipartisan efforts with Sen. Orrin Hatch (R-Utah) and Sen. John McCain (R-AZ) to expand healthcare benefits for the physically handicapped and children. For Kennedy, healthcare access was a moral imperative and a measure of the nation's character, Obama said.

Speaking for Congressional Republicans, Dr. Charles Boustany (R-LA) responded with an appeal to "start over" with a new healthcare package. He warned that the Obama program would replace individual healthcare plans with government-run healthcare that will not deliver promised cost-savings. If enacted, the Obama plan would create 54 new bureaucracies and would cut Medicare by $500 million, he said.

As an alternative, Republicans support a targeted approach involving greater healthcare access, restrictions on onerous health insurance practices, and incentives for wellness care. While congratulating the president for changing his position on tort reform, Boustany said more is needed to deter what he characterized as "junk lawsuits."