The New Health Dialogue

Support for health reform is breaking even this month, according to the latest Kaiser Health Tracking Poll -- 43 percent oppose reform and 43 percent support it. Party affiliation is a good predictor of whether you want health reform to go through: 70 percent of Democrats and 39 percent of independents say they support reform, compared to only 14 percent of Republicans.

We should note -- the poll was conducted before President Obama released the details of his plan for reform but after the president announced the bipartisan summit on health care reform. Obama’s bill is based primarily on the Senate’s health care reform bill, but does reflect the policy negotiations between House and Senate leaders last month as they worked to resolve the differences between their two bills.

A majority of Americans are frustrated (53 percent) or disappointed (54 percent) that current health reform legislation has stalled. 59 percent think that the delays in passing health reform aren’t about policy disagreements so much as they are about both sides ‘playing politics’ with health care. In fact, 58 percent of Americans would feel disappointed or angry if Congress decided to stop work on health reform, and didn’t come out with a law this year. The reform fight has been pretty ugly at times, and the president stated he would like to see a more transparent process as we move forward with health reform. (The upcoming bipartisan health reform summit is intended to help accomplish that goal.)

When we talk about health reform, we shouldn’t be talking only about the political process (we won’t rehash what we’ve said before about making laws and making sausages). We should talk about what is really in health care reform legislation, and what health reform will accomplish when enacted. The Kaiser poll shows, as we've seen before, that when you ask about specific policies -- including the policies that are in the bill -- most Americans are supportive.

More than 70 percent of Americans agree that it is “very” or “extremely important” that the following elements of reform are passed into law: insurance reform, tax credits for small businesses, establishing health insurance exchanges, helping to close the Medicare Part D prescription drug doughnut hole, and expanding high risk insurance pools. 68 percent believe it’s important to provide financial help to low and middle income Americans to purchase insurance.  

These top health reform policies that Americans want to see passed are all in Obama’s version of health reform:

End insurance company abuses. No one can be denied insurance because of a pre-existing condition and there will be no lifetime caps on benefits. This was the most popular aspect of health reform -- 76 percent of Americans believe it is important.

Help for small businesses. The president’s proposal provides $40 billion in tax credits to small businesses at the beginning of this year. These tax credits will help small firms support coverage for their workers.

Risk pools and insurance exchanges. Like the Senate bill, the president’s plan calls for the creation of state-based insurance exchanges that can be run either by a government agency or a not-for-profit. While the exchanges are starting up and phasing in individuals, small businesses and then eventually large businesses, the government will immediately create a national high risk pool to cover those with pre-existing conditions.

Close the doughnut hole. The president’s plan will start to close the doughnut hole this year by giving Medicare Part D beneficiaries caught in the coverage gap $250 rebates. The plan will eliminate the doughnut hole completely by 2020.

Provide financial help to low/middle income Americans. The president’s plan provides more generous subsidies that the Senate bill to help low and middle income Americans purchase insurance. This reflects the concerns House members had over affordability.

Democrats are cautiously optimistic about Obama’s plan. Speaker Pelosi said she looked forward to reviewing the bill with her caucus. Senate Majority Leader Reid said Obama’s bill “brings together the best of the Senate bill and the best of the House bill in a fiscally responsible way.” Meanwhile, Republican leaders continued to lambast the Democrats’ health care ideas and call for the president to scrap everything and start over on health reform. The president has made it pretty clear he's not starting over -- but says he is interested in what the Republicans have to say. The bipartisan summit is an opportunity for everyone to get their ideas out in the open, and have a serious conversation about what works, what doesn't work, and the possibility for compromise and collaboration that could make the bill even better. A truly bipartisan bill would incorparate the best ideas from both sides of the political aisle -- not just Democratic ideas. And not just Republican ideas either.