The New Health Dialogue

Some Democrats floated a trial balloon of a “skinny” health care reform bill that could cover about 12-15 million of the nation’s 46 million uninsured. The focus would be on children and young adults, small businesses, and possible state-level Medicaid expansion.

The political calculations by Republicans are still being made. Politico's Glenn Thrush quoted  Newt Gingrich as saying Republicans should back a skinny Democratic bill and grab all the credit, and then going on to say that he doubted they would do that. A lot of the early signs are not promising. Republican leaders, as we wrote yesterday, have been disdainful of a Democratic compromise. A batch of conservative commentators have rolled out the usual agenda -- deregulation, consumer-directed health care, and malpractice caps. As Meredith Hughes wrote, GOP House doctors rolled out their reform principles again, but the legislation that they've touted would do little to address the problems that we all recognize.

Here are the possible skinny bill components floated in the NY Times.

• Children through age 18 could not  be denied coverage because  of pre-existing medical conditions.

• Families could keep their children on their policy through age 25 or 26.

• States would get  federal  incentives to expand Medicaid to cover childless adults and parents, but it would not be required.

• States could get federal grants to create regulated insurance exchanges.

• Small business would get tax credits to help pay for worker coverage.

• Policy holders who go outside their plan’s network of doctors and hospitals in an emergency wouldn’t have to pay extra out-of-network fees.

• Possibly a partial fill-in of the Medicare drug “donut hole.”

• Possibly unspecified payment changes in Medicare to reward quality instead of quantity.

The AP's Ricardo Alonso-Zaldivar reports on other ideas being floated by people including Mark McClellan, who ran Medicare and the FDA for President George W. Bush, but who has been moving in more bipartisan policy circles. These ideas include prohibiting insurers from dropping coverage of people once they become sick, eliminating lifetime coverage limits, and requiring insurers to spend a certain percentage on patient care, not on overhead, marketing or profits.