As one of the House’s chief deputy whips and vice chairwoman of the Energy and Commerce Committee, Rep. Diana DeGette of Colorado is helping map her party's strategy on health care legislation. Earlier this year, she pressed for an expansion of the Children’s Health Insurance Program. She talked with Kaiser Health News Senior Correspondent Mary Agnes Carey.
Q: What do you think will be the major differences between the House and Senate bills to overhaul health care legislation?
A: The major concern we have in the House is to pull all the committees of reference together to make sure we come out with a unified plan in the House. That’s what we’re focused on. We learned a long time ago that we should just do our work in the House and whatever the Senate does we will try to pull those bills together.
Q: Do you think it’s critical to have a public insurance plan in the House bill? Do you need to have an employer mandate? An individual mandate?
A: I think it’s important to have a public plan because if you don’t I think it will be difficult to get cost containment. That’s been the experience in Massachusetts where they didn’t have a public plan. The good news is they enrolled just about everybody but the bad news is that health care costs continued to climb in Massachusetts.
Having said that, I think that the public plan will have to be subject to the same kinds of requirements that we’re going to make private plans abide by. So, in other words, if you’re requiring certain (benefits) you’re going to have to make the public plan comply as well. And I think that should give insurance companies a bigger comfort level than they’ve had.
The concept of a public plan is a very broad concept. It can have many different meanings to many people. That will be part of our challenge, is how do we craft a public plan to compete with these plans that gives us a fair playing field.
Q: Do you think that individuals should be required to purchase coverage and that employers should be required to provide health insurance to their employees?
A: I think that you have to have universal coverage for employees. If you don’t make everybody be a part of the system then you can’t really address some of the fundamental problems we’ve had because healthier, younger people will opt out and you won’t get cost savings. You also won’t be able to get the kinds of prevention that you need. I’m kind of agnostic on whether you make employers pay…Even if you don’t require employers to provide health insurance it will still be attractive for employers to offer insurance because it will be a benefit for employees.
Q: How do you finance health care reform?
A: I don’t particularly favor the idea of taxing employer health care benefits because I think that gives employers a disincentive to offer health care. I would have to look at other methods of funding the program. I think we need to take a close, hard look at Medicare Advantage, like we have before, because we are wasting a lot of money in that program. I think we need to look at that as one source of revenue.
The other thing we should really focus on is how we can build quality into the savings and how we can encourage prevention and wellness. That may save some money in the system in the short term which would be very helpful.
Q: Can you get a sweeping, comprehensive bill this year? Will you get half a loaf? What if nothing happens at all?
A: Half a loaf is not an option. We have 47 million Americans without health insurance and millions more who are underinsured, so unless we really address ourselves to the fundamental issues around health care reform half-a-loaf won’t solve the problem. I’ve actually been very impressed with how much consensus we’ve been able to find. We’ve been moving along in a very positive way and I’m impressed actually with how well the development of the plan is going.
Politically, now is the time (to pass health care legislation) but I also think that if we really are going to hope to come out of this recession and retool our economy we are going to have to start addressing health care costs sooner rather than later so there’s a real urgency to the legislation. You could say, ‘Let’s do it in four years’ and it would still be just as hard a job.