Feb. 16 2010 07:08 PM

Congress member from San Diego County proves Republicans do have ideas for healthcare reform


U.S. Rep Darrell Issa sees a way to fulfill President Obama's health-insurance promises. Photo courtesy: Darrell Issa.

Not too long ago, Congressmember Darrell Issa ran into Sen. John McCain at the White House. The two Republicans got on the subject of healthcare reform and Issa, from San Diego County, argued that businesses that don't provide health insurance to their employees simply are shifting the burden to taxpayers. After all, those employees will turn up in state-supported emergency rooms when they eventually fall ill.

“I thought he was going to come over the table and punch me,” Issa tells CityBeat.

The anecdote isn't so much a testament to the Arizona senator's infamous temper as it is a refutation of the public perception of congressional Republicans. They aren't a unified “Party of No,” and not all the elements of the Democratic healthcare-reform bills are antithetical to conservative principles.

“Republicans have vilified these bills because saying there's one good thing in it or three good things in it or five good things in it wasn't particularly doable when we were locked out of the process,” Issa says. “So, the first thing we have to do is we have to start saying there are some things in here we agree on, should agree on or could agree on.”

Voting along party lines, the House passed a 1,990-page bill in November that included a government-run health-insurance option, though many now consider the bill as good as dead. Meanwhile, Senate Democrats are unable to secure the 60 votes needed to defeat a filibuster for its 2,074-page package, which does not offer the so-called public option. Congress could use cross-chamber negotiation to pass reform—or they could scale back the bill to attract a few Republicans.

“You have to look at healthcare reform two ways: What can you do to get people healthcare, and can it survive politically without putting the people who passed it out of power,” healthcare consultant Richard Eskow says. As a fellow with Campaign for America's Future, a progressive political organization, Eskow supported a public option but now considers the passage of any kind of healthcare legislation this year “a toss up.”

President Barack Obama has invited Republican leaders for a summit on Feb. 25  in an effort to engage Republicans. Issa wasn't included in the invitation, but he wants the administration and congressional leadership to consider a few of his ideas.

To fix the problem he discussed with McCain, Issa proposes a two-tiered federal minimum wage, which would require employers who don't provide health insurance to pay a higher “living wage.” He's looking for a Democratic co-sponsor for a bill that he says would pressure states to include health-insurance coverage in unemployment benefits. Neither idea is especially partisan, but his main bill, HR 3438, actually sets out to fulfill a Democratic campaign promise.

During a debate in the run-up to the 2008 election, Obama said, “If you don't have health insurance, then what we're going to do is to provide you the option of buying into the same kind of federal pool that both Sen. McCain and I enjoy as federal employees.” In a Jan. 12 letter to the House Democratic leadership, Issa says his bill does exactly that and cites a 6-month-old Rasmussen poll showing 78 percent of Americans like the idea.

Currently, the U.S. Office of Personnel Management negotiates health-insurance pools for more than 8 million current and former federal employees, including members of Congress and their families. Approximately 350 plans compete for coverage, which employees can compare side-by-side through the OPM's website.

Issa's bill—he calls it a “free-enterprise public option”—would require the OPM to use the same structural format to negotiate new pools open to all Americans.

“It's intended to be executable,” Issa says. “You really could have the same healthcare that I have at a substantially lower price than many people pay, with the same things I get: portability, no pre-existing-condition problems, no age discrimination, an annual ability to move from program to program.”

The bill, only seven pages long, doesn't exactly give Americans the same plans as members of Congress; it requires federal employees and the public to be in separate pools. However, OPM would have the authority to tell insurance companies they can't bid for federal employees unless they also offer insurance through this new exchange.

“It looks more like a gimmick than anything else, a political ‘gotcha' move,” Eskow says. “He took some Democratic rhetoric about reform that I never liked very much… and said, ‘Let's introduce a bill that says every American buy into the federal-employee system.' That's a good chess move, but the way he structured it, I don't think it's good policy.”

Eskow and other progressive analysts say their chief concern is that Issa's bill doesn't help lower-income families afford health insurance and it doesn't bring down the cost of healthcare. Plus, these pools could become even more unaffordable if the only people who join are the already-sick who can't find insurance elsewhere.

“This is a great bill for people earning $100,000 or $200,000 per year who are not insured, but if you're earning $20,000 or $30,000 or $50,000 a year, this does absolutely nothing,” says Timothy Jost, a law professor specializing healthcare reform at Washington and Lee University.  

But, combined with Issa's living-wage idea, Eskow concedes that Issa's approach is “intriguing” and “innovative.”

Jon Walker, a healthcare blogger for the progressive website FireDogLake.com, described his first impression of the bill to CityBeat as “about the most reasonable Republican healthcare bill I have yet seen.”

On further analysis, Walker added: “It's not really a healthcare reform bill, but a help-some-people bill. You know, maybe a million people would be able to afford it and find it helpful, maybe 2 million, but it's not really addressing the issue.”

Issa agrees to an extent; the bill is just one thing that needs to be done.

Issa says Congress could enhance his bill by approving subsidies for families. Furthermore, he says the bill leaves room for a public option if it doesn't accomplish his goals.

Jost says Issa's proposal is redundant; the Senate bill already includes insurance exchanges managed by OPM. The major difference is that Issa's bill allows for insurance to be sold across state lines, while the Senate requires state-based exchanges.

“If you go through the whole [Senate] bill, a lot of the provisions are clearly provisions Republicans have been asking for for years,” Jost says. “For them now to say, ‘Why are you not being bipartisan?' is a joke, and the media falls for it.”

Yet, Democrats share most of the blame, Walker says.

“The Democrats have messed us up pretty badly, and I don't see how they're going to get it passed,” he says. “The Republicans know that having the Democrats appear like they can't govern is doing them wonders in the midterms, so I don't think Republicans will support anything that will make Democrats look like they scored a major victory.”

In contrast, Issa says Republicans may get on board if the bill includes tort reform, amending law to reduce the cost of malpractice insurance and the tendency for doctors to order expensive and often unnecessary procedure in order to preempt lawsuits. That said, he doesn't suggest Congress start over from scratch, though they should start conceptually with a blank slate and add in existing Democratic proposals.

“I think there's a lot they could put back in, a great deal,” Issa says. “I don't think we have to back through the committee process to reinvent ideas.”   

Write to davem@sdcitybeat.com and editor@sdcitybeat.com.


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