White House Expects Health Reform in 2009

'Health Czar' Nancy-Ann DeParle Is Optimistic Legislation Will Pass This Year

By Todd Zwillich
WebMD Health News

Reviewed By Louise Chang, MD

April 15, 2009 -- President Barack Obama's top advisor on health reform says she expects Congress to pass national health care legislation by the end of the summer, despite significant political obstacles.

"No one wants the status quo," Nancy-Ann DeParle, head of the White House Office of Health Reform, told reporters at a briefing in Washington.

DeParle is in charge of negotiating for the White House as Congress attempts to overhaul the nation's health care system. Lawmakers are working on legislation that will try to control health care costs, insurance premiums, and spending, while spreading access to coverage for many of the nearly 50 million Americans who do not have it now.

DeParle expressed confidence that Congress would produce a bill that the president could sign this year, even though reform plans in the past fell flat, with disastrous political consequences.

"We're in a very different place" than in 1993, DeParle says, when employers, insurers, and others rebelled against reform plans pushed by President Bill Clinton and first lady Hillary Clinton, now the secretary of state.

DeParle expects the Senate to act first. "I think they expect to be on the floor with bills by the summer," she says. In the House, "I expect that to be around the August recess."

Difficult Policy Issues

Despite optimism at the White House, significant issues are still standing in the way of enacting reform to the $2.2 trillion health care sector this year.

The White House says it wants to form a new federally sponsored "public plan" to spread access to the uninsured.

Supporters say the plan would help provide insurance to people who now can't afford private insurance. Opponents worry that such a plan could become a large government bureaucracy that dictates prices for drugs and health services, potentially undercutting the private insurance system.

"I'm actually very hopeful we'll be able to reach an agreement on this," DeParle says. But she also cautions: "If it's a philosophical debate, then that's another thing and people may not be able to agree."

Ron Pollack, who heads the left-leaning health group Families USA, says Congress is likely to back the idea of national or regional insurance "connectors" in which insurance risk is spread widely as a way to cut costs and private plans offer insurance under the direction of the government.

"The issue is, will there be a public program that goes along side that" that competes with private insurance companies, Pollack says. "That's what this controversy is all about."

"How you get there and what you mean by a 'public plan' is still very much up in the air," says Dan Danner, president and CEO of the National Federation of Independent Business, the largest lobbying group for small employers.

Health Care and Taxes

Factions could also divide around a proposal to force employers to offer insurance to their employees, or if they don't, pay a fee into an insurance fund.

"We are against the employer mandate," Danner says. "To mandate what [employers] can't afford is guaranteed to create job loss."

Supporters of an employer mandate, mainly Democrats, point out that the government would offer subsidies or tax breaks to employers to help pay the costs of insurance.

Meanwhile, some lawmakers -- including powerful members of the president's party -- are backing the idea of changing tax exemptions that currently give workers an incentive to carry more expensive health plans.

DeParle emphasizes that Obama opposes using the tax code to alter the way employers cover health care for workers.

"He's very skeptical of those plans and he's been clear about that," she says.

The Senate Finance Committee has scheduled a series of discussions on health care over the next month to air out policy differences. Meanwhile, aides and lawmakers are meeting regularly on Capitol Hill, readying legislation for this summer.

"Clearly the farther you drive toward specifics, not everyone is going to agree, and that's inevitable," Danner says. 

SOURCES: Nancy-Ann DeParle, director, White House Office of Health Reform. Ron Pollack, president, Families USA. Dan Danner, president and CEO, National Federation of Independent Business.

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