HealthDay News -- President-elect Barack Obama is likely to begin taking steps to improve access to health care when he takes office in 2009. But federal budget constraints are likely to rein in the administration's efforts.
"There's not a lot of money in Washington, D.C. to do an ambitious government-financed health reform, but that doesn't mean that an ambitious health reform won't happen," said Joel White, executive director of the Coalition for Affordable Health Coverage.
One way Obama could advance his agenda without incurring significant federal costs is by mandating that every child have health insurance coverage, White said. The 44th president could also establish an insurance exchange, or "connector," as the state of Massachusetts has done, to help people find health insurance coverage.
Even the centerpiece of Obama's health reform plan -- a "pay-or-play" employer mandate - could be achieved without adding to the nation's economic troubles, he added.
"You could make all of that budget neutral by making the payroll tax great enough to cover the subsidies for the workers who don't get their insurance through an employer," he reasoned.
Still, achieving long-term health system reform means some upfront federal investment in things like health information technology "will need to be on the table," noted Karen Davenport, director of health policy for the Center for American Progress Action Fund.
Obama's approach to health reform builds on existing public and private coverage by encouraging employers to continue providing health insurance and expanding eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP).
SCHIP comes up for reauthorization in March 2009, making it a potential vehicle for expanding coverage to children and some Medicaid-eligible adults, White said.
In addition, Obama's plan largely replaces the individual market for health insurance by creating a National Health Insurance Exchange. People who lack private coverage or don't qualify for other public programs would receive federal subsidies to buy coverage similar to plans available through the Federal Employee Health Benefits Program.
In an analysis of the presidential candidates' health reform plans published last month, The Commonwealth Fund concluded that Obama's plan has greater potential to move the health care system towards "high performance" than Sen. John McCain's. While falling short of the goal of universal coverage, Obama's plan is likely to "provide more people with affordable health insurance that covers essential services," it said.
The new President and Congress will also need to address the Medicare physician payment system.
"Physician payment reform will no doubt be an issue in 2009, but a permanent fix could be a challenge because of the costs involved," said Tricia Neuman, a vice president and director of the Medicare Policy Project at the Henry J. Kaiser Family Foundation.
At issue is the "sustainable growth rate" (SGR) factor, which stands to clip physician reimbursement by 21 percent in 2010. Eliminating the SGR entirely would cost nearly $300 billion over 10 years, according to the Congressional Budget Office.
The question is whether the administration commits to putting those dollars on the table or does it "keep kicking the can down the road?" White said. "That decision, I don't think, is made yet."