HealthDay News -- With Democratic majorities in the U.S. House and Senate and key health committee leaders poised to take action, the climate for health reform in 2009 -- by many accounts -- is favorable. But given the nation's economic challenges, how it plays out is anybody's guess.
President-elect Barack Obama's transition team must decide what to focus on initially, said Fred Hannett, a consultant specializing in federal health markets with The Capital Alliance in Washington D.C., a company that helps in developing strategic planning. "Are they going to do healthcare reform writ large right out of the box?" he reflected. "Or are they going to include pieces of healthcare reform (in other bills)?"
One possible vehicle is the State Children's Health Insurance Program (SCHIP), which comes up for reauthorization in March. Obama has pledged to expand SCHIP, but even that scenario raises tactical questions.
"Do you want to rack up an early win on a subject that's pretty popular?" asked Ed Howard, executive vice president of the Alliance for Health Reform in Washington, D.C. "Or do you want to use that as an attractive ornament on a much broader bill that might bring along a few people who wouldn't otherwise vote for it?"
Policy experts agree that whatever choices the administration makes will be impacted by the nation's economic decline. When Obama takes office in January, he'll inherit a federal budget deficit projected to reach $1 trillion in the current fiscal year, which began Oct. 1, 2008.
A new analysis by PricewaterhouseCoopers' Health Research Institute concludes that Obama's health reform plan would cost about $75 billion in 2009 and more than $1 trillion over 10 years. Those figures assume full implementation in 2009 and are based on the premise that Obama's plan would operate in a similar fashion as Massachusetts' health reform initiative.
Amid it all, Congressional health leaders are jockeying for a piece of the health reform action. In the Senate, Finance Committee Chairman Max Baucus (D-Mont.) unveiled his own blueprint for health reform on Nov. 13 (see related story). Sen. Edward M. Kennedy's (D-Mass.) staff has reportedly held meetings with health stakeholders for months to seize the opportunity to lead health reform once the new administration takes office.
In the House, Rep. John D. Dingell (D-MI), Chairman of the Energy and Commerce Committee, wrote a letter to Obama outlining key principles for health reform and expressing his desire to work with the president and his administration on moving legislation forward. He and Rep. Henry Waxman (D-Calif.), a longtime health reform advocate, are engaged in battle for committee control, splintering the party along ideological lines.
And therein lies the challenge for the House Speaker Rep. Nancy Pelosi (D- Calif.) who presides over a party with many factions, from the fiscally conservative Blue Dogs, the moderate New Democratic Coalition and Congressional Black Caucus, to the liberal-leaning Progressive Caucus.
"She's had to walk that minefield and constantly reach out and negotiate with each one of those groups for virtually every major piece of legislation, and healthcare reform is going to be no different," The Capital Alliance's Hannett said.
Obama is reportedly considering former South Dakota Senator Tom Daschle as his Secretary of Health and Human Services to help steer the process. The President-elect also brings a seasoned team with him who knows how things get done on the Hill and in the White House, which bodes well for avoiding the Clinton-era gaffs that doomed health reform in the 1990s.
"A lot of them have been through the wars and have the scars to prove it," Howard said, "and I'm sure they're make mistakes, but they won't likely make the same ones."