The Treasury Department and Internal Revenue Service recently released 2009 guidelines for maximum contribution levels for Health Savings Accounts (HSAs) and out-of-pocket spending limits for high deductible health plans (HDHPs) that must be used in conjunction with HSAs. The 2009 IRS requirements are:

Minimum Deductible: $1,150 single plan; $2,300 family plan
Maximum Out-of-Pocket: $5800 single plan; $11,600 family plan
Contribution Maximum: $3,000 single plan; $5950 family plan

New Annual Contribution Levels for HSAs

• The maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000.

• For family coverage, the maximum annual HSA contribution is $5,950.

• Catch-up contribution for individuals who are 55 or older is increased to $1,000 for 2009 and all
years going forward.

• Individuals who are eligible individuals on the first day of the last month of the taxable year (December 1 for most taxpayers) are allowed to make the full annual contribution (plus catch up
contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who do not maintain eligibility for the 13-month
testing period following that date, both the HSA contribution and catch-up contribution should be prorated based on the number of months of the year a taxpayer was an eligible individual. New Amounts for Out-of-Pocket Spending on HSA-Compatible HDHPs

• The maximum annual out-of-pocket amount for HDHP self-coverage increases to $5,800. The maximum annual out-of-pocket amount for HDHP family coverage is twice that at $11,600. Minimum Deductible Amounts for HSA-Compatible HDHPs

• The minimum deductible for HDHPs increases to $1,150 for self-only coverage and $2,300 for family coverage. In addition, a fiscal year plan that satisfies the requirements for an HDHP on the first day of the first month of its fiscal year may apply that deductible for the entire fiscal year.

Tags: health insurance, Health Savings Accounts, hsa, irs, irs insurance

The Assurant Health MaxPlan, CoreMed, and OneDeductible now include TelaDoc, a service that offers physician access—24 hours a day, 7 days a week, and 365 days a year. When members need non-emergency medical care, they can call TelaDoc from anywhere and let the doctor come to
them by phone, and, in most cases, in less than an hour.

Members with the MaxPlax and CoreMed plans designed without an office visit copay will receive 3 free telephone consultations per person each year and additional consultations are only $35 each.

Members with the OneDeductible plan will be charged $35 for each consultation, and are covered, subject to deductible and coinsurance. New members will receive registration information with their new policy welcome packets.

Tags: 24/7 physician access, Assurant, health insurance, phone consultation, phone physician, teladoc

NEW YORK (Reuters) – UnitedHealth Group Inc on Tuesday reported a 72 percent drop in quarterly profit on a big charge from a legal settlement and challenges in its businesses serving seniors and employers, although its results surpassed previously lowered expectations.

The largest U.S. health insurer by market value said second-quarter net earnings fell to $337 million, or 27 cents per share, from $1.23 billion, or 89 cents per share, a year earlier.

Excluding items, UnitedHealth earned 67 cents per share, 2 cents ahead of the analysts’ average forecast, according to Reuters Estimates.

Earlier this month, UnitedHealth estimated earnings for the quarter at 64 cents to 66 cents per share, excluding special items, far below analysts’ forecasts at the time.

Second-quarter revenue rose 6.7 percent to $20.3 billion.

Earnings from operations at its main health-care benefits unit fell 35 percent to $1.14 billion.

Pressure in its commercial business serving employers — where the company has cited tough competition — hurt margins and enrollment. Membership in the company’s plans for which it assumes full insurance risk fell by 95,000 from the first quarter to about 10.5 million members.

Profitability in the company’s Medicare business for seniors also was under pressure, as the company offered overly attractive benefits to those with special-needs plans.

The company’s consolidated medical care ratio, which measures the portion of premiums spent on medical costs, worsened to 83.2 percent from 80.3 percent a year ago.

Overall, the Minneapolis-based company provided medical benefits to 32.68 million members at the end of the quarter.

The company said it still expected full-year adjusted earnings per share of $2.95 to $3.05. UnitedHealth lowered the outlook earlier this month, marking the second such reduction to initial 2008 expectations.

UnitedHealth shares have fallen 59 percent so far this year, worse than the 44 percent drop for the Morgan Stanley Healthcare Payor index , amid setbacks for its commercial business for employers and Medicare plans for seniors.

The company earlier this month agreed to pay more than $900 million to settle lawsuits related to past stock options practices. The legal settlements brought it closer to moving past a scandal over the manipulation of stock option dates that led to the departure of William McGuire as chief executive.

Tags: health insurance, health insurance carriers, insurance companies, insurance settlement, lawsuit, stock market, stocks, United Health, United Healthcare

Medicare is trying to curb an opaque industry practice that inflates what some older and disabled people pay for medicines under the federal insurance program’s prescription-drug plan.

Medicare Part D, introduced in 2006 to extend drug coverage to beneficiaries, is provided through private health-insurance companies. Many insurers in turn contract with so-called pharmacy-benefit managers to administer their plans. Among other functions, these PBMs negotiate lower drug prices with pharmacies. But some companies, under a practice allowed by Medicare, then charge a higher price to health insurers and, ultimately, the government.

This approach is called “lock-in pricing” because the insurers pay the PBMs a set amount for the drugs, even if that differs from what the drugs really cost at the pharmacy. Lock-in-pricing can boost costs for Medicare beneficiaries because they pay a percentage of their drug costs. Also, the practice can more quickly drive consumers into the notorious gap in coverage known as the doughnut hole, where they generally must begin paying the full cost of their medicines. The doughnut hole kicks in when total drug expenditures by the beneficiary and the plan reach $2,510. Medicare drug plans start paying again once total expenditures reach $5,726.

Lock-in pricing “has a detrimental effect on the beneficiary because it pushes him into the coverage gap faster,” says Abby Block, director of the arm of the government’s Centers for Medicare and Medicaid Services (CMS) that runs the drug benefit. Under a current Medicare proposal, PBMs would be allowed to continue claiming the higher prices for reimbursement. But beneficiaries’ own drug costs would be calculated without the extra amounts included.

Pharmacy-benefit managers — including Express Scripts Inc., Medco Health Solutions Inc., and units of CVS Caremark Corp. and UnitedHealth Group Inc. — carry out their functions behind the scenes, including developing lists of covered drugs, maintaining networks of participating pharmacies and paying the pharmacies when beneficiaries buy drugs.

CMS figures that 19% of the hundreds of Medicare drug plans are using lock-in pricing this year, affecting 14% of the 25.8 million enrollees in the Medicare drug program. Other plans use what is known as pass-through pricing, in which PBMs charge insurers the same prices they pay the pharmacies.
CUTTING COSTS

Ways to control costs in a Medicare drug plan:
• Compare drug costs in different plans using the Prescription Drug Plan Finder at medicare.gov/mpdpf.
• Track your drug expenses and progress toward the ‘doughnut hole’ using your explanation of benefits.
• When possible, use generics, which tend to cost less than branded medicines.

Patients who take lots of drugs are most affected by lock-in pricing. For example, one female patient who last year regularly took six generics and two branded drugs had average monthly costs of about $256, according to the patient’s explanation of benefits. At that rate, the patient was on track to reach the doughnut hole in October. But without the PBM’s higher charge based on lock-in pricing, the patient would have paid $215 a month on average for the same drugs — and she wouldn’t have hit the doughnut hole until December, according to an analysis of data provided by the patient’s pharmacist.

The price spreads tend to be much greater for generics than for branded drugs. That’s because generics are much cheaper for pharmacies to acquire, making it easier for PBMs to negotiate down the prices they pay and less noticeable to patients and insurers when the extra costs are included.

PBMs that administer lock-in pricing plans argue that the method is common in the private insurance market and should be available for Medicare as well. Some PBMs say the extra money they make under the pricing method provides funds to encourage more consumers to use lower-cost generic drugs. Express Scripts, for instance, says it analyzes beneficiaries’ drug-purchasing habits and sends patients letters to explain how changes in their purchasing habits could lower their costs. And some companies, including UnitedHealth and CVS Caremark, which operate both as PBMs and insurers, have warned that if those extra amounts aren’t included in drugs’ costs, insurance plans that would be affected by any change may have to increase premiums, the monthly price that seniors pay for the plans.

To be sure, a large majority of older people are satisfied with their Medicare drug-benefit plan and say they are paying less for drugs than they were before the benefit existed, when seniors relied on a hodgepodge of private and public drug benefits, or made do without coverage. In a Wall Street Journal Online/Harris Interactive survey over the Internet of 571 U.S. adults age 65 or older, published in December, some 75% of respondents said their plan had saved them money and 83% said their plan was easy to use. Some 12% said they had to pay the full price for medicines because they had hit the doughnut hole.

The Kaiser Family Foundation projected this spring that the average premium for most Medicare Part D plans would rise nearly 17% to $31.99 a month in 2008 from $27.39 a month last year. That follows an average premium increase of 5.6% in 2007 from a year earlier.

The difference between what PBMs pay pharmacies and what they are reimbursed by insurers under lock-in pricing is generally a secret. Medicare itself doesn’t have this information and therefore doesn’t estimate the total cost of the practice.

For consumers it may be possible to determine the size of the price differences under lock-in pricing by looking at the full cost of your drug listed on your explanation of benefits, and asking your pharmacy how much it was paid. But many pharmacists are prohibited from disclosing pricing information under terms of their contracts with PBMs.

“It is absolutely unacceptable for any government benefit program to be based on questionable [numbers] or numbers that aren’t transparent or easily understood by a beneficiary,” says Michael Burgess, director of the New York State Office for the Aging, who says he was unaware of the issue until recently.

An analysis of explanation-of-benefits documents from consumers and payment data from pharmacies shows that the size of the price differences varies widely from as low as just a few dollars to well over $100. In one case, a patient filled a prescription for a 90-day supply, or 270 pills, of the generic antinausea medication prochlorperazine. The difference between what the PBM, Express Scripts, paid the pharmacy and the price that showed up on the patient’s explanation of benefits was $146.53.

Express Scripts spokesman Steve Littlejohn said it is “extremely rare” for price differences to get above $100, and it occurred in this case because the patient purchased the drug at a quantity greater than is typically prescribed. Broadly, Mr. Littlejohn said that PBM pricing on generics “is very competitive, and is generally far better than [uninsured] cash-paying customers obtain on their own.” He added that the differences on costs of branded drugs are much slimmer and that overall the company’s per-prescription profit margin is a “single digit” percentage.

Medicare has been battling lock-in pricing almost since the inception of the drug-benefit program. But efforts to curtail or stop the practice have faced numerous delays, amid intense lobbying on the subject.

“We thought we had a clear policy” barring lock-in pricing when the drug benefit was created, says Ms. Block of CMS. “We learned that there were different ways of interpreting a policy statement,” she adds.

Under Medicare’s current proposal, PBMs wouldn’t be able to hide the extra costs of drugs. Instead, they would have to declare the extra amounts as “administrative” costs that an insurance plan pays the PBM. Patients’ own drug costs would be calculated without the extra amount included, thereby easing the burden on consumers.

Although the proposal wouldn’t prohibit lock-in pricing, health-cost experts say the transparency and accounting that would be needed to include the extra costs as a separate “administrative” item could effectively curb the practice. CMS hopes to finalize its proposed regulation late this summer to go into effect in 2010.

The PBM trade group, the Pharmaceutical Care Management Association, opposes the CMS proposal because it says insurers should be able to choose what type of pricing they want. The drug benefit “program is working,” says Mark Merritt, the group’s chief executive. “Unless it can be decisively shown that one model offers more end savings for consumers or is decisively able to manage drug [costs] better for the program, we think there ought to be flexibility and choices.”

A spokeswoman for CVS Caremark, which administers Medicare drug plans as a PBM and also sponsors plans through its SilverScript Insurance Co. subsidiary, says lock-in pricing is used in its SilverScript plans and is also common in other Medicare plans for which CVS Caremark serves as the PBM. UnitedHealth says it uses lock-in pricing on United Rx Basic and United Rx Value Medicare plans.

Not all major PBMs use lock-in pricing in Medicare, including Medco Health and Humana Inc., an insurer that acts as its own PBM for its Medicare plans. Humana spokesman Tom Noland says pass-through pricing, the alternative to lock-in pricing, gives patients “the full benefit of our negotiated discounted rates with network pharmacies and also promotes transparency of pricing.”

In the meantime, Medicare drug-benefit participants buying drugs should consider checking low-price sellers of generic medications, such as Costco Wholesale Corp. and Wal-Mart Stores Inc., to see if their retail prices are lower than those in the insurance plan.

That is what Len Steinberg of Scottsdale, Ariz., did, and he found that Costco’s retail price for his generic nasal spray was about half of the drug’s total cost under his plan.

Mr. Steinberg, a 73-year-old retired employee-benefits consultant, says he now pays cash for certain cheap generics at Sam’s Club and Costco, rather than using his drug coverage. That allows him to avoid the doughnut hole and continue receiving coverage for his more expensive branded medications, he says.

Tags: Congress, healthcare, Medicare, Medicare Bill, Medicare Part D, PBM, pharmacies, prescription, prescription drugs, Rx, seniors

North suburban hospital operator Evanston Northwestern Healthcare said it will acquire Rush North Shore Medical Center in Skokie, committing more than $160 million to the deal, according to a definitive agreement finalized today.

As part of the deal, which still needs approval of regulators including the Federal Trade Commission, Evanston Northwestern will retire Rush North Shore’s $54 million in debt and contribute $10 million to a community foundation. In addition, Evanston Northwestern will commit $100 million in capital over the next several years that includes establishing an electronic medical record system at the Skokie hospital.

“The merger will provide enormous benefits to the patients and families we serve for generations to come,” said James Frankenbach, president of Rush North Shore.

Evanston Northwestern operates hospitals in Evanston, Glenview and Highland Park. Rush North Shore is affiliated with Rush University Medical Center on the West Side and Rush-Copley Medical Center in Aurora through a so-called obligated group, which allows them to cooperate on financing needs. If Rush North Shore issues debt through the group, the other member hospitals would have to sign off on the spending plan.
But the obligated group these days is more focused on funding a huge renovation at Rush University Medical Center on Chicago’s West Side so Evanston Northwestern’s retirement of the Rush North Shore debt will help in the Rush University financing plan.

The Federal Trade Commission, which has taken issue with Evanston Northwestern’s acquisitions in the past, has not asked for additional information from the merging parties in this deal, Rush North Shore executives said.

Evanston Northwestern and Rush North Shore executives said they expect the deal to close by the end of the year.

Earlier this year, the FTC made official an earlier decision ordering Evanston Northwestern and Highland Park Hospital to contract separately with managed-care plans. Although Highland Park is owned by Evanston Northwestern, the FTC said that the two parties must allow health insurance companies to “negotiate separately again for those competing hospitals, thus reinjecting competition between them for the business of [managed-care organizations].”

Last year, the FTC affirmed a 2005 ruling by an administrative law judge that found Evanston Northwestern’s 2000 acquisition of Highland Park to be anti-competitive and in violation of federal law. The FTC did not order a divestiture of Highland Park but the agency and Evanston Northwestern came to an agreement .

The FTC alleged prices at Highland Park rose 50 percent or more in certain instances after the merger, compared with price increases of 4 percent to 6 percent in the several years preceding the combination.

Evanston Northwestern argued that its rate increases were catching up with poor managed-care contract negotiations in the past and that it invested more than $150 million in the facility.

Tags: Evanston hospital, merger, Northwestern Hospital, Rush Hospital, Rush North Shore Hospital

Effective July 13, 2008, Blue Cross Blue Shield of Illinois will no longer print and mail Explanation of Benefits (EOBs) that relate to all patient share zero liability claims. Zero liability claims are those claims that are covered and paid for by Blue Cross and Blue Shield of Illinois and do not require any additional payment by members. Zero liability claims can still be viewed and downloaded online through Blue Access® for Members at www.bcbsil.com/members.

In mid-December, 2008, Blue Cross Blue Shield of Illinois will begin to bundle all EOBs into one envelope on a weekly basis. However, any EOB accompanied by a check will be excluded from the bundling process and instead will be immediately mailed.

Tags: Blue Cross Blue Shield, EOB, green, health care, illinois insurance, insurance

(BestWire Services Via Acquire Media NewsEdge)
An increasing number of employers are participating in employee health and wellness programs in a bid to reduce health care costs due to chronic illnesses, officials from Blue Cross Blue Shield companies and the National Business Group on Health announced. The Blue Cross Blue Shield Association of America also released a new report finding that workplace education efforts can increase worker participation in wellness programs by 21% or more.

Joined by participating companies, the insurers were in the nation’s capital to lobby Congress on the benefits of wellness programs.

With chronic conditions such as heart disease, diabetes, obesity and smoking accounting for approximately 75% of health care costs, employers have a strong incentive to utilize workplace wellness programs, panelists said at the National Press Club. Blues’ representatives did not provide national statistics on how many companies and employees have joined such plans.

Dr. Douglas Woll, senior vice president and chief medical officer for the Blue Cross Network of Michigan, said the nonprofit insurer gave participating member companies an up-front 10% discount on health insurance premiums in exchange for enacting health and wellness programs. In less than two years, 575 employers with 75,000 employees have signed up, a figure that is growing by about 1,000 employees monthly.

Insurers began offering wellness, disease management programs and pharmacy benefit management services over the past decade because they learned that employers were willing to pay for them, according to Edward Kaplan, national health practice leader with the Segal Co., a New York-based employee benefits consulting firm. These programs also are helping insurers boost revenue in an environment where they?re struggling to grow membership, he said (BestWire, June 16, 2008).

While anecdotal and qualitative findings show increased participation by employers and employees, Blue Cross and Blue Shield of North Carolina Vice President and Chief Medical Officer Don Bradley said insurers have to show hard numbers verifying cost savings from wellness programs.

Otherwise, he said, “I’ll be polishing up my resume.”

Tags: Blue Cross Blue Shield, health insurance, wellness

By Monique Garcia | Chicago Tribune reporter

When Brianna Dicianni was diagnosed with autism two years ago, doctors said the girl would never learn to speak.

Undeterred, her family sought therapy, only to run into another roadblock: Because their insurance company didn’t cover treatment for autism, they would have to pay for the costly sessions out of pocket.

Brianna’s parents borrowed against their home, dipped into college savings for their three children and—$80,000 later—Brianna, now 5, can talk.

On Sunday, Gov. Rod Blagojevich moved to help families like the Diciannis, using his amendatory veto power to alter legislation so insurance companies would be required to cover diagnosis and various therapies for autistic children.

“The billion-dollar profits of insurance companies are being put before our children, and it’s wrong, it’s criminal,” said Brianna’s father, Peter Dicianni.

The legislation would force insurance companies to cover up to $36,000 a year in occupational, physical, speech and behavioral therapies in addition to psychiatric and psychological services. Children would be covered until they turned 21.

Proponents of the legislation said early treatment is vital to the development of children with autism. By undergoing therapy early in life, they are more likely to gain the communication and social skills needed to live independent lives.

“This is literally about whether a child can grow up and live a good and happy life, or whether a child will grow up and be in his own isolated world, unable to communicate,” Blagojevich said at a news conference announcing the legislation.

For Peter Dicianni, the governor’s action comes after more than a year of lobbying lawmakers and insurance companies to cover autism treatments. But hurdles still remain. Lawmakers in both chambers must approve the governor’s changes.

Tags: autism, blagojevich, healthcare, illinois insurance, Illinois Senate

WASHINGTON (CNN) — Congress voted to halt planned cuts in Medicare payments to doctors Tuesday, overriding President Bush’s veto in a battle that pitted health insurers against physicians.
President Bush says he objects to the bill because it takes choices “away from seniors to pay physicians.”

President Bush says he objects to the bill because it takes choices “away from seniors to pay physicians.”

The new law stops a 10.6 percent cut in Medicare payments to doctors, part of a scheduled cost-saving formula that went into effect July 1.

The money for the doctors will be taken from the government-subsidized Medicare Advantage program, which the Bush administration strongly supports.

Bush spiked the bill Tuesday, telling lawmakers they would be “taking choices away from seniors to pay physicians.”

“I urge the Congress to send me a bill that reduces the growth in Medicare spending, increases competition and efficiency, implements principles of value-driven health care and appropriately offsets increases in physician spending,” he said in his veto message.

The Senate voted 70-26 to enact the law over Bush’s objections, the third time in his presidency that Congress has overridden his veto. The margin in the House of Representatives was a lopsided 383-41, well beyond the two-thirds majority needed.

The American Medical Association lobbied heavily for the bill, warning that its members could be forced to curtail seeing Medicare patients if the cuts went into effect. But insurers, which receive government subsidies to offer Medicare Advantage plans, warned that 2 million seniors could lose health benefits if it passed.
Don’t Miss

* Kennedy helps break Republican filibuster
* Senate GOP pressured to stop Medicare ‘meltdown’

A total of 21 Senate Republicans joined 47 Democrats and two independents in the override vote.

Supporters broke a GOP-led filibuster of the bill last week, aided by the dramatic return of Sen. Edward Kennedy of Massachusetts. Kennedy’s vote came in his first appearance on the Senate floor since surgery to remove a brain tumor in early June.

Though he did not vote Tuesday, Kennedy praised his colleagues for overriding the “misguided” veto.

“It’s a great vote, and a great day for America’s seniors,” he said in a written statement.

Those Republicans who opposed the bill argued that it would roll back many of the changes made to Medicare in 2003, when Congress created privately run, government-subsidized prescription drug coverage and expanded the role of private insurers in other coverage.

“These are not pro-patient policies,” said Sen. Jon Kyl, R-Arizona. “Rather, the bill reduces access, benefits and choices for Medicare beneficiaries.”

But critics of the 2003 reforms say Medicare Advantage subsidies end up costing more than the government would pay to cover the same people through regular Medicare, the federal health insurance program for seniors. The Congressional Budget Office estimates that the bill will reduce federal spending by $12.5 billion by 2013, largely by reducing Medicare Advantage enrollment.

Sen. Patty Murray, D-Washington, said the bill also made “vital improvements” by supporting rural health care and lowering fees for mental health care.

“Today, we can stand up for Medicare,” she said. “We did it last week, when we came together and voted for this measure by a veto-proof margin, and I believe we can do it today by overriding that veto.”

Congress had passed only two bills over Bush’s objections: a $23 billion water-project legislation that the president vetoed in 2007 and a $300 billion farm bill he spiked in May.

The Medicare system pays for the health care of roughly 40 million elderly Americans. Rising health care costs have made Medicare a growing part of the federal budget, and the stress on the system is increasing as more baby boomers reach retirement age.

While the debate was raging over the bill, the AMA said the cuts could lead to a “meltdown” of the government’s health care system for the elderly.

A recent survey by the group found that 60 percent of physicians will be forced to limit the number of new Medicare patients they can take on if the cuts go into effect.

“We stand at the brink of a Medicare meltdown. … For doctors, this is not a partisan issue; it’s a patient access issue,” AMA President Nancy Nielsen said in a statement after last week’s Senate vote.

The AMA ran radio and TV ads over the July Fourth congressional recess targeting 10 Republican senators, seven of whom are up for re-election.

The AARP, the nation’s largest organization of retired people, and other groups also are weighing in against the cuts.
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Gerald Harmon, a family physician who practices in Pawleys Island, South Carolina, said the cuts could lead to doctors taking fewer Medicare patients, making it difficult for the program’s elderly patients to get the care they need.

“This Medicare access problem is a real issue, not just a political football,” said Harmon, who said 35 percent of his patients were eligible for Medicare. “It affects your dad when he’s sick. It affects my patients in my practice. This has to be addressed.”

Tags: Congress, health insurance, healthcare, Medicare, President Bush, veto

A coalition of liberal groups that includes major labor unions such as the Service Employees International Union and the activist group MoveOn.org announced today it will spend $40 million to make health insurance a major issue in the campaign, with Elizabeth Edwards, the wife of former Democratic presidential candidate John Edwards, as the one of the group’s main spokespersons. The group, which has dubbed itself “Health Care for America Now!” plans to spend its money running ads in battleground states, canvassing 45 states to get people to sign petitions supporting the initiative and trying to get every member of Congress to sign a pledge to expand health insurance to all Americans.

Meanwhile, on Capitol Hill, Democratic staffers are trying to set up a structure for getting a bill through Congress next year.

The staffs of Sen. Max Baucus (D-Mont.), the chairman of the Senate Finance Committee and Sen. Ted Kennedy (D-Mass.), who heads the Senate’s Health, Education Pensions and Labor Committee, are already meeting with key health care experts, including some from Massachusetts, which passed a landmark health care law two years ago.

In a series of meetings over the next month, Senate aides plan to meet with doctors’ groups, insurance companies, business associations and other key players in reforming health care. Their goal is to have the outlines of a health care proposal by the end of this year that can be introduced in the opening days of the next president’s administration.

“We want to create a mandate,” said Richard Kirsch, one of the leaders of the health care organization of the liberal groups, many of whom worked together to oppose President Bush’s 2005 Social Security plan.

Barack Obama has already pledged to make passing health care reform a centerpiece of his first term, and his campaign has recently added a group of advisers who specialize in the subject, including Elizabeth Edwards, Sarah Bianchi, a former Clinton White House aide and Neera Tanden, Hillary Clinton’s policy director during the primaries. Tanden is working as a domestic policy adviser, while Bianchi and Edwards are participating in campaign conference calls on health care with other experts.

“It’s important for this to be one of the first things that’s considered,” Edwards said in an interview, referring to the priorities of a new administration. “I’d like to see it on the agenda in 2009.”

The coalition of liberal groups is hoping to make sure health care is a priority even if John McCain is elected and to make sure the majority of Congress backs the goal as well.

McCain has also said he would make health care a major issue if he wins the presidency, but Democrats and labor groups oppose many of his proposals, as the Arizona senator is trying to transform the health care system into one in which individuals buy their own health care in a less-regulated market, which means they could have lower costs but also would assume more risk.

The new coalition, while not outlining a specific health care plan, has goals that resembled what Obama and the Democratic candidates proposed in the primaries, offering subsidies to people so health insurance is affordable to the 47 million Americans who currently don’t have it, creating new regulations that would prevent insurance companies from charging high prices or not offering insurance to people who already have chronic illnesses and allowing people to either buy insurance from a private company like Kaiser or enroll in a government-managed health care plan that would be run like but separate from Medicare.

But, even if Obama were elected, there’s no broad agreement on exactly how a universal health care bill would work, which is the problem Democrats faced in 1993 when the Clintons pushed the issue. Insurance companies, who drove much of the opposition in 1993, have signaled they would not support an approach like Obama’s, which add regulations for them but does not require all people to purchase health insurance. Democratic Senate aides are pointing to the legislation passed in Massachusetts in 2006 as a model. That legislation included increased subsidies for low-income people but also a mandate that all people in the state purchase insurance, something Obama has railed against on the campaign trail.

A bipartisan coalition that now includes more than a dozen senators is pushing a more radical health care reform in which people would buy coverage directly from insurance companies instead of getting it through their employers, with people getting tax credits to buy insurance in a more-tightly regulated system. Obama advisers had earlier largely ruled out that idea as too much of a drastic change for the vast majority of Americans who currently get their insurance through their employer.

While Obama has suggested ending tax cuts for people who make more than $250,000 a year to fund the health care subsidies, few Republicans will back what is effectively a tax increase, and some members of the GOP would likely need to support an agreement so it could pass in the Senate.

“It’s much easier to oppose something than get something passed,” Kirsch admitted.

By Perry Bacon Jr. of The Washington Post

Tags: democrats, insurance, Obama healthcare, politics