Speaking Wednesday, March 11, in Washington before the annual meeting of the National Business Group on Health, Sen. Max Baucus, D-Montana, said he rejects a single-payer system and instead wants to build on the current employment-based system.
“My vision for reform is one of shared responsibility,” Baucus said, noting that in an earlier position paper he endorsed requiring employers to either provide coverage or pay into a pool to provide health insurance premium subsidies for the uninsured, an approach Massachusetts took nearly three years ago that moved the state to near-universal coverage.
Baucus acknowledged there are many details yet to be resolved in structuring a play-or-pay system. One key concern, he said, is the minimum level of benefits employers would be required to offer to avoid paying into a pool.
“How would that standard relate to what employers already are providing?” he asked.
But the Finance Committee chairman already has come to other conclusions about an employer mandate. The smallest firms, he said, should be exempt, while federal tax credits should be available to other small companies that provide coverage to partially offset premium costs.
Baucus asked the business community, which in the past has largely opposed an employer mandate, to keep an open mind until the legislation he is putting together is complete.
“I urge all of us here to suspend judgment until you can see the whole picture. Wait until we can see all parts of the puzzle,” he said.
And he appealed for employer input. “Help us to develop a play-or-pay structure that works,” he said.
Baucus said he wants his committee to start considering and voting on a reform package in June, with a bill sent to President Barack Obama before the end of the year.
That fast-track schedule is deliberate, he said, noting that history has shown that the greatest chance of passing significant legislation is during the first year of a new presidential administration.
To further delay, he said, could result in disastrous consequences with costs continuing to escalate, resulting in, among other things, employers having less money to grow their businesses and more companies dropping coverage.
Drafting and passing comprehensive health care reform is a huge challenge, Baucus said. The last attempt—in 1993—resulted in the Clinton administration's biggest domestic failure.
But that risk must be taken. If reform legislation is enacted and is successful in expanding coverage, improving quality and controlling costs, “It may turn out to be one of the most important things that we ever do,” he said.