Baucus bill to take spotlight as health-care debate resumes in Congress

Dr. Thomas Eppes Jr. sees the debate over health-care reform moving where it belongs -- into the political center of public opinion after a summer of boisterous battles on the left and right.

Eppes has concerns, both as a family practitioner in Bedford County and as president of the Medical Society of Virginia. But he is eager to see Congress follow the lead of President Barack Obama in reaching compromise on an issue that matters intensely to all Americans.

"This is probably one of the greatest opportunities we will ever have to change things in ways that will help everybody," he said Friday. "The public is really energized."

The health-care debate is scheduled to begin again tomorrow in the Senate Finance Committee in Washington, where a new proposal for health-care reform has emerged that has satisfied some political concerns while raising others.

Sen. Max Baucus, D-Mont., the committee's chairman, has taken the spotlight away from proposals that emerged this summer from committees in the House of Representatives, where work also is expected to resume on more than 100 proposed amendments that were not acted upon before Congress recessed.

"With the emergence of the Baucus bill, we are making clear progress," Rep. Rick Boucher, D-9th, who voted against the incomplete reform bill adopted by the Energy and Commerce Committee at the end of July.

Obama also appears to have moved the debate forward with a nationally televised speech Sept. 9 to a joint session of Congress. He outlined his priorities for health-care legislation and opened the door for compromise on contentious issues, such as a proposed government-run option for insurance to compete with private plans on an open exchange.

"The president's speech begins to move a little more to the center," Eppes said. "The question is whether the leadership of the House and Senate is going to agree with him."

The outlook appears less positive to U.S. Rep. J. Randy Forbes, R-4th, who said last week that hospitals, nursing homes, doctors, and business leaders in his district are worried that proposed reforms will push them toward financial ruin.

"Overwhelmingly, they are adamantly against the proposals that are coming down from the House," Forbes said. "I don't see a big difference with the one in the Senate."

Others see a major shift, especially with Baucus' decision to exclude a public option insurance plan and substitute a subsidized system of insurance cooperatives.

"It's taking out the federal option, and that is something we just couldn't live with," said Dr. Sheldon M. Retchin, CEO of the Virginia Commonwealth University Health System, which cares for more uninsured people than any hospital in the state.

Not everyone likes the retreat on the public option. "I'm worried that's coming off the table," said Jason Guard, a board member for the Virginia Organizing Project. "We're talking about a Band-Aid that isn't going to stop the bleeding."

Retchin said he can support the proposals for expanding insurance coverage under the Baucus bill -- projected to reduce the number of uninsured by 29 million people -- because it would gradually reduce federal subsidies for hospitals that care for people without insurance. He worries about the cost, estimated at $774 billion over 10 years that would be more than offset by projected revenues and savings. The Congressional Budget Office pegs the net cost at $500 billion.

"I can't believe it," he said. "I think it's going to cost more."

On the other hand, advocates worry that the Baucus proposal doesn't provide sufficient subsidies for low and middle-income Americans to afford insurance. They also voice concern about a proposal to require businesses that don't insure employees to pick up the cost of subsidies for those who qualify. "The provision could make it harder for low-income Americans with subsidies to find jobs," said Michael Cassidy, executive director of The Commonwealth Institute, an advocacy group in Richmond.

Some of the biggest concerns revolve around reimbursements to doctors, hospitals and other providers through the federal Medicare program for the elderly. The Baucus proposal is counting on substantial savings from Medicare, but doctors say they're already been shortchanged by a reimbursement formula that doesn't keep pace with their costs. The House proposal fixed the formula, but the Senate bill puts the issue back in play.

That concerns Eppes, who fears that many doctors simply could stop seeing Medicare patients or close their practices. "You can't get into a situation where you are continuing to lose money," he said.

On the other hand, he has high hopes for improving the system with legislation that has bipartisan support.

"There is probably no physician in the country who doesn't think that health care needs to be reformed," Eppes said.

Contact Michael Martz at (804) 649-6964 or .