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Judd Gregg Can Help Save Health Reform Because His Ideas Are Already In It

By Igor Volsky  

"Judd Gregg Can Help Save Health Reform Because His Ideas Are Already In It"

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JuddGregg2Politico reports that retiring Sen. Judd Gregg (R-NH) could help the White House “save” the health care bill and broker a deal with Democrats. “It’s clear already that Gregg’s restless energy is drawing him back into the fray, and the New Hampshire conservative brings both a proven ability to swing Republican votes and a background in health care and deficit issues,” the paper writes, noting that Gregg is “promoting his own lower-cost approach focused on preventive care and guaranteed catastrophic coverage for all families.”

But Gregg’s viability as a deal maker has less to do with his energy and more with his health care plan. Despite Gregg’s instance that Democrats need to “reset” health care talks by abandoning “the House or Senate-passed partisan bills,” his health care plan actually resembles core elements of the Senate legislation. No need to add Gregg’s solutions, they’re already in the bill:


Gregg Proposal Senate Bill
Individual Mandate “Requires proof of health insurance for every American over age 18 and requires insurers to offer coverage to all applicants, regardless of health status. The bill has an individual mandate and guarantee issue requirement.
Affordability Credits “The proposal includes direct subsidies for low-income individuals..up to 300% of the Federal Poverty Level (FPL).” The bill includes subsidies up to 400% FPL.
State-based Exchanges “The proposal directs states to create points of entry for low-income families and individuals… Mechanism design and functions of the point of entry (state-based insurance exchange, regulator, etc.) would be left up to the states.” The bill relies on state-based exchanges.
Limiting Tax Exclusion “The proposal limits the extent to which employer-paid health insurance premiums and health spending from FSAs and HSAs are excluded from taxation.” The tax on Cadillac health care plans limits the amount of health care spending excluded from taxation.
First Dollar Coverage For Prevention The proposal provides first dollar coverage for preventive benefits and disease management with nominal co-payments for related office visits. The Senate bill also excludes prevention services from co-payments or high deductibles.
Employee Wellness Program “To provide employers with the opportunity to further develop incentive-based wellness programs, the proposal modifies the Health Insurance Portability and Accessibility Act (HIPPA) to allow rewards for wellness programs to exceed 20 % of the cost of employee-only coverage under a group health plan.” Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs.
Reducing Hospital Readmissions Payment incentives to encourage hospitals to reduce HACs and readmission rates for potentially preventable conditions Adjusts payments for hospitals paid under the inpatient prospective payment system based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions.
Accountable Care Organizations “CMS would develop a voluntary program in which hospitals, multispecialty group practices and large primary care groups would establish organized delivery systems to care for chronically ill patients.” Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid, Rewards Accountable Care Organizations (ACOs) that take responsibility for the costs and quality of care received by their patient panel over time.

To be sure, Gregg’s proposal is significantly smaller than the Senate alternative. He relies on catastrophic coverage, encourages the individual market and certainly doesn’t invest enough in public health or adequately regulate insurers.

But the similarities undermine Gregg’s claim that the Senate bill is a hyper partisan plan and bolster the progressive argument that Democrats have already compromised with Republicans both in person and in substance. Republicans have simply refused to budge — and that’s a point that bears repeating.

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