Senate Dems eyeing earlier enactment for healthcare reform

Senate Democrats have begun preliminary discussions on how to speed up implementation dates for healthcare reform, even as leaders are still struggling to reach the necessary votes for the legislation.

From leaders to senior members to rank-and-file lawmakers, Democrats acknowledged unease that major pieces of the program would not launch until at least 2013. While members said no specific amendments to speed up enactment are being considered yet, talks are ongoing to put some minor provisions into effect immediately and start studying ways to speed up enactment of other, more major sections.

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“I don’t see why 2014 has to be — that’s a long time,” said Health, Education, Labor and Pensions (HELP) Committee Chairman Tom Harkin (Iowa). “It probably should be done by 2012. We might push for [earlier implementation] in conference. The sooner the better.”

But paying for earlier implementation would be extremely difficult because the bulk of the costs from the healthcare reform bills occur in the latter half of the 10-year scoring window. Moving up the date for targeted universal healthcare would significantly increase the bill’s price tag, and Democratic lawmakers are already struggling with ensuring that the legislation does not add to the federal deficit.

The Senate’s two healthcare bills seek to launch different provisions at different times. The HELP Committee version would authorize tax credits for small businesses that offer health insurance to their employees as early as 2010, for example, with penalties for non-compliance beginning in 2013. The Finance Committee bill, meanwhile, seeks healthcare tax credits for middle- and lower-income Americans starting in 2013.

Both bills leave the heavier lifting for later years. A transparency and accountability crackdown on insurance companies wouldn’t start until 2014, for example, while marquee pieces of the program such as an “opt-out” public-option plan likewise wouldn’t be in effect until that year.

Politically, such a prolonged beginning poses the problem of forcing Democratic incumbents to go through the 2010 and 2012 election cycles with few tangible benefits to show voters. Conversely, however, the party could also escape voters’ wrath if the reforms suffer a sluggish or troublesome start.

Republicans have accused Democrats of playing politics with the implementation date, noting that most of the coverage benefits wouldn’t go into effect until after the next presidential election year. Some Democrats have also privately raised concerns about the timing of when the bulk of the benefits would kick in.

“Is it a problem? Yes, it’s a problem,” said Sen. Dianne Feinstein (D-Calif.). “People expect something will happen, and then nothing happens. We’re going to look at that.”

“I do think that 2013, 2014 does seem a long ways away,” said Sen. Kay Hagan (D-N.C.), who was elected last year, adding, “We have to look at what we can do on a piecemeal basis. Things like getting more physicians, nurse practitioners and medical technicians in the pipeline need to begin immediately.”

Majority Whip Dick Durbin (D-Ill.) said he is also unaware of any specific amendments to speed up enactment, but that members are openly considering how to jumpstart the legislation’s start dates.

“The question is whether it’s practical to do it,” Durbin said. “The things that have to change are big changes, and we don’t want to do it so quickly. Four years does seem like a lot, but I will tell you that some of the most routine bills take months and even years to write regulations and implement them.”

One idea under consideration, members say, is to leave big-ticket items such as establishing a public-option system until the outlying years, and in the meantime launch other reforms that the party can point to immediately.

Sen. Ron Wyden (D-Ore.) said he plans to propose provisions to trigger marketplace reforms that can keep healthcare premiums from increasing as soon as a bill is signed.

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“We’ve had a series of conversations in the caucus about how you show the American people some immediate successes and results,” said Sen. Mark Udall (D-Colo.). “In some cases you want to do that quickly, and in other cases you want to have a longer time frame so you do it right. Those conversations will continue.”

Sen. Chris Dodd (D-Conn.), who played a major role during the HELP Committee’s healthcare deliberations this summer, pointed out that many provisions will go into effect within the next couple of years.

“Some of the screenings, the tests, the physicals, the doughnut-hole issue — there are a lot of things that would happen very quickly,” Dodd said. “There are other things that would take time. Establishing the requirements for people being part of the program — those things would take awhile, because you’re talking about a lot of people.”

A few Democrats, such as Finance Committee member Jay Rockefeller (W.Va.), say they understand the political frustration over the lengthy implementation, but that they doubt much can be done.

“Substantively, maybe it will take that long to get some of those arrangements worked out,” Rockefeller said. “I mean, right now there are no state exchanges.

There is no public option at this point. So you have a lot of things to get going. We’ll just have to do some explaining.”

Likewise, some key Democrats are wary of launching the effort prematurely and suffering at the polls for problems that result from too little preparation.

“You have to understand that these things never run as smoothly as you’d like them to,” said Dodd. “So you’d like to prepare for the bumps in the road but not end up in a situation where just because you’ve agreed to an abbreviated timeline you’re causing people more problems than would otherwise be the case. It really is a trade-off between having this work smoothly and getting it running as fast as you can.”

In 2003, Sen. Frank Lautenberg (D-N.J.) offered an amendment on the floor to speed up the implementation of the Medicare prescription drug benefit, which took two years to set up. The amendment failed.