Former Senate Majority Leader Tom Daschle visited the University of Maryland on April 26 to participate in the Stamp Distinguished Speaker Series. He spoke to students about how the new health care reform law passed earlier this year will affect them. Before his talk, Daschle graciously sat down with Stephen Majors — a graduate student in the School of Public Policy assisting with the “Implementing Health Care Reform” blog — for a “Q and A” on health care reform. Here is Part II of the conversation:
SM: The (insurance) exchanges — a key component to expand coverage to the uninsured — have to be formed by 2014. How are they going to find the balance between the federal government and the states in terms of how they work? Is that something you’ve been advising on?
Sen. Daschle: That’s a very good question. There was a fairly significant debate between advocates for a federal exchange and advocates for state exchanges. The compromise was to allow states the opportunity to do this, but within a federal framework. So you’ve got a federal architecture and state administration. They are going to be incented to do a number of things. They will get $9.80 for every $10 spent on new Medicaid funding. In other words, they are going to get almost all of it paid for by the federal government for the first 10 years, and then it drops down to 10 percent.
They are also going to be in a position to set the criteria for the insurance companies that participate in the exchange, so long as they have at least one silver and one gold plan. The plans are based on their actuarial value, and by actuarial value I mean how much does the plan actually pay? They’re going to start at 60 percent as the floor. That’s the bronze. The silver is 70, the gold is 80 and the platinum is 90. They have to have a minimum of 60 and they have to offer at least one 70 and one 80. So that’s a federal requirement.
SM: There’s been a lot of talk about how this legislation didn’t do all it could or should have in terms of addressing the cost problem. Both politically and policy wise, when do you think is the right time to take that next step?
Sen. Daschle: There’s good and bad news. The bad is that we didn’t go far enough. But I think we went as far as the political landscape would allow. The good news is that we have a number of tools now to begin bending the cost curve. And I think if we use them right and use them effectively over the course of the next 10 years, I believe we can accomplish a great deal with regard to cost containment. CBO has said we could save $141 billion in the first 10 (years) and $1.2 trillion in the second ten (years). And I think we can even do better than that.
SM: What would your former colleague, the late Sen. Ted Kennedy (one of the strongest advocates for health reform), think about this law that just got passed?
Sen. Daschle: Ted Kennedy was an incredible pragmatist. He always knew that you had to settle for what you could get and keep building after that. And that’s exactly what he would look at here. All of his life he either was working to put something new in place or build on something we’ve already done. So he would say, “Let’s keep building.”
SM: There was a whole lot of rhetoric and debate back when Medicare got passed and people thought it was big government coming in to steal the show. Now, you talk about taking away Medicare, and people are up in arms and they’ve come to expect it and depend on it. Do you see folks 30-40 years from now looking back at this, and this becoming the same kind of established piece of the landscape?
Sen. Daschle: I don’t think there’s any question. The same thing happened with Social Security. Alf Landon was the Republican candidate for president in 1936. One of the main planks in his platform was the repeal of Social Security, which had just passed the year before. He lost and you never heard anyone call for repeal again. I think the same thing will happen with health reform. It’s legislation that will be here for a long, long time to come, in large measure because it helps just about every American in ways large and small.
SM: Is there anything about this health care law that would be important to the audience of this blog, that hasn’t gotten covered much in the mainstream media, or anything that we didn’t talk about today that you think is particularly important?
Sen. Daschle: I think that it’s probably going to affect your generation more than just about any other for a lot of reasons. You’re going to be the first generation affected by a lot of the legislation in much more of a meaningful way than I am. You’re going to be required to buy health insurance for the first time; fortunately there are significant subsidies available to those who are going to have trouble financially doing that. But that’s a big issue.
Beyond that, I think you hopefully are going to benefit far more from wellness and prevention than we’ve ever seen before. One of the big problems with your generation and those who are younger is that obesity is becoming a huge problem, almost pandemic levels now. Almost one in three people in your generation are considered obese today. And that’s going to lead to diabetes and a whole range of other chronic illness that we’re going to have to address. This legislation is designed to deal with that. It’s going to be, with the risk pool and the opportunity to participate in these exchanges, really the first opportunity you are going to have, regardless of circumstance, to buy health insurance. We’ve never had that before in our country.
The final thing is there’s really going to be an effort to try to entice people to consider primary care medical school as a profession. We want to see more people go into medical school as primary care doctors and nurses. This bill will incent that.
SM: What is your role in health reform going forward?
Sen. Daschle: I haven’t really decided. One possibility is to work in a semi-official or semi-public way with the White House and Health and Human Services. No decisions have been made in that regard. I’ve been writing a book on health policy that is out in October. I’ll be on a book tour and do public speaking on health.
Background: Sen. Daschle currently works for the global law firm DLA Piper and serves as a Distinguished Fellow at the Center for American Progress. In 2007, Daschle and three other former majority leaders created the Bipartisan Policy Center, an organization that seeks to find workable solutions to the most challenging public policy problems.
NOTE: This is Part II of our interview with Sen. Daschle. Please check out the previous post for Part I of the discussion.