03-17-2001

CONGRESS: An Idea Incubator Turns Up the Heat

Despite this year's crowded health care agenda, members of Congress are
promising to address the issue of the uninsured, and that has prompted a
key outside policy group to scramble to recruit lawmakers to help it
influence the legislative outcome.


For the past two years, a group of health care policy experts, business
representatives, and congressional aides has been quietly rendezvousing
about once a month at Maryland's secluded Wye River Plantation to debate
major health care reform concepts. Now the group is hoping to raise its
profile and hone its focus by enlisting the participation of influential
lawmakers, including a number of committee chairmen, as well as Bush
Administration officials.


"There are a lot of people in the group, and on the periphery, who
are interested in raising the group to a new level," one participant
said. "The idea is to give the group focus, so the ideas have a
chance of being implemented. This will provide a place to discuss
proposals with people from the industry, the Hill, and the
Administration."


Participants hope to fashion the so-called Wye Group to serve the same
purpose that the Jackson Hole Group did during the 1993-94 health care
debate. That earlier group of policy experts, industry officials, and
informal Hill representatives met in Jackson Hole, Wyo., to examine
various congressional proposals before rallying around the managed
competition approach that became the starting point for then-President
Clinton's health care legislation.


More than 42 million Americans are uninsured, and that number will
probably rise if the economy worsens and health care costs continue to
increase. Although Medicare reform and prescription drug benefits for
seniors are Congress's first order of business on health care, Republican
and Democratic lawmakers see an opening to help the uninsured as part of
the major tax-cut legislation now moving through both chambers.


Members of both parties agree that refundable tax credits should be used
to help the uninsured buy health care coverage on their own. During the
2000 presidential campaign, George W. Bush and Al Gore advocated such tax
credits. Also last year, House Majority Leader Dick Armey, R-Texas, a
staunch conservative, and liberal Rep. Fortney H. "Pete" Stark,
D-Calif., collaborated on a proposal providing tax credits to the
uninsured. But that legislative odd couple never was able to agree on the
bill's details.


In fact, the details are what the Wye Group hopes to provide assistance
with. Since its creation, the "thinking group" has taken a
low-key, low-publicity approach so that its approximately 60 members would
be able to talk openly about new ideas and to work through potential
partisan problems.


"The idea now would be to sort out different proposals, and determine
what's the most and least do-able" to help the uninsured, said a
participant, who added that the Wye Group could serve as a "steering
committee on proposals."


The group has already explored several health care reform ideas, including
tax credits and the creation of "health marts" that would allow
small businesses to jointly purchase health insurance for their employees
at a lower price than they could get on their own. Its participants have
also mulled over proposals for "defined contributions," whereby
an employer would give an employee a specified amount of money to buy
insurance, thereby limiting the employer's liability.


The group meets at the Aspen Institute's Aspen Wye River Conference Center
on Maryland's Eastern Shore. (In 1998, King Hussein of Jordan journeyed to
this same site from his deathbed to jump-start Middle East peace
talks.)


Blue Cross and Blue Shield of Texas first organized the meetings, but the
Wye Group now operates independently of the insurer. The group is
bipartisan, although its members are generally centrists or to the right
of center. The foundation for the U.S. Chamber of Commerce is providing
financial assistance, and corporate members-representing employers,
hospitals, pharmaceutical companies, and insurers-are encouraged to pay
annual dues of at least $25,000 to cover administrative costs.


Well-known health care policy analysts such as John Goodman, president of
the conservative National Center for Policy Analysis in Dallas, and Regina
Herzlinger, an economics professor at the Harvard Business School, have
participated in the group. (Both advised Bush during his campaign.) The
two principal think tanks that have been involved are the National Center
for Policy Analysis and the Progressive Policy Institute, an arm of the
centrist Democratic Leadership Council.


Health care aides to influential Republican and Democratic members of
Congress, such as Armey, have attended the Wye Group's meetings.
Responding to the group's recent drive for new members, Sen. Bill Frist,
R-Tenn., has agreed to participate. A member of the Senate Health,
Education, Labor and Pensions Committee and a heart transplant surgeon,
Frist works well with both parties, and he is considered an informal
liaison between Bush and the Senate.


In addition, John McManus, staff director of the House Ways and Means
Health Subcommittee, will participate on behalf of committee Chairman Bill
Thomas, R-Calif., and Health Subcommittee Chairwoman Nancy L. Johnson,
R-Conn. Thomas and Johnson are expected to show up occasionally for
meetings. Monica Tencate, health policy adviser for the Senate Finance
Committee, will also participate.


Marilyn Werber Serafini

National Journal