From the August 2009 issue of Ceridian Connection.

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The broad consensus for President Obama's initiative to reform America's healthcare system has eroded recently as Congressional committees drill down into specifics and unearth not only new complexities but sharp controversies.

The adage that "the devil is in the details" couldn't be truer than in the president's ambitious effort to control soaring costs and extend coverage to 47 million uninsured.

On March 5, at a special White House forum on healthcare reform, President Obama summed up the consensus objective of healthcare reform as to lower costs for everyone, improve quality for everyone, and expand coverage to all Americans. Between March 5 and August 1, however, no less than five Congressional committees undertook the Herculean task of drafting detailed provisions, over 1,000 pages in all, to translate that goal into legislation that would merit not only the votes of the House and Senate, but the support of the American people.

Notwithstanding the urging of President Obama and countless hours of debate by senators and representatives, Congress embarked on its August recess period without completing work on healthcare reform legislation -- indeed, with neither the House of Representatives nor the Senate taking a single floor vote on the legislation. Lawmakers are beginning to realize why presidents from Harry Truman in the early 1950s to Bill Clinton in the early 1990s, spanning over a half-century to the present, have been unable to resolve the core issues that surface in trying to change a system that now represents over 15 percent of our economy.

Ceridian's Jim O'Connell provides a description of the key issues that continue to bedevil the White House and Congress as they try to restructure the health care system and achieve their shared goal of access to affordable coverage for all Americans.

Four consensus issues
Let's start with four "easy" issues -- on which there is general agreement and that could be enacted into law quickly:

1. Insurance market reform


2. Creation of a health insurance exchange


3. Subsidies for lower income households


4. Support for wellness and prevention

The challenge, however, is that as Congress makes progress in addressing each of the areas of general agreement, new issues arise that prove far more contentious. So far, these issues have become huge obstacles to reaching final agreement.

Four roadblocks to reform
On healthcare reform, the devil is truly in the details of four areas of major disagreement:

1. Financing healthcare reform


2. Saving for out-of-pocket health costs: FSAs in the spotlight


3. Public plan option in the health insurance exchange


4. Employer mandate

Outlook
It's now almost 100 years since President Theodore Roosevelt first talked about a national system of health insurance. Public support remains strong for the broad goal of "affordable health coverage for all Americans."

The U.S. Congress, however, has now moved from generalizing about broad healthcare reform principles to grappling with difficult legislative complexities -- and controversies. No one can predict whether President Obama and members of the Senate and House of Representatives will be able to resolve all of those controversies. And no one can predict exactly what compromises lawmakers will strike on the most contentious issues.

But given the powerful constituency that exists today to slow the growth of health costs and expand health coverage, it is possible to predict that President Obama will sign some form of healthcare reform legislation into law by Thanksgiving 2009 -- and at least begin the process of extending affordable health coverage to all Americans.

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With more than 30 years of experience in federal legislative and regulatory affairs, Jim O'Connell focuses on HR and payroll policy issues, keeping customers informed about fast-changing and complex compliance regulations and workforce trends. O'Connell is a frequent participant in national and chapter HR and payroll industry meetings. He is an adjunct professor at Georgetown University in Washington, D.C., and specializes in international business-government relations. O'Connell has been with Ceridian since 1982. Before joining Ceridian, he served in the U.S. Senate as chief legislative assistant to New York Senator Jacob K. Javits and later with Connecticut Senator Lowell P. Weicker. O'Connell holds a Ph.D. in economics from New York's Fordham University.