City Bar Issues Statement of Principles for Bipartisan Deliberation on Health Care Reform Legislation

The New York City Bar Association has issued a statement of principles to help shape the terms and tenor of deliberation on health care reform legislation going forward, and to measure the likely success of any proposed legislation.

Issued by the City Bar’s Health Law Committee – comprised of a broad spectrum of lawyers working in health care – these principles seek to accomplish two key objectives: “1) the public will actually understand and have the opportunity to provide input on any proposed health care reform legislation; and 2) any legislation enacted by Congress will achieve both bipartisan support and the presumed shared goal of greater access to health care and broader coverage among Americans.”

Noting that “[W]hatever the infirmities or shortcomings that beset the current state of health care law, any reform legislation should not undermine the gains already achieved, under the Affordable Care Act (“ACA”) or otherwise, in patients’ access to health care and health insurance coverage, and the means to finance needed care and coverage, while continuing to pursue innovative ways to contain costs and improve care outcomes going forward.”

With these objectives in mind, the Health Law Committee issued the following set of principles:

  1. Ensuring the Integrity of the Legislative Process

“[A]ny legislation impacting Americans’ health insurance coverage or access to care, through Medicaid or the public exchanges, should not be decided in summary fashion or behind closed doors, under the guise of ‘reconciliation’ or otherwise.” There should be adequate time and deliberation, with time for the Congressional Budget Office (CBO) to score its impact on health coverage and the federal budget; hearings and floor debate, with invitations to the key stakeholders to share their concerns and views; and evidence-based proposals, with Congress soliciting and reviewing actual data and analyses.

  1. Avoiding Deleterious Impact on Health Care Access and Delivery Systems

Legislators should consider some guiding principles to ensure the health care delivery system is stable, is not disrupted, and is available to those who seek care, including the following: ensure continued or enhanced access to health care to individuals and their families; offer insurance plan options to health care consumers that are both comprehensive in scope and comprehensible to consumers; and establish actuarially sound mechanisms for financing health care and insurance coverage, to ensure that (i) the uninsured population does not increase and (ii) hospitals do not become the “insurer of last resort” bearing additional risk and greater losses for bad debt and charity care without any commensurate increased reimbursement or other compensation.

  1. Avoiding Deleterious Impact on State and Local Governments

“States and municipalities not only administer and share the cost of the Medicaid program.  They are also on the front lines of the delivery of health care and, in many cases, serve as the ‘provider of last resort’ for Americans struggling financially, and striving to stay healthy and receive needed medical care.” Further, “Congress should approach any health care reform judiciously, and seek to avoid imposing any untoward consequences on State and local governments along with their budgets and programs.” 

  1. Avoiding or Preventing Uncertainty in the Rules and Requirements for Health Benefits and Coverage, for Insurers and Individuals Alike

“At the outset,” the statement notes, “[i]ndustry and businesses as well as individuals expect, and need, to understand that current statutes and promulgated regulations governing health care and health insurance will be faithfully implemented and enforced, and government programmatic commitments fully funded….Any action to amend existing health insurance or health care laws and regulations should similarly seek to avoid or prevent uncertainty about what the rules and requirements might be going forward, for both insurers and individuals.”

  1. Avoiding Loss or Erosion of Health Insurance Coverage

“The lack of health care insurance presents a profound threat to the health and well-being of the uninsured and their families.” The uninsured often do not obtain needed medical care due to its prohibitive cost and they are more likely to defer routine and preventive care for their health problems or chronic conditions. When they do seek care and are forced to pay, the resulting medical debt for many can trigger financial setbacks, including a loss of credit, foreclosure, and personal bankruptcy. Any reform of health care insurance should “strive to make health care coverage readily accessible, comprehensive in scope, and comprehensible to individual consumers, both when they are seeking to purchase insurance on the exchange and availing themselves of the plan’s coverage.”

Maintaining or improving the extent of health insurance coverage is a critical component to any health care reform legislation. Moreover, “[i]t is insufficient to offer plans that do not insure against the unexpected illness or medical need – the very purpose of insurance — or whose terms of coverage cannot be understood by Americans at the critical moment when the need for coverage arises.”

The full statement of principles can be read here:

About the Association
The New York City Bar Association, since its founding in 1870, has been dedicated to maintaining the high ethical standards of the legal profession, promoting reform of the law and access to justice, and providing service to the profession and the public. The Association, through its 24,000 members, continues to work for political, legal and social reform, while implementing innovative means to help the disadvantaged. Protecting the public’s welfare remains one of the Association’s highest priorities.