Sixty years is how long Democrats say they've been pushing for legislation that provides health care access for all Americans. They'll have to wait another three if President Barack Obama gets a bill to sign this year.
Under the Democratic bills, federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start flowing until 2013 – after the next presidential election. But Medicare cuts and a sizable chunk of the tax increases to pay for the overhaul kick in immediately.
The eat-your-vegetables-first approach is causing heartburn for some Democrats. Three years is a long time to wait for dessert, and opponents could capitalize on misgivings about the complex legislation to undo what would be a signature achievement for Obama.
"The real danger is that health reform could be vulnerable to what we see with the stimulus package," said Democratic health policy consultant Peter Harbage, referring to criticism that Obama's $787 billion economic plan hasn't stemmed rising unemployment. "There needs to be more focus on what can you do quickly so that real people will start seeing change sooner, rather than later."
Said Judy Feder, a senior health official in President Bill Clinton's administration: "Just as we are fending off ideological attacks to get the bill passed, we will be fending them off as we implement the law."
Obama administration officials and Democratic lawmakers say the reason for the three-year wait is the time it's going to take to set up insurance marketplaces, write consumer protection rules and reconfigure the bureaucracy to carry out the legislation. It took President George W. Bush's administration two years to phase in the Medicare prescription benefit, a more modest undertaking.
"It's very important to get the execution right," White House budget director Peter Orszag told The Associated Press in a recent interview.
There's another reason, less talked about: to make the costs of the plan seem more manageable under congressional budgeting rules.
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