Last week, work on health care reform began in earnest on Capitol Hill. Senators Kennedy and Baucus (the Chairman of the Senate Health Education and Labor Committee and the Chairman of the Senate Finance Committee, respectively) began the week by issuing a joint letter about their intent to move health care reform bills, by the end of the Spring, that are coordinated and closely aligned.  This was followed the next day by the first of three roundtables hosted by the Senate Finance Committee to discuss health care reform.

And finally, just this week, the decision has been made by the Democratic leadership to leave budget reconciliation on the table as an optional vehicle to pass health care reform legislation. An important caveat in this decision is that Congress would only have until October 15 to pass a health care reform legislation before the reconciliation mechanism goes into effect.  If Congress fails to pass health care reform legislation by October 15, the reconciliation process would be triggered; allowing the Senate to pass the legislation with a simple majority of 50 votes–if health care reform is paid for–rather than the 60 votes they would need under the normal legislative process. As Jonathan Cohn of the New Republic pointed out, this is a “real game-changer.”  He cautions that while it improves the chances of health reform being passed, it is still far from inevitable.  However, it certainly puts pressure on Senators to come to the table and work hard to get a bill they like through before allowing a simple majority to pass it’s version of health reform.

The stark contrast between this process and the 1993 health reform efforts is striking, to say the least.  This time around, the conversations and the debate are happening largely in the halls of Congress instead of inside the White House. This seems to be an intentional strategy on the part of the President.  While he and his Administration have set out a vision for what they’d like to see included in health care reform, they are relying on Congress to put meat on the bones and eventually get a bill to his desk.

Trying to tease apart the many complexities that this process will include is a daunting task.  It is even tougher to envision what type of health reform bill might emerge. Just as you might need a program to fully enjoy a sports event, I thought a guide might be of use to those who are following this for America’s children and families.  Here’s what CCF will be looking for…

• What happens to Medicaid and CHIP?  One out of every four children in the United States is covered by Medicaid or CHIP. Moreover, Medicaid provides important protections for children through the Early Periodic Screening and Diagnosis Treatment (EPSDT) program.  Similar to how health care reform offers the opportunity to improve the privately-funded health care system, it also provides an important opportunity to strengthen these important programs.  Furthermore these programs may provide important models as to the type of care that children need.  One question we often hear when talking about these programs, is whether or not children covered by them are able to sufficiently access primary care.  It is important to recognize that while this may be a problem, it is not a problem only evident in Medicaid and CHIP but across the health care system in general and should be an important component of health care reform.

• How are the unique health care needs of children addressed?  As any pediatrician will remind you, children are not “little adults”.  As such, it is critical that the unique health care needs of children are taken into consideration in designing any benefits package for children.

• How will we cover children who don’t qualify for Medicaid or CHIP and who lack private coverage now: will there be a public plan that they can enroll in?  One of the most heavily debated issues on Capitol Hill is whether or not a public plan should be offered.  On one side of this issue are those who say that offering a public plan only makes sense in providing an affordable option and that it will force private plans to compete and result in lower overall costs for everyone.  On the other side of this argument, opponents say that offering a public plan will encourage people to leave their private plans and eventually drive up costs across the system and people can no longer afford what they may currently have or what is available in the private market. Just last week Senator Kennedy authored an opinion piece outlining why he believes that it is critical that a public plan be included in any health reform package.

While Congress decides the process, the rest of us should keep our eye on the ball by continuing to discuss what children and families need from health reform.  You can expect to hear much more from the team at CCF throughout the health reform debate via this blog and new research and analysis.  For now though, we thought we’d ask you: what do you think are the most important issues impacting children and families in health reform?