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Know Your Rights
Source: The Washington Post
Subject: Health Justice & Access
Type: Media Coverage

A Move Toward Requiring Health Coverage

In Letter to Senate Democrats, Obama Suggests Hardship
Waiver for the Poor

One day after signaling a fresh willingness to consider
taxing employer-sponsored health insurance, President Obama indicated yesterday
a new openness toward a nationwide requirement that every American have health

In his push to enact sweeping health-care reform legislation
this summer, Obama previewed what could be the outlines of a compromise on two
of the thorniest issues confronting Congress. He said he could support mandates
on both individuals and employers to contribute to the cost of health insurance
if the bill provides protections to certain small businesses and poor people.

"If we do end up with a system where people are
responsible for their own insurance, we need to provide a hardship waiver to
exempt Americans who cannot afford it," he wrote in a letter to top Senate

During the presidential primaries last year, Obama attacked
then-Sen. Hillary Rodham Clinton‘s
proposed individual mandate as a scheme to "go after people’s wages."

In the letter, however, he said he understands that key
committees are "moving towards a principle of shared responsibility —
making every American responsible for having health insurance coverage, and
asking that employers share in the costs."

The approach tracks closely with a universal health program
enacted in Massachusetts
three years ago in which individuals must have coverage and businesses must
either offer insurance to employees or pay into a state fund that provides
coverage. In Massachusetts,
individuals can receive free or subsidized care based on income.

Broadly speaking, the business community has opposed
requirements to "pay or play," as the employer mandate is often
known. But a survey conducted by the **Main
, a
small-business coalition advocating reform, found that 77 percent of 1,200
small firms interviewed are willing to pay a portion of workers’ health-care

"Do we feel a responsibility to help our employees
afford health care? Yes, we do," Freddy Castiblanco, owner of La Terraza
Cafe in Queens, N.Y., said in congressional testimony
yesterday. "Are we willing to contribute? Yes."

Castiblanco, who employs 11 people, said any health-care
overhaul should include the option of a government-sponsored insurance policy
for people having trouble buying coverage on the private market.

That idea got a boost from Obama, who said in the letter
that he "strongly" believes in giving Americans the choice of a
public option.

"This will give them a better range of choices, make
the health-care market more competitive, and keep insurance industries
honest," he wrote.

Obama also pledged — without providing details — to trim
an additional $200 billion to $300 billion out of Medicare and Medicaid
spending over the next decade. That would be on top of the $309 billion in
Medicare reductions in his budget, though Congress has not embraced the

For the first time, the president also said he is
considering proposals that would empower the Medicare Payment Advisory Commission
to implement cost controls on the health program for seniors and the disabled.
The idea is similar to legislation sponsored bySen. John D. Rockefeller IV (D-W.Va.), who wants to make the commission
an independent agency in the executive branch functioning along the lines of
the Federal Reserve Board. Obama, however, suggests following the model of the
military base closing commission, with Congress still involved in Medicare’s
coverage and price decisions.

Senate Finance Committee members were told privately
yesterday that the panel will probably see draft legislation on June 17 and
begin marking up the bill the following week.

**Make the Road New York (MRNY) is a leading member of the Main Street Alliance