Skinny or Dead

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Pharmaceutical Technology, Pharmaceutical Technology-03-02-2010, Volume 34, Issue 3

If both sides of the aisle don't agree on even mild healthcare reform soon, the bill could die out.

"You can never be too rich or too thin," Wallis Simpson, the late Duchess of Windsor once famously said. But the new healthcare reform bill may well be both. Largely thought to be a dead issue since Republican Scott Brown was elected to fill the Senate seat left vacant by the death of Massachusetts's Senator Edward Kennedy, the bill is expected to be a pared down version that includes provisions acceptable to partisans on both sides of the aisle. This so-called "skinny" bill could contain the following provisions, according to a Jan. 21, 2010 New York Times article (1) :

  • Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.

  • Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.

  • The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.

  • The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.

  • The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.

  • If a health plan provides care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency. Co-payments for emergency care would have to be the same, regardless of whether a hospital was in the insurer's network of preferred providers.

Michelle Hoffman

In its slimmed-down version, the legislation would likely cover fewer than half of the estimated 30 to 40 million uninsured individuals in the United States. Nevertheless, the bill may face funding hurdles—especially in this economic climate. "While both parties might agree on what should be in the bill," said Steven Usdin, senior editor at BioCentury Publications during a roundtable on the subject at the Biotechnology Industry Organizations' annual CEO and Investor Conference in early February, "they disagree on how to fund it." In other words, the reform measures may still be too rich for lawmakers' blood.

Ironically, healthy people continue to opt out of insurance plans, causing insurers to raise their rates even more. If this continues, health insurance will cover only the sickest, wealthiest Americans—a scenario that can't be good for anyone, including the pharmaceutical industry.

Not to be deterred, the White House made one more push in early February to bring all the parties back to the table. The president issued an invitation to Democrats and Republicans to participate in a televised summit in which representatives will attempt to reach a consensus about the contents—and maybe the financial support—of a healthcare bill. Fortunately, representatives from both parties have accepted the invitation.

The meeting may well represent the last chance for lawmakers to craft a plan with some meat on its bones at a price that does not require a king's ransom.

Michelle Hoffman is editor-in-chief of Pharmaceutical Technology. Send your thoughts and story ideas to


1. New York Times, Jan. 21, 2010,, accessed Feb. 22, 2010.