On the campaign trail, Obama promised to let people keep their current insurance if they like it. But they also would have the option of buying coverage from the sort of cooperative that's available to federal employees. People who can't afford to buy coverage would get help from the federal government. His plan also would force insurance companies to cover pre-existing conditions while also trying to block the skyrocketing costs of medical care. Whatever the final contours, this plan will have a huge impact on powerful forces: patients, doctors, hospitals, insurers and drug companies.
Daschle will be at ground zero of the same sort of massive lobbying battle that hamstrung then-first lady Hillary Rodham Clinton.
Medicare Part D
Passed under the Bush administration, Medicare Part D was the largest expansion to the Medicare program since its inception. Under Part D, the government pays for some of the cost of prescription drugs for seniors and others on Medicare. The president -elect supports the program but with some major changes -- chief amoung them, allowing the federal government to negotiate for lower drug prices for the Medicare program.
The new administration also wants to try to close the so-called "doughnut hole." Seniors who have already had a certain amount of their drug costs covered by the government fall into that "hole," where the government will no long reimburse for prescription drugs until seniors have paid out a certain amount of their own money. Then the government again picks up coverage.
Food and Drug Safety
At the FDA, concerns about food and drug safety reached new levels on the Bush administration's watch. Concerns about the safety of diabetes drug Avandia and recalls of the painkiller Vioxx have some wondering whether the FDA is effectively regulating drugmakers. Consumers have also worried about whether the FDA has been doing enough to inspect foreign food and drug plants, as the FDA has recently been tasked with identifying the source of salmonella outbreaks, blocking the import of Chinese milk products, and zeroing in on where along its international supply chain the blood thinner heparin became tainted.
Questions of Bioethics
Whether considering stem cell research, access to birth control, abortion, abstinence education or terminally ill patients, the next HHS secretary will be front and center as the Obama administration navigates complex questions of bioethics. President Bush signed an executive order that banned federal funding for stem cell research -- housed at NIH -- except for lines already in use. The new administration could reverse that decision with a new executive order permitting federal funding for embryonic stem cell research, a stance opposed by the U.S. Conference of Catholic Bishops.
Increasing SCHIP and Medicaid Payments
One of the first orders of business for HHS is likely to be expanding the State Children's Health Insurance Program (SCHIP), which provides health coverage to children of low-income families. Bush has vetoed efforts in Congress to expand SCHIP in the past. House Speaker Nancy Pelosi has said quickly sending a new SCHIP expansion to President Obama will be near the top of the to-do list for the next Congress.
The incoming HHS secretary is likely to take some steps, too. Jeanne Lambrew, a former Clinton HHS official who helped co-write Daschle's health care book, said SCHIP expansion should be first on Daschle's list.