The survey found voters are unaware that the major components -- $450 billion in subsidies to purchase coverage and a menu of insurance market reforms -- wouldn't kick in for four years. Forty-nine percent of respondents said they expected people to begin receiving financial assistance to buy coverage this year or next. Fifty-one percent said they expected insurers to begin accepting customers regardless of preexisting conditions this year or next.

1. The most significant changes to the health care system wouldn’t kick in until 2013 – two election cycles away. A Kaiser Family Foundation poll released last week showed Democrats risk disappointing voters with the delayed timetable

2. Democrats are anxious to mix the good with the bad since some of the pain would be phased in early, including more than $100 billion in industry fees

3. The front-load strategy could help blunt GOP attacks on the bill as a toxic mix of higher taxes, rising premiums and cuts to Medicare.

4. The strategy also could ease some of the disappointment among voters who expect more immediate reforms than the bill can deliver

5. There are billions in new taxes on insurers, device manufacturers, and pharmaceutical companies that come due in 2010.

6. The changes to Medicare funding, which Democrats say is aimed at redirecting wasteful spending but Republicans say would hit senior citizens, would be implemented immediately.

Dems push for SOME benefits to kick in by 2010, in time for election. It's nothing to do with what's right for America, it's all about Democrat control of government and re-election

Democrats are pushing Senate leaders and the White House to speed up key benefits in the health reform bill to 2010, eager to give the party something to show taxpayers for their $900 billion investment in an election year.

The most significant changes to the health care system wouldn’t kick in until 2013 – two election cycles away. With Republicans expected to make next year a referendum on health care reform, Democrats are quietly lobbying to push up the effective dates on popular programs, so they'll have something to run on in the congressional midterms.

Democrats are anxious to mix the good with the bad since some of the pain would be phased in early, including more than $100 billion in industry fees that critics say could be passed on to consumers.

“We want to be able, within the cost framework and the implementation framework, to have as much start as early as possible, even though we know all of it can’t,” said Sen. Debbie Stabenow (D-Mich.), a Finance Committee member who is working with other senators on the effort. “And the White House wants to have as much as possible to start.”

Under the Democratic wish-list, senior citizens would receive discounts on brand-name drugs next year. Small businesses that provide insurance would see tax credits. And a $5 billion high-risk pool would cover people with preexisting conditions.

Democratic strategists expect the 2010 election to present a stark contrast between the parties, particularly if the health care bill receives minimal Republicans support. The front-load strategy could help blunt GOP attacks on the bill as a toxic mix of higher taxes, rising premiums and cuts to Medicare.

The strategy also could ease some of the disappointment among voters who expect more immediate reforms than the bill can deliver, including on the much-debated public insurance option. Democrats in both the House and Senate are closing in on finding the votes to include some form of a public option in the bill, but a government-run insurance plan would likely be one of the last pieces to kick in fully, if it passes.

“Democrats will be the party that passed health care reform, and Republicans will be the party that tries to repeal it,” said Jim Kessler, vice president for policy at Third Way, a centrist policy organization. “The challenge on health care has always been to demonstrate to the middle class that this bill is really for them and that it will provide them stable coverage that they can count on through thick and thin.

“It’s important to have a few things to point to that go into effect right away,” Kessler said. “This is a case where good policy and good politics coincide.”

Sen. John Cornyn (R-Texas), chairman of the National Republican Senatorial Committee, said the strategy was a transparent attempt to paper over the less palatable aspects of the bill.

There are billions in new taxes on insurers, device manufacturers, and pharmaceutical companies that come due in 2010.

Starting in 2013, insurers that offer family plans worth more than $21,000 a year would pay a tax, which unions say would hit middle class families. Beginning in 2014, the penalty on people who do not purchase insurance would kick in. The changes to Medicare funding, which Democrats say is aimed at redirecting wasteful spending but Republicans say would hit senior citizens, would be implemented immediately.

“I can understand their desire to have some fig leaf to protect them against understandable voter concern about the fact that insurance premiums are going to go up. You are taking half-trillion dollars from Medicare and you are going to raise taxes on middle class families,” Cornyn said. “Those are unpopular positions, so I can understand their desire to front-load and show something for it.”

A Kaiser Family Foundation poll released last week showed Democrats risk disappointing voters with the delayed timetable, which lawmakers view as necessary given the complexity of implementing the reforms.

The survey found voters are unaware that the major components -- $450 billion in subsidies to purchase coverage and a menu of insurance market reforms -- wouldn't kick in for four years. Forty-nine percent of respondents said they expected people to begin receiving financial assistance to buy coverage this year or next. Fifty-one percent said they expected insurers to begin accepting customers regardless of preexisting conditions this year or next.

The Senate Finance Committee has already posted a one-page memo on its website titled “What You Get Right Away: Immediate Relief for Families and Small Businesses.” The Health, Education, Labor and Pensions Committee, which also passed a health care bill, prepared its own list of immediate benefits.

Both documents read like a blueprint of Democratic talking points for the 2010 elections.

“It helps to have more to run on in the midterms and to prime the pump for 2012,” said a senior Democratic aide of the front-load strategy. “Also, you want to have real, practical effects folks can feel right away so the issue is a clear tangible – not just rhetorical – victory. It’s a big part of this.”

Stabenow said she is working with other senators to influence the closed-door negotiations between Senate Majority Leader Harry Reid (D-Nev.), White House Chief of Staff Rahm Emanuel, Finance Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.), who is representing the HELP committee. In several cases, the HELP bill offers earlier effective dates on key provisions – and Stabenow and others are pressing Reid to go with the more immediate approach.

“We want to have as much front-ended as possible,” Stabenow said.

The Senate HELP bill would immediately require family policies to cover young adults until age 26, while the Finance bill sets up a “young invincible” policy beginning in 2013.

Both Senate bills establish a reinsurance fund that protects early retirees from losing their health care coverage, but only the HELP bill kicks into effect immediately. Pushed by Stabenow and Sen. John Kerry (D-Mass.), the fund would cover catastrophic claims of retirees between 55 and 64 who receive coverage through employer-based plans.

Insurance companies would be required to report the proportion of premium dollars that are spent on items other than medical care. Hospitals would need to itemize charges so consumers can compare prices. States would be compelled to establish an insurance ombudsman office that would intervene with companies on behalf of consumers.

Under both bills, people who have been denied insurance due to preexisting conditions or who have been uninsured for six months could seek coverage in a high-risk pool available in 2010.

Out-of-pocket costs for prevention and wellness programs under Medicare would be eliminated in 2010 under the HELP bill and 2011 in the Finance bill.

“Anything that we can do to realize reforms that won’t take money upfront and at the same time create real relief for families, we are for,” said Sen. Robert Menendez (D-N.J.), chairman of the Democratic Senatorial Campaign Committee. It doesn't matter if the bill for this is huge, we pay it later.

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