Copyright 2000 The National Journal, Inc.
The National Journal
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April 1, 2000
SECTION: HEALTH; Pg. 1038; Vol. 32, No. 14
LENGTH: 1663 words
HEADLINE:
Bush And Gore's Positions On Health Care
BYLINE:
Marilyn Werber Serafini
BODY:
Al Gore and
George W. Bush have settled into a pattern on health
care issues: Gore
attacks and Bush defends. Gore has made health
care and the uninsured a
central theme of his campaign, whereas
Bush has spoken on the subject only
in small doses. In some ways,
it's reminiscent of the 1992 presidential
campaign, when Bill
Clinton and Al Gore used the issue of the uninsured
against
Bush's father, then-President George Bush, who was slow to
respond with a plan of his own.
But Gore is
departing from Clinton's script in one
important way. Unlike Clinton, who
advocated a massive overhaul
of the health care system and saw his proposal
die in Congress in
1994 amid criticism that it would be bureaucratic and
unwieldy,
Gore wants to build on the existing system in increments. He
would enroll more children in the Children's Health Insurance
Program
and in Medicaid. He also would give the parents of
children in Medicaid and
CHIP access to those programs. Moreover,
uninsured people between 55 and 65
could pay for Medicare
coverage. For other uninsured people, he would offer
a tax credit
worth 25 percent of their health insurance costs to help them
buy
coverage on their own.
Gore estimates that
about 88 percent of Americans would
have some sort of health insurance under
his plan, an increase
from the 83.7 percent who are now covered.
Despite the failure of the Clinton Administration's
health care
reform proposal, many health care activists have
grown to trust Gore,
because he has been a strong advocate on
issues such as AIDS policy, medical
research, Medicaid
flexibility, and CHIP. "They looked for help to the White
House,
and they got it," said one analyst.
Bush,
meanwhile, has not yet articulated a comprehensive
plan-or philosophical
approach-on health policy issues. The
Republican contender indicated early
on that he wanted to be a
major player in the health care debate. "It's not
a party issue.
It is an issue that needs to be addressed," Bush said in a
July
1999 interview with National Journal. At that time, he said that
he
wanted to focus on the working poor who have no insurance. "I
support the
idea of allowing people to deduct their own health
insurance costs, like
small-business people, farmers. That will
help some," he said. About tax
credits? "I'm inclined."
But since then, Bush has
been mostly silent on the issue
of the uninsured. Part of that may be due to
political custom
(health care traditionally is more of an issue in
Democratic
primaries than in Republican ones), and part of it may be due to
fiscal realities (health reform plans are expensive).
Health care analysts who have been working on the Bush
campaign say
that cost has been a major factor in the delay.
Bush's advisers have
been-and continue to be-divided over whether
Bush should propose significant
tax breaks for purchasing health
insurance. Tax credits for the uninsured
can be expensive,
depending on how many people qualify and how generous the
credits
are. Some proposals would cost as much as $ 50 billion a year in
lost federal revenue. One Bush adviser-John Goodman, the
president of
the Dallas-based National Center for Policy
Analysis, a conservative think
tank-produced one of the earliest
proposals for a health care tax credit,
and he's pushing Bush to
develop a comprehensive approach. Goodman has
proposed providing
a tax credit for every American who wants one to help buy
insurance, and to provide a federally funded safety net for those
who
fall through the cracks. But Deborah Steelman, a lawyer who
is leading
Bush's health care team, has indicated that Goodman's
proposal may be too
ambitious.
Bush recently called on two respected
health care
analysts for help. One is Regina E. Herzlinger, a
market-oriented
professor at Harvard University's Graduate School of
Business
Administration, and the other is Gail Wilensky, chairwoman of the
Medicare Payment Advisory Commission, which advises Congress on
Medicare
payment policy.
A health care analyst close to Bush
said that the Texas
governor is stepping up discussions about the uninsured
in hopes
that he can announce a position in a couple of weeks.
Bush's record in Texas-a state in which about 25
percent
of the population is uninsured, a rate that exceeds the national
average-could offer some clues about how he would approach health
reform
issues. After Congress two years ago created the
Children's Health Insurance
Program, which gives states a block
grant to insure more children, Bush
proposed using the program to
cover children whose families have incomes up
to 150 percent of
the poverty level, even though federal law would have
allowed him
to set the limit at 200 percent. The Texas Legislature
eventually
passed a bill, which Bush signed, that allows the state to cover
as many children as federal law permits. (Still, Bush touts his
actions
on CHIP as a plus, and he criticizes Gore for his record
on the uninsured.
"Under Clinton-Gore, the uninsured rolls have
increased by more than 8
million people," Bush campaign spokesman
Ari Fleischer said recently.)
Gore also has knocked Bush on the issue of patients'
rights. During the Senate debate on the patients' bill of
rights
last summer, Bush announced his support for a GOP proposal
that
would have excluded employees of most large firms because large
companies generally self-insure. Gore said the GOP plan would
leave too
many people without protection
But on this issue, Bush is fighting back. He
boasts that Texas
was the first state to pass legislation that gives
patients the
right to sue their health plans when they suffer adverse
consequences because of denied coverage.
Bush
highlights that law as a sign of his ability to get
things done on health
care and assist patients. However, Bush
doesn't usually mention that he
vetoed the first patient
protection bill passed by the Legislature, and
considered vetoing
the one that became law.
On the Stump
Bush
National Journal interview, July 22, 1999
The country's done a fairly
good job of helping poor people
access health insurance. The issue ... is
the working poor. I
support the idea of allowing people to deduct their own
health
insurance costs, like small-business people, farmers. That will
help some.... I'm inclined (to support tax credits for the
purchase of
private insurance), but I need to know the costs. It
is one of the
solutions.
I think health care is a very important
issue for all of
us. It's not a party issue. It is an issue that needs to be
addressed, and the thing that is important about health care is
to
understand that there are different needs for different folks.
I don't view
health care in the context of a universal plan....
And then, obviously,
HMOs. Should HMO health reform be enacted?
You bet. We've done a lot of that
in Texas. You've got a
complaint with your HMO, and your HMO says you're
wrong, well,
we've set up an independent review organization where you can
take your complaint. And if the IRO (Independent Review
Organization)
makes a ruling that the HMO ignores, then that
becomes the cause of action.
That's vastly different when you've
got a complaint and you don't like it
and you can sue the HMOs.
There's an arbitrary dispute mechanism in place.
Gore
Children's Hospital Los Angeles, Sept. 7, 1999
As President, I
will lead the fight to move this nation toward
quality, affordable health
coverage for every family. We will
begin with the earliest years, by
extending access to affordable
health coverage to every American child. Let
me be crystal clear
on this point: If you elect me President, I will ensure
that by
the year 2005 every single child in our country has full access
to fully affordable health coverage. If you want a President who
will
take the oath of office on Jan. 20, 2001, at high noon,
committed, heart and
soul, to achieving that goal, then I ask for
your support-because I'll make
it happen.
There are still 4 million uninsured
children eligible for
Medicaid who are not yet enrolled. And there are
millions more
eligible under the children's health initiative we passed in
1997
who have not yet been signed up. In some states-Texas springs to
mind-one quarter of all children are still out in the cold. I
will
propose to expand the current children's health initiative
so that families
earning up to $ 41,000 per year-250 percent of
poverty-will be eligible for
the benefits it provides.
Position
Bush
*
supports medical savings accounts
* favors ability
to sue health plans
* considering health care tax
credits as a way to make
insurance more affordable
Gore
* supports enrolling more children in Children's
Health
Insurance Program and in Medicaid
* wants
parents in CHIP, Medicaid
* supports health care tax
credits as a way to make
insurance more affordable
By the Numbers
Would you favor a Clinton Administration plan to
spend $110 billion over 10 years to provide health care coverage to at
least
5 million uninsured Americans, or would you rather have the
money returned
to you in the form of a tax cut?
Favor plan 75%
Prefer tax cut 20%
SOURCE: Fox News Channel-Opinion Dynamics,
1/27/00
Allies and Advisers
Bush
* Deborah
Steelman, attorney, Steelman Health Strategies
*
John C. Goodman, president, National Center for Policy
Analysis
* Donald W. Moran, president, D. Moran Co.
Gore
* Donna Shalala, Secretary of Health and Human
Services
* Richard J. Boxer, urologist, Milwaukee
* Sen. Edward Kennedy, D-Mass.
LOAD-DATE: April 3, 2000