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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


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
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.
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.

     * supports medical savings accounts

     * favors ability to sue health plans

     * considering health care tax credits as a way  to make
insurance more affordable

     * 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

     * Deborah Steelman, attorney, Steelman Health Strategies

     * John C. Goodman, president, National Center for Policy

     * Donald W. Moran, president, D. Moran Co.

     * Donna Shalala, Secretary of Health and Human Services

     * Richard J. Boxer, urologist, Milwaukee

     * Sen. Edward Kennedy, D-Mass.

LOAD-DATE: April 3, 2000

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