04-01-2000

HEALTH: Bush And Gore's Positions On Health Care

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.


Marilyn Werber Serafini

National Journal