POLITICS - How Much Emphasis On Health Reform?
By Marilyn Werber Serafini, National Journal
© National
Journal Group Inc.
Saturday, Aug. 07, 1999
Making health insurance more available to Americans who
are not now covered is an issue that Democrats have traditionally
championed. But Texas Gov. George W. Bush suggests that he, too,
might make it a priority--by giving the uninsured a tax break to
help them buy insurance on their own.
''It's not a party issue. It is an issue that needs to be
addressed,'' Bush said in an interview with National Journal. He
stated that he wants to focus on the ''working poor'' who have no
insurance. (Three out of four uninsured people have jobs.) ''I
support the idea of allowing people to deduct their own health
insurance costs, like small business people, farmers. That will
help some,'' Bush said. About tax credits? ''We're costing that
out right now. I'm inclined, but I need to know the costs. It is
one of the solutions.''
Nevertheless, it's far from clear how ambitious Bush will
be on the subject during the campaign. Not everyone on his health
care team--or on his other advisory squads--agrees that medical
services care should be a top campaign issue. Sources close to
Bush say his advisers are divided over whether Bush should
propose significant tax breaks for insurance or more broad-based
tax relief. Tax credits for the uninsured can be an expensive
proposition; some proposals would cost as much as $ 50 billion a
year in lost federal revenue.
Two of Bush's health care specialists--R. Glenn Hubbard,
a professor of economics and finance at Columbia University, and
Timothy J. Muris, a professor of law at George Mason University--
are also on his economic team, and will be among those
recommending which way to go.
''The question now is what the right policy framework is
today,'' said one Bush adviser. ''You can make a strong case that
the federal government ought to do more in this area (of the
uninsured), and therefore maybe use tax credits. But if you're
President of the United States, you have to be interested in
everything, not just health care. How much new money do you want
to put into a tax credit structure? If you believe in tax relief,
do you believe in tax relief for health care, or more general
(tax relief)?'' the adviser added.
Bush has pulled together a team of six health care
advisers--both conservatives and moderates--several of whom are
old friends of each other's who served in the Reagan and Bush
Administrations. The team is headed by Deborah Steelman, a
Washington lawyer and consultant who served on the recently
expired National Bipartisan Commission on the Future of Medicare.
Steelman, who is considered a moderate, is a proponent of market-
based solutions to health care problems.
Bush is also soliciting help from Capitol Hill. He
brought Bill Thomas, R-Calif., chairman of the House Ways and
Means Health Subcommittee, to Texas in February for two days of
discussions about health care issues and strategy. Thomas, who
with Sen. John Breaux, D-La., co-chaired the bipartisan Medicare
commission, is one of the most respected congressional
Republicans on health care issues.
Bush has hired for his staff an esteemed health care and
tax aide, Sally Canfield, from the office of Rep. Jim McCrery, R-
La., a Thomas ally on Ways and Means, to be a deputy issues
adviser. Canfield had been concentrating on ideas about tax
credits for the uninsured.
Bush's health care team has already briefed him on a
number of matters, including options for restructuring Medicare
and giving beneficiaries a prescription drug benefit. If Congress
and President Clinton don't agree on a prescription drug plan
this year, the issue could prove important in next year's
campaign. Bush's health care advisers generally agree that
Medicare should be revamped to give beneficiaries access to a
prescription drug benefit and more types of health plans.
Bush criticized Clinton for not ''doing something'' with
the Medicare restructuring proposal developed by the co-chairmen
of the Medicare commission. But Bush appears especially
interested in coming out strong on the uninsured.
Steelman says the health care team's marching orders are
clear. In Bush's view, she says, ''if Republicans don't solve
this problem, it won't get solved.'' During lengthy briefing
sessions, Steelman was struck by Bush's interest. ''To have a guy
who's going to sit there and spend four straight hours, without a
bathroom break, diving through the issue of the uninsured,
financing problems, administrative problems--it was just
thrilling,'' she said.
John C. Goodman, president of the National Center for
Policy Analysis, a Dallas-based conservative think tank, is
urging Bush to make the uninsured a high-profile issue in the
campaign. ''I think the Governor should be very aggressive on
health care issues,'' he said. ''Al Gore is very vulnerable on
this issue, on the issue of the growing numbers of people without
health insurance.''
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. Steelman said, though, that the group is not using
Goodman's proposal as a starting point. ''Goodman is so
ambitious,'' she said, noting some of the difficulty in paying
for so broad a plan.
As Governor of Texas, Bush is familiar with the issue of
the uninsured. His state has one of the highest uninsured rates
in the country (a quarter of all Texans have no coverage), but he
has not made the matter a top priority.
After Congress two years ago created the State Children's
Health Insurance Program, which gives states a block grant to
insure more children, Bush proposed covering kids whose families
have incomes up to 150 percent of the poverty level, although the
law would have allowed him to go up to 200 percent. Health care
lobbyists in Texas say it was a funding issue; each state has to
add money to its federal block grant to cover additional
children. The Texas Legislature eventually passed a bill, which
Bush signed, that allows the state to cover as many children as
federal law permits.
Bush has compromised on other health care issues as well.
Texas was the first state to enact legislation that allows
patients to sue their health plans--an idea many Republicans
oppose. The Texas law is not as sweeping as some proposals pushed
by congressional Democrats. Patient complaints must first be
considered by an independent review organization. And the law
allows patients to sue only for poor performance of service, not
for denial of coverage.
More recently, under pressure from a strong Texas
doctors' lobby, Bush reluctantly signed a bill that would allow
physicians collectively to negotiate fees and contract provisions
with health plans.
Bush's experiences as Governor should help him on health
care issues, said William L. Roper, dean of the School of Public
Health at the University of North Carolina (Chapel Hill) and a
Bush adviser. ''The great thing about Bush is that he comes to
the process having been a Governor of a large state that has
faced most of these issues. He's not having to begin with
briefings about how the Medicaid program runs. Health issues can
be mind-numbingly complex. That's not the case for the Governor
of Texas.''
Here's a closer look at Bush's health care team:
Deborah Steelman
An attorney in private practice in Washington, Steelman is the
leader of the health care advisory group. She has close ties to
the managed care industry (she represents industry clients). Like
others on the health care team, she started her government career
in the Reagan Administration, at the Office of Management and
Budget. She worked on George Bush's presidential campaign, but
did not hold an office in his Administration. President Bush did,
however, appoint her to head a commission on health care. More
recently, she served on the National Bipartisan Commission on the
Future of Medicare, and supported the chairmen's proposal to
restructure Medicare in a market-oriented way and to give some
lower income beneficiaries a prescription drug benefit.
John C. Goodman
President of the National Center for Policy Analysis, a
conservative think tank in Dallas, Texas, Goodman, 53, is the one
health team member without ties to the Reagan and Bush
Administrations. But he's from Texas, and he's been out in front
on a number of health care issues that Republicans in Congress
are embracing. (He's a regular adviser to House Majority Leader
Dick Armey, House Ways and Means Committee Chairman Bill Archer,
and Sen. Phil Gramm, all Texas Republicans.)
Goodman is an outspoken proponent of medical savings
accounts, which would allow people to spend tax-free dollars on
health care services, then purchase a high-deductible insurance
policy to cover big expenses such as hospital stays. He also
produced one of the first proposals for refundable tax credits to
help uninsured people buy policies on their own. He's urging Bush
to make the uninsured a high- profile issue in the campaign.
R. Glenn Hubbard
A professor of economics and finance at Columbia University,
Hubbard is also director of the program on tax policy at the
American Enterprise Institute for Public Policy Research in
Washington. Hubbard, 40, is a proponent of using the tax code to
help the uninsured buy health coverage, and he considers
Goodman's broad-based approach a ''good starting point.''
Hubbard is as much a tax expert as he is a health care
authority. He was deputy assistant secretary for tax analysis at
the Treasury Department during the Bush Administration. In that
capacity, he worked on Bush's 1992 health carereform package,
which included tax credits for the uninsured. ''We need health
care reform, but not what Clinton did,'' Hubbard said in an
interview. ''There are ways to improve the private sector.''
Hubbard is also advising Gov. Bush on taxes, budget, and the
economy.
Donald W. Moran
Moran, president of the D. Moran Co., a health care consulting
group in Fairfax, Va., was legislative director for then-Rep.
David Stockman, R-Mich., in the late 1970s and helped draft
legislation signed into law that helped health maintenance
organizations flourish. Moran also had a hand in a bill co-
sponsored by Stockman and Rep. Richard A. Gephardt, D-Mo., that
would have allowed tax credits for the purchase of health
insurance. (Congress never held hearings on the bill.)
Moran, 47, went with Stockman to the Office of Management
and Budget in 1981, and became executive associate director for
budget in 1982. In 1985, he left government and joined a health
care consulting group that eventually became the Lewin Group, a
respected health care market research company. He managed Lewin
until a year ago. That career gave him extensive experience in
examining the health care industry and its financial workings.
Health care lobbyists say Moran is particularly concerned about
the quality of health care.
Timothy J. Muris
Now a professor of law at George Mason University, Muris, 49, was
involved in setting social and health care policy during the
Reagan Administration as an official with the Office of
Management and Budget. Before then, Muris held several positions
at the Federal Trade Commission, including director of its
bureaus of consumer protection and competition, from 1981-85.
He held the position of executive associate director at
OMB from 1985-88, and remained a consultant to the budget office
during the first year of the Bush Administration. While an
economic conservative, Muris is considered a creative thinker on
social policy, according to a health care lobbyist who served
with him at OMB. Muris splits his time as a Bush adviser between
the health care and economics teams.
William L. Roper
The Bush campaign will look to Roper, 51, dean of the School of
Public Health at the University of North Carolina (Chapel Hill),
for his expertise on Medicare and Medicaid. He ran the programs
as head of the Health Care Financing Administration in the second
half of the Reagan Administration. After Reagan left office,
Roper directed the federal Centers for Disease Control and
Prevention under President Bush. He became senior vice president
of Prudential HealthCare in 1993, then moved to UNC in 1997.
''I've done both government and the private sector, and health
care financing and public health, so I bring to this a sense of
what needs to be done inside government and what can be done, and
how to leverage the system's strengths,'' he told National
Journal.
Roper says a good starting point in restructuring
Medicare is the proposal that the chairmen of the recent
bipartisan Medicare commission produced. He adds that it will be
important to provide some kind of prescription drug benefit for
the elderly. Roper is a moderate on the health care team. He
states that the problems of the uninsured require a multifaceted
solution, but that policy-makers should strengthen the current
employer-based health care system, and not replace it with a
system that would require everyone to buy insurance on their own.
