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October 15, 2000, Sunday, Late Edition -
Final
SECTION: Section 1; Page 30; Column 1; National
Desk
LENGTH: 1348 words
HEADLINE: THE 2000 CAMPAIGN: THE INSURANCE ISSUE;
Gore and Bush Health Proposals Fall Short of Counterparts'
Plans 8 Years Ago
BYLINE: By ROBIN TONER
DATELINE: WASHINGTON, Oct. 14
BODY:
Vice President Al Gore has accused Gov.
George W. Bush of ignoring the plight of the uninsured in
Texas, which ranks near the bottom in health coverage.
Mr. Bush has attacked Mr. Gore as just another liberal who wants a
"government-run health care system." The issue of the uninsured
has flared anew in the presidential campaign, with a fierce exchange in the last
debate and a new round of charges and countercharges about the Bush record in
Texas. But many health policy experts say that at least so far, the 42.6 million
Americans without health insurance have drawn far less attention in this
campaign than the experts would have hoped, given the budget surplus and the
booming economy.
Both candidates have offered proposals to expand
coverage, but neither plan is on the scale proposed by their counterparts in
1992, Bill Clinton and President Bush. Governor Bush's proposal to use tax
credits to help people buy private insurance "is simply dwarfed by his father's
plan," said Uwe Reinhardt, an expert on health policy at Princeton.
Mr.
Gore would expand the existing Children's Health Insurance Program to ensure
that all children have access to affordable coverage by 2005, a popular goal
that gets high marks from health advocacy groups. But it also falls well short
of the goal of health care for all, or universal coverage, that his party
insisted on in 1992.
The contrast is particularly striking, some health
experts said, because the more ambitious proposals of 1992 and early 1993 came
at a time when the annual budget deficits were at their peak, running at nearly
$300 billion.
For all of that, the step-by-step approach to expanding
health coverage has many defenders, who note that it has the great advantage of
being politically realistic. "I personally do not believe we're going to get
universal coverage in one piece of legislation," said Ron Pollack, head of
Families USA, a consumer advocacy group that is among the strongest advocates of
universal coverage.
"As a nation, we don't do very well at
redistributing income," Mr. Pollack said, "and if you're going to try to do
universal coverage, you're going to gore the ox of one of the big interests --
and they're going to spend a fortune in opposition."
Indeed, the
political collapse of President Clinton's attempt at universal health insurance
in 1993-94 still has an impact, pushing politicians to seek smaller, incremental
solutions. Republicans, who conducted a fiercely ideological campaign against
the Clinton plan are resurrecting it this year in campaigning against much more
modest initiatives.
Mr. Bush, for example, recently asserted that Mr.
Gore "likes Hillary-Care," adding, "He wants to nationalize the health care
system of America." (Not exactly. Contrary to Republican dogma, the exceedingly
complicated Clinton plan would not have nationalized the health care system; it
would have required employers to provide insurance and created regulatory
structures to oversee benefits and premiums.)
Senator Bill Bradley's
failed effort to build his Democratic presidential campaign around the cause of
universal coverage also probably had a chilling effect, several analysts said.
Throughout the fall and winter last year, Mr. Gore picked apart the Bradley plan
as unwieldy and unworkable.
"The high point of talking about the
uninsured was the Gore-Bradley debate," said Stuart Butler, a health expert at
the Heritage Foundation, a research group. But it was not, in the end, a pretty
moment.
Finally, the uninsured have been eclipsed this year by a more
popular health care issue with a more powerful constituency -- the lack of
prescription drug coverage for the elderly. "The elderly are a powerful vote,"
said Robert Blendon, an expert on public opinion and health care at Harvard.
"And not only do seniors vote more, but their ability to organize, to hold
forums, has garnered their cause a great deal more attention than the
uninsured."
Several analysts also noted that as complicated as the
prescription drug issue can be, it seems easier -- and cheaper -- to solve than
covering the uninsured.
Given this political context, some health
experts see hopeful signs that this campaign has at least revived the debate --
and maybe even helped prepare the way for action next year. "The fact is they
both take this issue seriously, they both have a plan," said Charles N. Kahn
III, president of the Health Insurance Association of America.
Dr. Gail
Wilensky, a health adviser to Governor Bush and a top health official in his
father's administration, said: "Right before an election is a hard time to know
where you are. But potentially, come February or March, we may be able to make a
move. And what we've clearly learned in the last eight years is that prosperity
alone is not going to make this problem go away."
In fact, the number of
uninsured rose throughout the long economic expansion; only last year, for the
first time in 12 years, did their ranks begin to show a significant decline,
according to recent Census Bureau data. Still, the numbers remain so large that
many health advocates fear what would happen in an economic downturn.
The two candidates' proposals reflect their different philosophical
approaches. Mr. Bush would use refundable tax credits -- up to $2,000 for
families and $1,000 for individuals -- to help low- and moderate-income families
buy health insurance on the private market. The full tax credit would be
available to families with incomes up to $30,000 and would gradually phase out
at higher incomes, with a cutoff at $60,000. Mr. Bush would also provide $8
billion in additional money over 10 years to community health centers.
The main criticism of Mr. Bush's plan is that the tax credits are too
small. "He's offering $1,000 for an individual policy that on average costs
$2,000, and $2,000 for a family policy that on average costs $6,000," said Dr.
Judith Feder, dean of policy studies at Georgetown University, and a former top
health adviser in the Clinton Administration. For a family making $30,000 or
less, Dr. Feder argued, that's the equivalent of "giving a 10-foot rope to
people in a 30-foot hole."
Mr. Gore would expand eligibility for the
Children's Health Insurance Program to cover all children in families with
incomes up to about $42,000; children in families with higher incomes, whose
parents did not have coverage through their employers, would be allowed to buy
into the program, with the help of a new federal tax credit. That credit, 25
percent of the health insurance premium, would be aimed at middle-income people
who had to buy insurance on their own. Moreover, the children's program would be
expanded to cover uninsured low-income parents.
Mr. Gore is proposing to
spend more money on expanding coverage -- his campaign puts the price tag at
$146 billion over 10 years, to Mr. Bush's $75.1 billion in the same time period
-- and his focus on children and their parents has earned praise from advocacy
groups.
"If I had to pick two increments, I'd pick getting the job done
for kids and providing meaningful coverage for low-income parents," Mr. Pollack
said.
But several health care experts said that a more notable step
would be to combine the Bush and Gore proposals. "I think there's a possibility
of a real compromise after the election," Mr. Butler said, with conservatives
willing to accept some expansion of the children's program and liberals willing
to accept a greater use of tax credits for more moderate income people.
Dr. Drew Altman, president of the Kaiser Family Foundation, a health
research group, asserted, "Ultimately, what would make most sense is if the two
parties agreed to stop fighting over ideological differences and combined the
two approaches."
Dr. Altman noted that for years, health analysts had
assumed that the primary hurdle to doing something about the uninsured was the
lack of money. Given the current surplus, he added, the basic question becomes,
"If we're not able to deal with this issue now, when will we ever be able to
deal with it?"
http://www.nytimes.com
GRAPHIC: Photos
Chart: "Expanding Health
Coverage"
SPENDING
GEORGE W. BUSH -- $75.1 billion
over 10 years, including $63 billion for a new health tax credit and $8 billion
for community health centers and other safety net providers.
AL
GORE -- $146 billion over 10 years, including $95 billion for expanding access
to health coverage, primarily through the Children(TM)s Health Insurance Program
(CHIP).
TAX CREDITS
GEORGE W. BUSH -- Provides
families with a refundable tax credit of up to $2,000 ($1,000 for individuals)
to help them buy health insurance if they do not qualify for coverage with their
employer or government assistance. Full tax credit available to families with
income up to $30,000; gradually phases out for families at $60,000.
AL GORE -- Provides a 25 percent refundable tax credit for health insurance
premiums for the uninsured who buy private or public plans. This includes people
55 to 64 years old who would be allowed to buy into Medicare.
PUBLIC PROGRAMS
GEORGE W. BUSH -- Aims at increasing number
of covered children under the Children(TM)s Health Insurance Program by giving
states more flexibility to run the program.
AL GORE -- Expands
CHIP to children in families with incomes up to about $42,000 for a family of
four. Higher-income families without job-based insurance could buy CHIP or
Medicaid coverage for their uninsured children, aided by new federal tax
credits. Expands CHIP to low-income parents of children enrolled in the program.
Allows early retirees to buy into Medicare, with help of a 25 percent tax credit
to help pay premiums.
LOAD-DATE: October 15, 2000
