Copyright 2000 Gannett Company, Inc.
USA TODAY
September 22, 2000, Friday, FINAL EDITION
SECTION: NEWS; Pg. 8A
LENGTH: 1770 words
HEADLINE:
Prosperity doesn't cover the uninsured
BYLINE: Mimi Hall
BODY:
All Carletta Brown needs to ease her mind is a simple medical
procedure:
the removal and biopsy of a suspicious mole her doctor
recently noticed on
her back.
But the $ 100 or so it would cost is more than the Lake
View, Iowa,
nurse can afford right now. Although the hospital where she
works
offers a health plan to its employees, Brown earns
less than $ 10
an hour, and she says she can't spare $ 150 a month out of
her
paycheck to sign up. So she's just praying that she'll stay healthy.
Brown, 49, has plenty of company. The number of Americans without
health insurance is 44 million and growing. Most of them,
like
Brown, have jobs. They just can't afford the insurance premiums.
"The people hardest-hit by this phenomenon are working families,"
says
Ron Pollack of Families USA, a consumer advocacy group based
in Washington.
"This is not a story about -- whatever the stereotype
is -- some poor slob
who doesn't want to work."
Surprisingly, the plight of the uninsured
has worsened even as
the nation enjoys its longest economic expansion in
history. But
President Clinton, who often boasts about the state of the
economy,
does not talk much about the rising numbers of uninsured, although
he had vowed during his 1992 campaign to solve the problem by
establishing universal health care.
For that matter, neither the
Republican nor the Democratic candidate
hoping to succeed Clinton highlights
the problem or talks about
a big fix. Instead, Republican George W. Bush and
Democrat Al
Gore are focusing on piecemeal approaches. Examples:
* Giving seniors prescription-drug coverage under Medicare.
* Covering more children under a 1997 program financed
jointly
by the federal and state governments.
* Offering tax credits for
families that buy private health
insurance.
To many health care
advocates, Bush's and Gore's proposals fall
far short of helping the one in
six Americans lacking coverage.
In 1992, then-president George Bush
proposed a $ 100 billion, five-year
plan to control costs and shrink the
numbers of uninsured. The
plan was condemned by liberals and conservatives
alike as timid,
and it went nowhere.
Today, the candidates are
proposing to spend much less: Gore would
spend $ 120 billion and Bush $ 132
billion, both over 10 years instead
of five.
"We haven't even
seen proposals as bold and far-reaching as President
Bush's," says Dallas
Salisbury, president of the Employee Benefit
Research Institute, a
non-partisan organization that focuses on
issues such as education and
health care.
Cautious approaches
Experts cite several
reasons Bush and Gore are moving cautiously:
* The collapse of
Clinton's costly and controversial 1994
health care plan, a massive overhaul
that sought to expand coverage
by imposing new regulations and mandates.
Some estimates said
the plan would cost as much as $ 50 billion a year, and
Republicans
and the health care industry helped turn the public against the
plan by successfully portraying it as an intrusive, big-government
solution.
The issue was so powerful, it helped Republicans
capture control
of Congress in the 1994 elections.
* The issue
has less resonance among insured workers in
today's strong job market .
Eight years ago, workers with insurance
were far more anxious than they are
today about losing their jobs
and health coverage because of layoffs.
* Although health care premiums are showing double-digit
increases in some areas of the country, studies show that employers
are
covering most of the increases so they don't lose workers.
As a result,
employees are less likely to worry about having to
drop out of their
insurance plans because of steep increases in
premiums.
Robert
Helms, director of health policy at the conservative American
Enterprise
Institute, says polls may show that most Americans
support the idea of
universal coverage, but in reality, people
don't want to pay more in taxes
or insurance premiums to make
sure everyone has coverage.
The
percentage of people without insurance has continued to climb
during these
good times, experts say, because rising insurance
premiums discourage some
cost-conscious companies from offering
employer-sponsored plans. Another
reason: Many families moving
from welfare to work under the 1996 welfare
reform act are losing
coverage under Medicaid, the federal health program
for the poor.
Just getting by
Even so, the problem "has lost
credibility with a lot of voters
because people look at the uninsured and
say, 'People do this
(forgo coverage) by choice,' " Helms says.
That's true for Brown. The divorced mother of three grown children
is trying to build a better life.
Most of the elements are in
place. She has a job working 30-35
hours a week. She meets her mortgage and
car payments and pays
her utility bills. And she recently scraped together
enough cash
to buy badly needed tires for her 1991 Ford Tempo and $ 235
worth
of books for the classes she's taking to get an advanced nursing
degree.
Next year, after Brown gets the degree, she hopes to get
a better
job and be able to afford insurance.
In the meantime,
she says she's lucky that she's in good shape
and doesn't have any chronic
health conditions that require repeated
visits to the doctor. As for the
mole, the best she can do, she
says, is watch to make sure it doesn't change
and wait until she
can afford to have it removed.
She says she's
not too worried about it, but "it stays in your
mind. I ask myself, 'Is this
(choosing school over insurance)
the right choice?' "
Insuring
children
It is not, however, a choice that the 11 million children
without
insurance can make for themselves.
Both candidates have
proposals that they say would make insuring
children a priority by building
on the 1997 Children's Health
Insurance Program (CHIP). This state-run
program covers children
from families that don't qualify for Medicaid but
cannot afford
to buy insurance. Washington kicked in $ 40 billion over 10
years
to launch CHIP, and states add money. Congress must approve program
changes.
Gore's plan would raise the income limit for
eligibility to 250%
of the federal poverty level, up from 200% now, and let
some parents
into the program. Under federal rules, a family of four with an
annual income below $ 17,050 is considered to be living in poverty,
so
250% of that would be $ 42,625.
Gore says his plan would guarantee
access to affordable health
care for all children by 2005 and help cover
former welfare recipients
who lost Medicaid when they went to work under
welfare reform.
"We will move toward universal health coverage, step
by step,
starting with all children," Gore told the Democratic convention.
"We will fight for affordable health care for all, so patients
and
ordinary people are not left powerless and broke."
His prediction of
universal coverage for children seems optimistic
to experts. CHIP already
has been criticized for getting off to
a slow start and enrolling far fewer
children than expected. About
two million have been enrolled in its first
three years.
Bush has been criticized because 24% of residents in
Texas lack
health insurance. Only Arizona has a higher percentage of
uninsured.
"Bush's record there -- I don't know how to say it softer --
stinks," says Pollack of Families USA.
To be fair, health care
problems in Texas, stretch back decades
before Bush became governor. And
over the past 10 years, the percentage
of uninsured people in Texas has
grown no faster than it has nationwide.
Moreover, the four states along the
Mexican border lead the nation
in uninsured rates, a trend traced to the
flood of legal and illegal
immigration into that region.
Even
so, critics say Bush has run CHIP poorly in Texas.
Although federal
law lets states enroll children living at up
to 200% of the poverty level
(and, in rare cases, higher), Bush
initially fought to limit the number of
kids allowed into his
program to those living at 150% of the poverty level.
Only last
year did he sign legislation to raise eligibility to 200%.
Some governors complain that federal rules limit enrollment in
CHIP. They suggest that if states could offer less coverage or
charge
families a small fee for enrolling, more needy kids would
be helped.
Bush supports this approach to boost CHIP participation, but hasn't
offered specifics.
Gore vs. Bush
Beyond their
differences over how to handle health coverage for
the poor, the candidates
have fundamentally different approaches
to making insurance more affordable
to working families.
Gore supports tax credits equal to 25% of a
household's health
insurance costs for those who are not offered an employer
insurance
plan.
Bush favors an annual tax credit of up to $
1,000 per person or
$ 2,000 per family to cover up to 90% of private
insurance for
those who can't get it through their employer. The size of the
credit would depend on the family's income.
"Every low-income,
working family in America must have access
to basic health insurance, for
themselves and for their children,"
Bush said last spring. "Of all the bills
in life, medical costs
are the most unpredictable, and can be the most
expensive."
Paul Fronstin, a senior researcher at the Employee
Benefit Research
Institute, says he doesn't believe either plan would enable
many
more people to afford health insurance.
"Even after 25%
off," he says, referring to Gore's tax credit,
"it's still a lot of money
for a family."
Workers with employer-sponsored plans now pay an
average $ 1,656
a year for family coverage. But if a worker without an
employer
plan buys insurance through a managed-care plan to cover a family
of four, the average annual bill would be more than four times
higher: $
7,016. If that same family buys a traditional fee-for-service
plan, the cost
would be $ 8,752.
Still, Helms says Bush's plan "gives the insurance
industry incentive
to look at that pot of money and say, 'We need to design
some
new kinds of health insurance that are lower-cost.' "
However, few experts expect much to happen no matter which candidate
wins in November.
"Politicians have talked about the uninsured
in campaign after
campaign after campaign," says Karen Ignagni, president of
the
American Association of Health Plans, which represents HMOs. But
the
poor and the uninsured don't have political clout, she says,
so "when it
comes to after the election, the issue drops off
the radar screen."
GRAPHIC: GRAPHIC, Color, Frank Pompa, USA TODAY,
Source: Census Bureau; KPMG Survey of Employer-Sponsored Health Benefits,
1988-1996; Kaiser/HRET Survey of Employer-Sponsored Heath Benefits, 1999-2000;
Employee Benefit Research Institute; Bureau of Labor Statistics (Bar graph,
Map); PHOTO, Color, Steve Pope, AP; "Is this the right choice?" Carletta Brown
of Lake View, Iowa, goes without health insurance as she works and studies for
an advanced degree.
LOAD-DATE: September 22, 2000
