GOVERNMENT & MEDICINE

Groups seek common ground on uninsured

A new spirit of compromise inspires the crafting of proposals designed to provide health coverage to many of the 44 million Americans now without insurance.

By Susan J. Landers, AMNews staff. Jan. 31, 2000. - Additional information.

Washington -- Groups representing major players in the health care field have unveiled plans to provide health coverage for at least some of the nation's 44 million uninsured residents.

The issue is already a topic of debate among Democratic presidential contenders and will likely be on Congress' agenda this year.

The plans were presented at a day-long conference sponsored by the Robert Wood Johnson Foundation, the consumer advocacy group Families USA and the Health Insurance Assn. of America. Several of the plans took surprisingly similar incremental approaches to providing coverage that would rely on an expansion of current private and public programs.

And now is a good time to craft a plan, said Paul Fronstin, PhD, an economist with the Employee Benefit Research Institute. The economy is continuing its robust performance of the past several years, and unemployment is now at 4.1%.

"If we can't solve the problem today, we probably never will," Dr. Fronstin said.

Families USA, a supporter of the ill-fated Clinton health care plan of 1993-94, and HIAA, sponsor of the famous "Harry and Louise" ads that gave high visibility to the plan's opponents, are groups not usually found on the same side of an issue. But both presented proposals during the Jan. 13 conference that were fashioned with an eye toward compromise.

Joining them in providing details of their own plans were the AMA, the American Nurses Assn., the Catholic Health Assn., the Service Employees International Union and the U.S. Chamber of Commerce.

Families USA, not usually a fan of the private sector, recommended an approach that builds on the current employer-based system of health insurance through which 155 million Americans receive coverage. HIAA, typically no fan of public-sector intervention, recommended creating a new federal program modeled on the 2-year-old State Children's Health Insurance Program, or SCHIP, to care for those whose income is below 100% of the poverty level.

HIAA has also resurrected "Harry and Louise" for a series of print and cable television ads designed to help promote its program, called "InsureUSA." The ad campaign is costing HIAA $1 million and was set to run for 10 days, concluding on Jan. 30.

While Families USA still favors universal coverage, "the problem of the uninsured is of such overwhelming importance that organizations and people of good will must transcend ideological and other divides to make real progress -- immediately," said Ron Pollack, the group's executive director.

Chip Kahn, HIAA president, added, "It is critically important for the health insurance industry to join with other organizations, regardless of their philosophical stripes, to find ways to promote health coverage for those who lack it today."

Among their plans' specifics:

• Families USA would extend Medicaid to everyone whose family income is up to 133% of the federal poverty line, or $18,460 for a family of three in 1999; expand SCHIP to adults and children whose incomes are up to 200% of the poverty level; and provide nnew incentives for states to reach the 7.5 million uninsured children whose family incomes are below 200% of the poverty level. The group estimates that implementation of its plan would provide health insurance to more than half of those currently uninsured.
• HIAA would create a new state and federal program modeled on SCHIP that would provide coverage for those who earn up to 100% of the federal poverty level, or about $16,500 for a family of four; subsidize the cost of private health insurance coverage foor those with incomes between 100% and 200% of the poverty level; and allow individuals to deduct the cost of their health insurance from their federal income taxes.

The plan, HIAA estimates, would trim the ranks of the uninsured by more than half by the year 2004.

Plans proposed by the AMA, the American Hospital Assn. and the Catholic Health Assn. included variations on portions of the plans offered by Families USA and HIAA.

The AMA's plan, for example, focused on expanding SCHIP and Medicaid, establishing a system of income-related, refundable tax credits for purchasing health insurance, and creating opportunities for groups other than employers to pool risk. The plan, presented by AMA Past President Nancy W. Dickey, MD, also featured choice of coverage ranging from comprehensive benefit packages to catastrophic coverage offered through medical savings accounts.

A variety of views

Some groups took a different tack. The American Nurses Assn. proposed expanding Medicare to cover all Americans as a universal, "seamless" program of health coverage.

The Service Employees International Union also promoted universal coverage by 2005 and presented a plan that would enable families to choose their own health coverage that, at a minimum, would provide benefits equal to those offered to members of Congress under the Federal Employee Health Benefit Program.

The U.S. Chamber of Commerce focused its recommendations on market-based reforms that would expand the employer-based system.

None of the plans came with a price tag, but their costs are estimated to be in the billions of dollars. Conference moderator Susan Dentzer, a correspondent for "The News Hour with Jim Lehrer," said that failing to focus on reform's cost could allow for sharper focus on other aspects.

Judy Feder, PhD, dean of policy studies at Georgetown University, and Sheila Burke, executive dean at the John F. Kennedy School of Government at Harvard University, applauded the overall spirit of compromise at the conference.

"I sensed a willingness to stand back from the rhetoric," said Burke, aide to former Sen. Robert Dole (R, Kan.), who presided over the 1993-94 health care debate.

"The absence of compromise means polarization," said Dr. Feder, who worked on the Clinton plan for the White House, "and that makes things impossible."

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