GOVERNMENT & MEDICINE

Bush weighs in on affordable insurance

George W. Bush's support of tax credits to help the uninsured buy coverage earns applause from some physicians, but others say his plan falls short.

By Susan J. Landers, AMNews staff. May 1, 2000. Additional information

Washington -- Advocates for universal health coverage had reason to celebrate when Texas Gov. George W. Bush recently introduced his health care proposal. Now both presidential candidates have made affordable health insurance a high-profile issue for this fall's election.

Vice President Al Gore had introduced his plan to extend coverage to more uninsured people earlier in the campaign.

"We are pleased that both candidates are addressing the health care issues and particularly the issue of the uninsured," said AMA Board Chair D. Ted Lewers, MD.

Harvard University School of Public Health professor Robert J. Blendon, ScD, also applauded Bush's entry into the national debate over the uninsured.

"I think there was a possibility that, if Bush had chosen not to discuss the uninsured, many in his party would have followed suit," Dr. Blendon said. If Bush were to win, he added, Republican party members could say, " 'Look, we never talked about this uninsured problem; we aren't even going to go near it.' "

The plan put forward by Bush in mid-April includes as its centerpiece a $2,000 refundable tax credit for U.S. families to use in purchasing health insurance and a $1,000 tax credit for individuals. The credit would be available only to those who have no health insurance and whose incomes are too high to allow them to qualify for Medicaid.

The plan also would ease regulations in the State Children's Health Insurance Program, or SCHIP, and transform the 3-year-old state and federal effort into a state block grant program.

In addition, small businesses would be able to band together under the Bush plan to purchase health insurance for employees at more affordable rates; individuals who invested in flexible savings accounts would be able to carry funds over from one year to another; and medical savings accounts, set to expire this year, would become a permanent option.

Gore, on the other hand, has proposed a program that is based more broadly on the expansion of government programs, including Medicare and Medicaid, and relies less heavily on tax credits.

Dr. Lewers said many features of the Bush plan were similar to those included in an AMA proposal designed to broaden access to health insurance. "We are particularly pleased that Gov. Bush has seen fit to include tax credits, as that is one of our policy issues," he said.

Dr. Lewers also praised both Bush's and Gore's emphasis on expanding the SCHIP program, and he pledged that the AMA would continue to work with both as they fill in their plans' details.

The American College of Physicians--American Society of Internal Medicine congratulated Bush on developing a plan, but faulted both candidates for failing to go far enough toward covering all 44 million uninsured Americans.

"A lack of health insurance is just as much a risk factor as using tobacco, abusing alcohol or failing to wear seat belts," said the group's president, Whitney Addington, MD.

Dr. Addington said he, like Dr. Lewers, was pleased at Bush's reliance on tax credits and the expansion of SCHIP. Similar ideas were included in a plan the internist group released last year.

Although ACP-ASIM approves of the use of "sequential" reforms that provide coverage to poorer Americans as a start, "the job won't be complete until everyone is covered," said Dr. Addington.

Naysayers speak out

Quentin Young, MD, an internist and coordinator for Physicians for a National Health Program, took issue with an incremental approach to providing coverage. "The folly that we are taking small steps toward an overall solution is just that, a folly," he said.

It is particularly "uncivilized," he said, that the "richest country in the world should have 11 million children without insurance."

Dr. Young did, however, salute a Bush proposal to spend $3.6 billion over five years to increase the number of community health centers. A recent Institute of Medicine report emphasized the need to support clinics and public hospitals as they struggle to provide free and low-cost care to those without health insurance. The Gore plan also calls for strengthening the nation's safety net.

Several critics of the Bush proposal have noted that his tax credits are not generous enough to allow poor people to purchase health coverage, especially a family policy.

"A typical family health plan is likely to cost approximately $5,000 to $6,000 a year," said Ron Pollack, executive director of Families USA. Low-income families still will be unable to afford coverage, he said.

Pollack also faulted Bush's proposal to expand medical savings accounts. "As young, healthy and wealthy families sign up for MSAs," he said, "sicker and poorer people will be left alone in insurance pools and their premiums will become increasingly unaffordable."

Gore adviser Richard Boxer, MD, a Milwaukee urologist, predicted that Bush will have very little money to pay for his health proposal because he has already spent it on a promised tax cut.

"We believe that although he is talking the talk, there is no money to walk the walk," said Dr. Boxer, a Gore supporter for about 17 years.

Back to top.

Texas Gov. George W. Bush recently added to his presidential campaign platform a plan to expand health insurance access to the 44 million Americans who lack coverage. It would:

• Provide a $2,000 refundable tax credit to help low-income families purchase health insurance. Individuals would receive a $1,000 credit.
• Lift restrictions on the State Children's Health Insurance Program to transform it into a flexible block grant program.
• Allow small businesses affiliated through association membership to pool together to use their buying power to purchase more affordable health insurance.
• Make medical savings accounts a permanent option and lift the 750,000 cap on the number of accounts that can be established.

Back to top.

Box: Health reform plan