The centerpiece of Democratic
presidential candidate Al Gore's health care agenda is his promise to
make sure every child in America has health insurance by 2005.
For voters who want to give the Vice President a mandate to achieve
this goal over the next five years, it seems only fair to examine the
record about what the Clinton/Gore administration has done for uninsured
children during the last eight years.
It doesn't look good.
When President Clinton and Vice President Gore were elected in 1992,
8.7 million children were uninsured – or 12.7 percent. But by 1998, the
most recent year for which Census Bureau figures are available, 11
million children were uninsured, or 15.4 percent. That's a 21 percent
increase in the number of uninsured children during just their first six
years in office.
All uninsured rates rise
To be fair, it is not only the number of
uninsured children that has increased during the last eight
years, but also the number of Americans overall. In 1992, 38 million
Americans lacked health insurance. By 1998, 44 million were uninsured.
The fact is that children are uninsured for the same reasons their
parents are: They are in lower income families, they are Black, Hispanic
or foreign-born, and they are in households where the breadwinner moves
frequently between jobs. All of these demographics point to an increased
risk of being uninsured, whether children or parents. You can't fix one
without the other.
The health care reforms that the Clinton/Gore administration offered
and implemented appear to have backfired. That is particularly alarming
because Mr. Gore says he plans, with one refreshing exception (more on
that later), to continue the major programs of the Clinton
administration on health care.
He says, for example, that he wants to expand the struggling State
Children's Health Insurance Program (S-CHIP) so that it covers not only
uninsured children, but their parents as well. He wants to allow
millions more people to buy into Medicaid, the government health program
for the poor. He wants to allow early retirees as young as age 55 to buy
into Medicare, the government health program for the elderly. And he
wants to tack a hugely expensive and misguided government-run
prescription drug benefit onto this already failing program.
Major expansion of government
programs
These are not just small steps but major steps to lure millions more
Americans into some form of government run health program.
When Mr. Gore first announced his health program, he said he would
institute a mandate that all children MUST be covered by health
insurance. But a children's mandate is no more likely to work than the
employer mandate that was a centerpiece of Mr. Clinton's failed plan to
institute universal coverage for everyone.
Who's to blame?
It is difficult for Mr. Gore to blame the Republican Congress for the
rising number of uninsured. In 1996, Congress passed the Kennedy
Kassebaum bill, imposing major federal regulation on the health
insurance industry in an effort to increase access to coverage. Then in
1997, Congress enacted the $48 billion S-CHIP program – the largest new
government entitlement program since Medicare and Medicaid – to provide
health insurance for children with joint federal-state spending.
The administration actively supported both bills and has been even
more active in implementing associated regulations to get their agenda
in place. For example, when governors began to implement S-CHIP, the
Clinton administration virtually insisted that they use the new program
to expand Medicaid. While many governors resisted, most ultimately gave
in and now are trying to make the rules as simple as possible to get
kids enrolled.
Resisting bigger government
But parents themselves are resisting signing their children up for a
welfare program – which is what Medicaid is – just as they rejected the
sweeping government-dominated plan that Mr. Clinton proposed in 1993.
The solution to the rising number of uninsured lies not in expanding
government programs but in liberating the private, competitive health
sector to create more attractive, more affordable health insurance for
American families.
A fresh idea
The bright spot on the Democratic horizon is the refreshing exception
to expansion of big government programs, namely Mr. Gore's support of
tax credits for the uninsured.
Amazingly, Mr. Gore and Gov. Bush of Texas are on the same track in
proposing this fundamental change – a change that also has broad
bi-partisan support in Congress.
Both are embracing the fresh idea of providing tax credits for the
uninsured to purchase health insurance. The candidates' two approaches
are different: Bush would offer a $2,000 credit to families while Gore
would offer a credit worth 25% of the cost of a policy. But while they
disagree on the technique, the idea is right.
As a first step, instead of putting more children into Medicaid, the
S-CHIP money could be used to provide refundable tax credits or vouchers
to families to help families purchase private health insurance. That is
a directive the Clinton/Gore administration could take care of right now
– if their interest is genuinely in doing the right thing for children,
and not using the issue for political gain.
