HEADLINE: Next Big Health Debate: How
to Help Uninsured
BYLINE: By MILT
FREUDENHEIM
BODY: Concerned
that millions of workers are losing their health insurance coverage at a time
when health costs are surging, employers and Congressional leaders say the next
great health care debate will be over how to help the uninsured.
Senator John B. Breaux of Louisiana, an influential moderate Democrat,
and leaders of the nation's largest pension plans are trying to drum up support
for universal health insurance, a proposal that has received little attention,
except from labor unions and liberals, since the collapse of the Clintons'
health plan.
The House Republican leaders -- Speaker
J. Dennis Hastert and Dick Armey, the majority leader, who is retiring -- have
been working on a package of less sweeping measures, including tax credits for
the uninsured, in hopes of defusing the issue before the Congressional elections
this fall.
Kate Sullivan, health policy director of the
United States Chamber of Commerce, predicts that the issue will heat up next
month when the Census Bureau announces the number of uninsured for last year,
which may climb above 40 million -- from 38.4 million in 2000 -- and when the
Kaiser Family Foundation reports the latest double-digit increases in health
costs.
On costs, "the 2003 and 2004 projections are
going to be much worse than the 2002 projections," said Helen Darling, president
of the Washington Business Group on Health, a group of large employers.
One of the nation's largest purchasers of health care, the
California Public Employees Retirement System, or Calpers, which covers 1.2
million people, recently agreed to 25 percent increases in health premiums for
next year. The state's $1.58 billion in spending for the Calpers health budget
is expected to double in three years, said William Crist, an economist who is
president of Calpers.
As retirees are forced to spend
more of their funds, higher payments for health care "are essentially taking
away pensions," he said. Mr. Crist, who said he was "trying to get support for
coalitions working toward a political base for universal coverage," recently
sent invitations to other big state pension plans to join the National Coalition
on Health Care, a Washington-based group that favors universal insurance.
The Commonwealth of Massachusetts Group Insurance
Commission, the New York State Teachers' Retirement System and the New York
employees retirement fund -- which is run by H. Carl McCall, the state
comptroller and candidate for governor -- have all joined the coalition.
Paying for the uninsured is making health care even more
expensive for private employers and government programs. Corporations, consumers
and taxpayers end up covering the escalating health costs of people who lost
jobs in the economic slowdown or who risk going without expensive insurance.
"The uninsured should be a big issue in the coming year,"
said Bruce E. Bradley, director of managed care plans at General Motors.
Adding to the urgency, employers are passing along more of
those costs to workers and retirees, and they are increasingly angry and
frustrated about those costs.
"We need to do something
about the coming meltdown in health care financing," said Larry Atkins,
coordinator of the Corporate Health Care Coalition, which includes big companies
that supported the Clinton health plan in 1994. "I think the issue is going to
pop up in the 2002 elections."
At the Heritage
Foundation, a conservative research center, Robert Moffett, a health policy
expert, said: "The climate is increasingly ripe for a re-examination of old
ideas about health insurance." Heritage is promoting its own longstanding
proposal for universal coverage, to be financed by tax credits.
Lack of, or inadequate, coverage is cited along with problems with
Medicare as the two "most important health care issues for government action" in
a public opinion survey published on the Internet this month by Health Affairs,
a policy journal.
"These findings suggest that this
issue may emerge as an important one in the post-2002 Congressional election
term," said the survey director, Robert J. Blendon, a researcher at the Harvard
School of Public Health.
Charles E. Grassley of Iowa,
the ranking Republican on the Senate Finance Committee, said incremental or
piecemeal measures still had the best chance of paring the numbers of uninsured.
He suggested "a combination of something like medical savings accounts, tax
incentives and refundable credits for individual insurance policies."
But Tom Daschle of South Dakota, the Senate majority
leader, said recently that "many of us have concluded that incremental
approaches to health care are not the solution."
A
Senate aide said Democrats were expected to work on "a dual track -- seeking to
expand the Child Health Plus subsidies to parents," as New York and a few other
states have done, as well as "laying down markers for a debate next year on
universal coverage."
Labor unions, which have long
supported universal coverage, are preparing for tough bargaining over health
benefits in the coming months and possibly strikes, said Gerald Shea, assistant
to the president of the A.F.L.-C.I.O., John J. Sweeney.
"Wages are being traded for continuing health coverage," Mr. Shea said.
Union workers at Hershey Foods walked out for seven weeks in the spring over a
demand by the company that employees pay more for their health benefits.
Rob McGarrah, an A.F.L.-C.I.O. senior policy aide, said,
"Universal coverage is back on the table."
Senator
Breaux, who headed a bipartisan commission on overhauling Medicare and is active
in the politically charged debate over a Medicare prescription
drug benefit, has been discussing approaches to universal coverage with a
number of colleagues, including Mr. Grassley and Senator George V. Voinovich, a
conservative Republican from Ohio.
As Mr. Breaux noted,
coverage is available now for the elderly in Medicare, for veterans from the
Department of Veterans Affairs, for the poor under Medicaid and for millions of
workers in employer-sponsored health plans.
"As a
nation, it is very important to have national insurance for everybody," he said
in an interview.
Each existing program has "its own
bureaucracy and rules and regulations and duplication of the others," he said,
adding: "We need to get a lot more younger and healthy people in the insurance
pool, hopefully reduce the costs for the people who have insurance now."
Existing programs could be reorganized and continued, he
suggested, with the government making sure that health care is "delivered
properly and also that it is paid for." He mentioned subsidies for low-income
people that would be adjusted according to income.
Both
companies and their employees get tax advantages for their health costs, he
noted, saying: "There is a lot of money in the system already. I think we can
rearrange it and spend it more wisely."
Deductions for
medical expenses reduce state and federal tax collections by $140 billion a
year, Mr. Moffett of the Heritage Foundation said.
The
White House and many Republicans, including Senator Grassley and Representative
Bill Thomas, chairman of the House Ways and Means Committee, want to provide tax
credits, which they say would make insurance affordable for many uninsured
people.
Democrats in the Senate have opposed the
credits. "Tax credits would undermine the good employment-based coverage on
which most Americans depend, forcing them to rely on the often-volatile
individual insurance market," Senator Edward M. Kennedy of Massachusetts
said.
In a compromise within the recently passed trade
bill, however, both House and Senate voted to include a modest tax credit
measure and new federal money to help pay for health care for workers who lose
jobs as a consequence of future trade pacts.
http://www.nytimes.com
GRAPHIC: Photo:
Senator John B. Breaux, who has been examining approaches to universal health
insurance. (Associated Press)(pg. C2)
Graph:
"Without Coverage" Although the percentage of Americans without
health insurance fell as the economy boomed, the number is expected to grow to
more than 40 million people, from 38.4 million in 2000.
Graph tracks AMERICANS WITHOUT HEALTH INSURANCE Percentage of total
population, nonelderly since 1990.
(Source:
Employee Benefit Research Institute)(pg.
C2)
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