Virtually silent about healthcare since the start of his presidential bid, Texas Gov. George W. Bush unveiled plans to help the poor receive access to care during several speeches in mid-April.
Bush's move was widely seen by political observers as an attempt to position himself as a "compassionate conservative" and wrestle the issue away from Vice President Al Gore, who has made healthcare a key component of his campaign.
Healthcare has been a winning issue for Democrats in general and Gore in particular, so "it's not surprising that there wouldn't be a lot of initiative" by Bush, says Ed Howard, executive vice president of the Alliance for Health Reform in Washington, a nonpartisan, not-for-profit organization. "This isn't the way you woo the Republican primary electorate," which is generally less concerned with healthcare than with taxes, defense and the size of government.
Gore, by contrast, unveiled extensive plans in the fall to alter healthcare and was continually challenged on the issue during the Democratic primaries by former New Jersey Sen. Bill Bradley, who proposed an even grander plan.
The centerpiece of Bush's proposal calls for $34.7 billion to be spent over five years in tax credits, tax incentives and vouchers to help lower-income Americans buy health insurance. Under the plan, those without insurance and who don't qualify for Medicaid are eligible for tax credits up to $2,000 per family or $1,000 per individual to cover up to 90 percent of the cost of insurance. The maximum benefit for families would be for those earning $30,000 or below. The credit would phase out as income rose, tapering off at $45,000 a year for individuals and $60,000 for families.
In addition, Bush seeks:
- $4.3 billion to be spent over five years to expand service to poor inner cities and rural areas;
- $3.6 billion to be used over five years in federal aid to create 1,200 new community and migrant health centers;
- $500 million to make grants for pilot programs to address specific health concerns, such as diabetes;
- To encourage multistate health plans among small businesses and expanding limits on medical savings accounts and flexible benefits accounts;
- A patient bill of rights similar to the one that passed in Texas. The Texas law is less expansive than the patients' rights bill passed by the U.S. House in that it requires patients to exhaust more grievance mechanisms before being allowed to go to court. Bush opposes a federal bill that supersedes state laws, so legislation would apply only to states with no law. Bush allowed the Texas law to be enacted without his signature, a sign he did not wholeheartedly endorse the measure until he faced criticism on the campaign trail.
Gore has also come out in favor of:
- Giving Medicare recipients a prescription drug benefit, which would cost $200 billion over 10 years;
- A strong patient bill of rights;
- Using the budget surplus to keep Medicare solvent;
- Outlawing genetic discrimination.
At this point, Howard says, it's unclear how important healthcare will be as an issue in the race. If healthcare moves to the top of the agenda, it "does seem likely to favor Gore as people trust Democrats more than Republicans to solve these kind of problems." To fight back, Bush may try to attack Gore's plan as big government, he says.
One key factor is whether voters will be as concerned with healthcare as they are with the economy. While the number of uninsured Americans is great, millions have received health benefits as a result of the growth in new jobs. Americans also are less fearful about losing their health benefits if they quit because they believe they soon will be able to find another position. Should the economy contract or experience slower growth, more Americans may fear that their jobs--and their benefits--are in danger and voice their fears in polls and ultimately in election returns.
In other Washington news, the House and Senate conference committee trying to work out a compromise patient bill of rights is not making much progress. Lawmakers have yet to deal with the two most vexing issues: how many Americans would be covered by the bill and the right to sue health plans. Still, lawmakers say they have made progress in agreeing on an independent appeals process.
While it's unclear whether lawmakers will compromise on the two key issues, discussion has included capping damages for lawsuits or a deal in which Republicans allow lawsuits if Democrats agree to expand medical savings accounts.
Meanwhile, the bill that would allow doctors to collectively bargain with health plans and insurers was passed by the House Judiciary Committee by a vote of 26-2. But the bill must first get to the floor and then garner enough support to pass, neither of which are guaranteed.
The Education and Workforce Committee and the Ways and Means Committee asked House Speaker Dennis Hastert (R-Ill.) to delay a vote, fearing that the bill would drive healthcare costs higher and hurt employer-sponsored health plans. Both committees believe they have at least some jurisdiction over the bill, and sending it back to committee would block movement for the rest of the year. At this point, it's unclear whether Hastert will schedule the bill for a floor vote or send it back to those committees.
Also, doctors are likely to receive more Medicare pay next year as a result of a higher Medicare physician spending target. HCFA adjusted its sustainable growth rate (SGR) to 5.8 percent from 2.1 percent due to AMA-backed legislation that forced the agency to use more up-to-date information. As a result, HCFA can spend $1.8 billion more on doctor services without triggering a pay cut next year.
The SGR is the target for Medicare physician spending. If spending on physician services exceeds the SGR, the government lowers the following year's physician payment update. If expenditures fall below the target, the government increases the following year's payment update. Under the 2.1 percent SGR, payments to doctors would have dropped because growth would have exceeded the target.