The right alchemy may exist this year for Congress to shrink the ranks of the uninsured.
The simmering brew-a pinch of budget surplus, one noisy coalition of interest groups, a thimbleful of presidential support and a festering problem that promises to worsen-just might be the potion that can push through a bill to provide insurance coverage for more Americans.
The Health Insurance Association of America and Families USA-strange bedfellows, indeed-have found common ground on a strategy to reduce the estimated 42 million people (as of 1999) who lack health insurance. Congressional leaders now seem poised to achieve that same kind of unity on the issue.
As is always the case with this issue, the stumbling block is money. In a year when Congress is debating a massive tax cut and a Medicare prescription drug benefit, the question is whether the federal budget has room for a significant expansion of healthcare coverage.
President Bush's proposed budget includes $70 billion to $80 billion during 10 years for refundable tax credits to help the uninsured buy private coverage, according to Families USA Executive Director Ron Pollack. This total is below Bush's campaign proposal to spend $132 billion on the program.
Sen. William Frist (R-Tenn.) says he is "very positive" about the prospects of meaningful legislation to address the uninsured being completed this year.
A bipartisan group of senators plans to introduce legislation this week for refundable tax credits for low- to moderate-income individuals and families to buy health insurance, the same strategy Bush has championed. Sponsored by Sens. Tom Carper (D-Del.), Frist and James Jeffords (R-Vt.), the Relief, Equity, Access and Coverage for Health (REACH) Act would provide refundable insurance tax credits or vouchers of $1,000 for individuals and $2,500 for families.
Comparing the American healthcare system to a patchwork quilt made of private insurance and various government programs, Carper says, "There are a couple of holes in that quilt that still remain, and refundable tax credits will fill one of those."
The access law would reduce the uninsured rolls by an estimated 10 million to 17 million people, according to the sponsors.
Sens. Edward Kennedy (D-Mass.) and Olympia Snowe (R-Maine) will also introduce bipartisan legislation this week calling for the expansion of public insurance programs. The Family Care Act would give states $50 billion during 10 years to allow Medicaid and the State Children's Health Insurance Program to cover parents of children enrolled in the plans.
Yet another bipartisan bill to be introduced by Sens. Gordon Smith (R-Ore.) and Ron Wyden (D-Ore.) will propose an expansion of public programs and tax refunds for employers to buy insurance for their employees. This mix of strategies represents the compromise solution reached by Families USA and the HIAA.
The coalition formed by the groups also includes the American Hospital Association, the American Medical Association, the American Nurses Association and several unions. It has run full-page ads promoting healthcare access in the Washington Post and other publications. According to Pollack, the ad campaign, partially funded by the Robert Wood Johnson Foundation, is intended to draw attention to the problem of the uninsured, not to offer solutions.
So far, nobody involved in trying to fix the uninsured problem seems particularly attached to any one solution.
Sens. Snowe and Lincoln Chafee (R-R.I.) are sponsors of both REACH and the Family Care Act.
Frist says he is open to the potential combining of refundable tax credits and expansion of SCHIP. "There is going to be a marriage of the two as we move through" the legislative process, he says.
The number of people without insurance, though declining in 1999 for the first time in 12 years, is expected to climb again in the near future. The brief dip has been attributed to the implementation of SCHIP, which has helped reduce the number of uninsured children by 1 million, and the strong economy, which allowed employers to maintain generous insurance coverage while healthcare costs remained relatively flat.
Because of the widespread interest in finding a solution to the problem, the debate about which approach to fixing the uninsured problem is better has been muted. Critics of refundable tax credits say $2,500 for each family doesn't go very far in paying the $6,348 average family premium for employer-sponsored group coverage. Also, costs will be prohibitive for individuals trying to buy insurance on their own without significant market reforms, such as creating purchasing pools and mandating community rating.