Two months after taking office, President Bush has made good on his campaign pledge to address the problem of the uninsured.
Bush proposed about $70 billion in tax credits over 10 years for those who don't have coverage through their employers and don't qualify for Medicaid, says Ronald Pollack, vice president and executive director of Families USA, a nonpartisan organization dedicated to expanding coverage. Pollack says that while the number wasn't explicit in "A Blueprint for New Beginnings," an overview of President Bush's fiscal year 2002 budget that was released in March, the Office of Management and Budget provided him with the number.
The Bush administration proposes an overall federal budget of $1.96 trillion in fiscal 2002 compared with $1.86 trillion in fiscal 2001. Specifically, Bush plans to spend $368 million on Medicare and Medicaid in 2002, compared with $345 billion in 2001. In addition, Bush plans to spend $2.9 billion on a line item called "Invest in Health Care," for which no comparable number exists for fiscal 2001.
"The fact that there's money on the table is very important," Pollack says.
While the money is significant, it is about half of what Bush promised in his campaign and "unlikely to reach a significant number of people," Pollack says.
"The tax credit is too small and only pays for a small fraction of the premium costs that somebody would need to come up with if they purchased coverage."
In the document and in stump speeches, Bush also reiterated his campaign promises of reforming Medicare and helping low-income seniors pay for prescription drugs.
Larry Levitt, vice president of the Kaiser Family Foundation in Menlo Park, Calif., agrees that Bush's proposed $1,000 tax credit for an individual and $2,000 for a family falls far short of the typical annual premium of $6,000.
Though pleased with the proposed funding, Robert Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians-American Society of Internal Medicine, says "we want to see the administration getting behind" the approach of Sen. James Jeffords (R-Vt.).
Jeffords plans to introduce the Relief, Equity, Access and Coverage for Health bill, which would provide $2,500 tax credits for families. It would also provide Americans who do have access to employer-based insurance a $400 tax credit for an individual and a $1,000 credit for families.
Bush also seeks in his blueprint to expand healthcare access to more Americans through clinics, spending $124 million to increase the number of community health centers, which currently service 11 million people, to 4,200 from 3,000.
However, the funding is simply not enough, says Richard Roberts, M.D., president of the American Academy of Family Physicians and a professor of family medicine at the University of Wisconsin at Madison. "There are 45 million uninsured and 20 million underinsured. From a practical standpoint, it's nowhere going to meet the needs. From a philosophical standpoint, you don't want to be creating a two-tier system."
"We don't think the answer to the problem is propping up the safety net," Doherty says.
Consistent with his campaign messages, the blueprint calls for a total of $153 billion over 10 years to fund Medicare reform and "Immediate Helping Hand," a program to provide prescription drugs for low-income seniors through the states.
Like many items in the blueprint, however, there are "not a lot of details on how that (Medicare reform) money would be spent," Doherty says. Bush is likely to make the specifics of his fiscal year 2002 budget clear this month. Pollack, Roberts and others are keen on finding out the specifics of the drug program to see whether it will impose standards entitling residents of different states to similar benefits.
What is clear is that Bush is proposing a healthy $
2.8 billion increase to $23.1 billion for the National Institutes of Health, a measure which will likely sail through unopposed on Capitol Hill.
The blueprint also suggests ending a program that provides grants to hospitals and other healthcare facilities to train primary care physicians, based on the view that market forces have produced enough doctors. Doherty says the ACP-ASIM supports continued funding because many underserved areas of the country would benefit from the program.
While Bush's blueprint and speeches frequently mention healthcare topics, his key agenda, however, remains tax reform, says Roberts.
"Healthcare is in the top five (priorities), but my sense is that he is responding, more than having real enthusiasm for the issue," Roberts says.