Every January with Congress about to reconvene and the president set to deliver the State of the Union address, the healthcare industry gears up to capture the attention of legislators. With Medicare reform legislation complete and the number of Americans without health insurance rising, the uninsured has become the issue du jour.
A flurry of reports was released last week, all aimed at fixing the problem. But rather than prompting legislators and policymakers to find a solution, the reports may serve as background noise in the debate about how best to lower the number of uninsured, industry experts said.
"The real question is whether anyone will pay attention to any of these proposals in an election year," said Ed Howard, executive vice president of the Alliance for Health Reform in Washington. When elections loom, politics can blur the issues, he explained.
Of all the reports last week, the one from a committee formed by the Institute of Medicine that urged universal coverage by 2010 and focused on various models for achieving that goal drew the most attention. Almost lost in its wake were reports by Public Citizen, the American College of Physicians and the Blue Cross and Blue Shield Association that touched on the matter as well as a survey by the American Hospital Association indicating healthcare is once again a major concern of voters.
The U.S. Census Bureau reports 43.6 million Americans were uninsured in 2002 and as the country gears up for the presidential election, the issue promises to be a crucial point of debate. Healthcare has long been a key issue for Democrats, and nearly every Democratic presidential candidate has already unveiled a healthcare plan to lower the number of uninsured.
Republicans, meanwhile, have also grabbed hold of the issue. Senate Majority Leader Bill Frist (R-Tenn.) has created a task force, headed by Sen. Judd Gregg (R-N.H.), to address the problem. In the meantime, President Bush is expected to build upon his earlier plans to give tax credits to individuals and businesses and to expand the safety net for the indigent. Given a lack of federal action on the matter, states have also been pushing their own plans to reduce the number of uninsured (See related story below).
While the issue never really went away, it faded into the background during the last decade after President Clinton's proposal to revamp the healthcare system went down in flames. But after several years of skyrocketing healthcare costs and a bad economy, Americans have put healthcare back on the political agenda.
According to the AHA's survey, affordable healthcare tied for second place with terrorism and national security among Americans' concerns, outranked only by concerns about the economy and jobs. The AHA is pushing for universal coverage for individuals up to age 18 through extension of the Medicaid and State Children's Health Insurance Program. It is also calling for tax credits to employers and individuals, which it estimates would lower the number of uninsured low-income adults by 25%.
"What this survey shows is we are now at a moment of discontent (with the healthcare system) that is back at the level it was at in 1992," said Stanley Greenberg, president and chief executive officer of Greenberg Quinlan Rosner Research, one of the polling firms that conducted the AHA survey.
Also back is talk of establishing a single-payer system administered by the federal government, an idea that was all but politically unmentionable until recently. Democratic presidential candidate Rep. Dennis Kucinich of Ohio has made it the centerpiece of his health plan and in last week's Public Citizen report, researchers estimated national health insurance could save Americans at least $286 billion annually on paperwork, enough to offset the cost of covering the uninsured ($80 billion) and the cost of all out-of-pocket prescription drugs for seniors and those under 65 ($53 billion). The report was co-written by the Harvard Medical School and backed by Physicians for a National Health Program, which is pushing for a single-payer system.
But even the most ardent supporters acknowledge that a single-payer system remains out of reach in the short term. Indeed, while there have been cries for fundamental reform of the healthcare system by the federal government, Kate Sullivan, director of healthcare policy for the U.S. Chamber of Commerce, said Americans would not appreciate any drastic changes to the way they receive their healthcare.
Sullivan pointed to the early 1990s, when concerns about the system led to little legislation, saying, "Policymakers learned not to disrupt the way Americans get their care. ... People said, `I like my healthcare.' "
Presenting the Blues association's ideas for covering the uninsured, Mary Nell Lehnhard, senior vice president of policy and representation, said an incremental approach has the best chance of success. "There is the reality of budget constraints and what we can afford," she said.
The IOM report said that short of a major system overhaul, Americans would remain in jeopardy of losing their health insurance.
The report looks at four approaches to solving the problem. One option was to merge Medicaid and SCHIP programs, making Medicare available to 55-year-olds and giving a tax credit to moderate-income individuals. Another possibility would mandate that employers provide health coverage to workers. A third alternative would offer tax credits to individuals and require them to buy private insurance while merging public programs for those not covered at work. And the final approach would create a single-payer system administered by the federal government.
The other studies released last week took more incremental approaches. The Blues association is pushing for combining the expansion of the Medicaid and SCHIP programs and creating tax credits for small-business owners and individuals, while the American College of Physicians wants the federal government to guarantee coverage for all individuals who fall at or beneath 150% of the federal poverty level.