As the presidential election countdown continues, the candidates' healthcare plans remain a key voter concern. And though prospects may shift before the general election, from a healthcare perspective who becomes the next president may boil down to how much Americans are willing to pay to address the uninsured problem-$895 billion or $72 billion over 10 years.
The Democratic field may narrow after March 2, when several large states including California and New York hold primaries, but last week's primaries and caucuses further solidified Massachusetts Sen. John Kerry's status as the front-runner, putting him in position to challenge the president in the fall. This week, Nevada, Tennessee, Virginia and Washington, D.C., will hold caucuses or primaries.
Exit polls last week showed healthcare was the second-highest concern among voters, trailing only worries about the economy and jobs. And in Lansing, Mich., representatives of President Bush and five of the Democratic candidates convened to push healthcare proposals, less than a week before that state was to hold its caucuses.
Like the other Democratic candidates, Kerry has put forth a detailed plan for fixing the country's healthcare system by tackling the uninsured problem. Using an approach that incorporates private and public initiatives, his proposal carries a price tag of $895 billion, funded by repealing some of Bush's tax cuts and through cost-saving measures such as malpractice reform and greater use of generic drugs.
In contrast, Bush's approach to providing coverage to the uninsured is focused almost exclusively on getting more people into private health plans. The cost of his proposal is less than one-tenth of Kerry's.
In Lansing last week as the candidates waited for primary results, representatives for Bush, Kerry, Wesley Clark, Howard Dean, Rep. Dennis Kucinich and Sen. Joe Lieberman outlined their candidates' healthcare proposals.
Hosted by Public Policy Associates, a Lansing-based research firm, and attended by healthcare executives, the forum offered a chance to reiterate the candidates' policies. Like most states, Michigan is facing huge budget deficits that have constrained its Medicaid and other public health programs.
While receptive to the presentations, local experts expressed concern about the proposals. For example, Patrick Babcock, director of public policy at the W.K. Kellogg Foundation, said that while Kucinich's plan for a government-run, single-payer system may have its advantages, it could create access problems because of its reliance on a current system that is flawed.
All of the Democratic proposals aim to achieve universal or near-universal coverage, while Bush's takes an incremental approach. One of the contrasts has been the vast difference in cost between Bush's proposal and those of the Democratic contenders.
In response, Michigan state Rep. Lisa Wojno, who represented Kerry at the forum, said, "We are already paying for healthcare costs with rising premiums and uncompensated care."
Under Kerry's plan, the Medicaid program would be expanded to provide coverage to nearly every child in the country as well as some 13 million adults, with the federal government paying for it. Tax credits would also be provided to small businesses and their employees to help pay for coverage and allow large employers to join the same health benefits program currently available to members of Congress.
He also would create a "premium rebate" pool in which the federal government would pay 75% of the costs of care for Americans whose health costs exceed $50,000 and are covered through their employers. This would spare employers the high cost of covering such employees.
"It's a very interesting part of his proposal because it addresses not only the 44 million people without insurance, but the 150 million who do (have it)," said James Mongan, president of Partners HealthCare System.
Kerry's plan would cover 27 million Americans, according to the Commonwealth Fund.
Bush is pushing for tax credits for people without access to employer-sponsored coverage or public programs. He also supports association health plans and wants to expand health savings accounts by allowing for a tax deduction equal to 100% of the premium. Last year, his administration tried moving Medicaid to a block-grant approach, a strategy the administration said would make it easier for states to expand coverage. The plan met with heavy resistance from many fronts and was never adopted.
In his proposed 2005 budget released last week, Bush reduced funding for the uninsured to $72 billion from $89 billion budgeted for 2004. Based on the $89 billion figure, the Commonwealth Fund estimated his tax credit proposal would cover 4 million uninsured.
"Seventy-two billion is a pittance and that's not going to do anything," Mongan said.
The Rev. Michael Place, president and CEO of the Catholic Health Association, however, said he was reserving judgment of the president's plan, saying Bush may be just waiting to see how the issue plays out with the Democratic candidates and the public before he reveals more ideas.