To some degree, every presidential election is a job review of the incumbent. Just as the economy and Iraq will weigh heavily on voters' minds come November, the state of the nation's healthcare system may shape how Americans cast their votes in the fall. And for President Bush, that may not turn out to be such a good thing, some experts said last week.
"We have a system that's broken and needs attention and that hasn't been a priority with this administration," said Ed Howard, executive vice president of the Alliance for Health Reform, a nonpartisan Washington think tank.
Sen. John Kerry of Massachusetts swept through Democratic primaries and caucuses in 10 states last week, ensuring he will be the Democratic nominee to face Bush in November. Sen. John Edwards of North Carolina, who dropped out of the race, was the last viable Democratic opponent.
Immediately, the Kerry campaign went on the offensive, calling Bush's campaign ads "revisionist history" and taking him to task over his record on domestic issues, including healthcare. "He said he would make healthcare more affordable, but 2.8 million more have lost their health insurance," Kerry said last week.
Kerry's campaign strategy on healthcare is still unclear, as is how hard he can hammer away at his incumbent rival. Former Vermont Gov. Howard Dean questioned Kerry's record on healthcare, saying he had sponsored few healthcare bills during his Senate tenure and gotten even fewer passed. Given that, Kerry may be open to attacks himself.
Bush has his supporters, most of whom point to the Medicare Prescription Drug, Improvement and Modernization Act of 2003 as the healthcare crown jewel of his administration.
"There isn't a president who has done anything that comes close to this," said Tom Scully, who served in the Bush administration as the CMS administrator from 2001 until last December. "If you look at the substance (of the legislation), President Bush stuck his neck way out there. This is the biggest thing to happen in 38 years," since Medicare came into existence in 1965, he said.
But even before it was signed into law, critics were lining up to take shots at the bill, saying that it was more of a bonanza for drug manufacturers and managed-care companies than seniors (See related editorial, p. 30).
"I'm not sure the Medicare legislation will be much of a legacy once people start using it," said Mila Kofman, assistant research professor at Georgetown University's Health Policy Institute.
The administration has maintained that seniors will benefit significantly once the legislation takes full effect in 2006.
It is on the issue of the uninsured, however, that Bush may find his healthcare policies under attack. The percentage of Americans without insurance hit 15.2% in 2002, up from 14.6% in 2001.
As the election draws nearer, voter concern about healthcare costs and lack of access to care are likely to prod the administration into creating a more detailed and comprehensive healthcare platform, Kofman said.
The administration has several proposals on the table that are aimed at increasing health insurance coverage, including expanding tax credits for individuals to purchase health insurance in the private market, expanding health savings accounts and supporting association health plans.
By contrast, Kerry's healthcare proposal would expand the Medicaid program and State Children's Health Insurance Program to cover more adults and would create a "premium rebate pool" whereby the federal government would pay for 75% of healthcare costs of individuals when they exceed $50,000.