As Washington politicians unveiled their solutions to the problem of the uninsured last week, providers saw much to their liking in both the Republican and Democratic proposals.
Using Cover the Uninsured Week as a backdrop, members of both parties unveiled divergent proposals to bring down the number of uninsured Americans, estimated at 43.6 million in 2002. Sen. John Kerry, the presumptive Democratic presidential nominee, also made healthcare the focus of speeches he gave at several campaign stops.
Providers were reluctant to come out and endorse one proposal over another, and for good reason. Though fundamental differences remain between each party's proposed solution, there also are similarities, including the incremental nature of the approaches.
For Democrats, it is a significant strategic shift. Where once universal coverage was a rallying cry for the party, many party leaders have now concluded that it may not be feasible in the near term. "Given the complexion of Congress right now, it's impossible," said Rep. John Dingell (D-Mich.). Last week Dingell introduced legislation that would provide $50 billion in federal funding to expand Medicaid and the State Children's Health Insurance Program to allow parents of children in the programs to enroll.
Before that, a Republican Senate panel put together by Majority Leader Bill Frist (R-Tenn.) unveiled a broad spectrum of recommendations for the Senate Republican Conference to consider. The plan includes expanding health savings accounts, using tax credits and reforming medical liability laws. The recommendations would bring down the number of uninsured by as many as 29 million, the panel estimated.
Sen. Judd Gregg (R-N.H.), chairman of the panel and the Health, Education, Labor and Pensions Committee, said he hopes to soon draft legislation incorporating the proposals.
Though members of the Senate panel said their suggestions were not focused on pushing any GOP ideology, the recommendations center on Republican stands that had already been put forth or supported by the White House. "It's an attempt to make common-sense changes," to the healthcare system, said Sen. Jim Talent of Missouri, a member of the Republican panel.
Not to be outdone, House Democrats introduced three pieces of legislation a day after the Senate Republicans, aimed at expanding Medicaid and SCHIP, allowing Americans ages 55 to 64 to buy into Medicare, giving tax credits to small businesses and creating purchasing pools to make health insurance more affordable to small businesses. In total, the proposal would cover more than 20 million uninsured, Dingell said.
"We're encouraged that both parties are talking about the uninsured," said Kristen Morris, vice president of legislative affairs for the American Hospital Association. "But we have to look at this as planting seeds for the future." The AHA has pushed for using tax credits and expanding Medicaid and SCHIP to cover more Americans.
Similarly, the Catholic Health Association commended both parties for including plans to build on Medicaid and SCHIP and to expand the availability of tax credits for Americans to purchase coverage. The CHA supports expanding SCHIP to families, allowing people ages 57 to 64 to buy into Medicare and creating tax credits for individuals and employers.
After the GOP proposal was unveiled, Chip Kahn, president of the Federation of American Hospitals, which represents for-profit hospitals, released a statement saying it "would significantly reduce the number of uninsured Americans, assure safety-net care to millions, and help reduce healthcare costs." Federation spokesman Richard Coorsh said the group would not comment on the Democratic proposal. "We support any effort that uses private and public initiatives," he said.
Kerry reiterated his health proposal, which would expand Medicaid and SCHIP to offer coverage for some adults and provide tax credits to businesses that give coverage for employees. It would also allow for the reimportation of prescription drugs from Canada, cut costs by targeting fraud, waste and abuse, and cut malpractice insurance rates by weeding out frivolous lawsuits. His proposal would cover 27 million, he has said.
Despite the flurry of activity, legislators conceded that chances are slim that any significant legislation will make it through this Congress because of the presidential elections. The more realistic goal is for things to move next year. "This is obviously a daunting task, but it's not insurmountable," said Sen. Olympia Snowe (R-Maine) at last week's press conference held by the Senate panel.