Medicaid payments would be imperiled by Sen. John Kerry's healthcare plan, but fewer uninsured people would get help obtaining coverage under President Bush's health policy agenda.
Those were among the arguments that came out of a debate last week in Washington, where Doug Badger and Sarah Bianchi, representing the Bush and Kerry campaigns, respectively, squared off to discuss healthcare costs.
Badger, who serves as a special assistant to the president for economic policy and senior health policy adviser, defended his boss' record on addressing industry cost growth and expanding coverage and access. Bianchi argued that the Massachusetts senator would do more to reduce the number of uninsured and prevent growing costs from crippling the system.
In its annual report, the CMS reported healthcare spending rose to $1.6 trillion in 2002, up 9.3% from $1.4 trillion in 2001. That put healthcare spending growth in 2002 ahead of the growth rate of the overall economy, as measured by the gross domestic product, which rose 3.6% (Jan. 12, p. 8).
"I think we can get back to a more reasonable rate of growth in healthcare costs," Bianchi said at the debate, sponsored by the Harvard Forums on Health and moderated by political commentator David Gergen.
Gergen-who advised Presidents Nixon, Reagan and Clinton-said Kerry and Bush differ more on healthcare policy than they do on any other domestic matter, but that neither candidate has a broad, bold plan to address healthcare costs or the uninsured.
For hospitals, the future under either candidate is rosy or bleak, depending on which campaign one wants to believe. Kerry's healthcare plan, which involves moving more children and low-income families into Medicaid, would reduce the Medicaid disproportionate-share payments hospitals receive by $88 billion over 10 years, according to an analysis by Kenneth Thorpe, professor of health policy and management at Emory University's Rollins School of Public Health, who made the opening remarks in last week's debate.
Citing Thorpe's estimate, Badger said it represents a "potentially problematic" policy for hospitals that already receive less from Medicaid than they spend treating patients.
Bianchi disputed Thorpe's prediction. "We can guarantee every hospital receiving Medicaid (disproportionate-share) payments today will do better under the Kerry plan," she said.
Thorpe has estimated that Bush's plans to help cover the uninsured would cost $90.5 billion over 10 years, and Kerry's would cost $653 billion over that period. Through a combination of policies, Bush would expand coverage to 2.4 million people by 2008 and Kerry would cover 26.7 million uninsured by then, Thorpe has concluded.
Badger, speaking to reporters after the debate, said as many as 9.9 million uninsured would gain coverage under the initiatives Bush backs, including community health centers that provide access if not insurance.
Community health centers, Bush said last week at a discussion in Youngstown, Ohio, are "a common-sense approach to making sure that the healthcare system works."
Bush has pledged to open or expand 1,200 community health centers to serve an additional 6.1 million Americans by 2006. The president's budget for 2005 requests $1.8 billion for community health centers, a 57% increase since 2001, according to the White House.
While the debate was organized to discuss ways to control costs, neither campaign provided specific estimates of how much their plans would curb cost growth. Bianchi said it's possible Kerry would cut the annual growth rate in half, but that it would be dangerous to commit to such a target.
Badger said the Bush administration would "drive costs in the right direction" but declined to disclose any reduction goal.