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2003-12-14 -- Republicans Turn Efforts to the Uninsured

The following approaches of vouchers or tax credits to allow the
uninsured to buy private health insurance will involve devising and
standardizing the same kinds of stripped-down "basic" benefit packages
as the HMOs will provide Medicare patients under the new law.

New York Times, December 14, 2003

Republicans Turn Efforts to the Uninsured
By ROBERT PEAR

WASHINGTON, Dec. 13 - Fresh from their victory on Medicare,
Congressional Republicans and the Bush administration say they are
planning a new initiative to help provide health insurance to people
under 65 who have no coverage.

The Senate majority leader, Bill Frist, Republican of Tennessee, is
developing legislation and said it would be high on his agenda next
year.

Just minutes after President Bush signed the Medicare bill on Monday,
Dr. Frist said he was turning his attention to the uninsured.

"For my next three years," he said, "that will be the overriding
issue. That's the next big challenge."

Details of the package have not been decided. But members of Congress
and administration officials said they were considering several
proposals: tax credits to help individuals and families buy health
insurance; expanded eligibility for existing health programs; and new
tools to help small businesses band together and buy insurance.

Democrats are sure to emphasize the issue in the 2004 elections. The
Census Bureau recently reported that the number of people without
health insurance shot up last year by 2.4 million, the largest
increase in a decade, to 43.6 million. From 2000 to 2002, the number
of uninsured rose 9.5 percent, as health costs surged and many workers
lost coverage provided by employers.

President Bush fulfilled a campaign promise by adding a drug benefit
to Medicare, and Republican pollsters say that with a proposal on the
uninsured, he could cement his leadership role in an area of policy
long claimed by Democrats.

David H. Winston, president of the Winston Group, a Republican polling
firm, said: "Having passed the Medicare law, Republicans will be seen
as more credible when they offer proposals on the uninsured. The
public is not expecting perfection, but is looking for progress."

Administration officials said Mr. Bush would try to head off
Democratic criticism by proposing a major investment in tax credits
and other measures for the uninsured.

But prospects in Congress are clouded by lingering Democratic
bitterness over the Medicare law. Democratic leaders, shut out of
negotiations on Medicare, are in no mood to cooperate with Republicans
on another health care issue.

In addition, it will be difficult to find money for a major initiative
at a time of large budget deficits. Congress and the administration
are looking at proposals that cost $50 billion to $80 billion over 10
years.

Republicans and Democrats have worked together on some initiatives,
including a 2002 law that provides tax credits to pay 65 percent of
health plan premiums for people who have lost their jobs because of an
increase in foreign imports.

Senators Charles E. Grassley, Republican of Iowa, and Max Baucus,
Democrat of Montana, recently introduced a bill to extend that tax
credit to anyone receiving unemployment compensation. Senators Olympia
J. Snowe, Republican of Maine, and Edward M. Kennedy, Democrat of
Massachusetts, have introduced a bill that would provide coverage to
parents of children who already qualify for Medicaid or the Children's
Health Insurance Program.

The major Democratic candidates for president have offered
comprehensive proposals to expand health insurance coverage. For
example, Senator John Kerry of Massachusetts has outlined a plan to
guarantee coverage for virtually all children. Howard Dean, a
physician, advocates "a repeal of Bush's tax cuts so that we can
provide universal health care," and he points to his record as
governor of Vermont, where the proportion of people without insurance
is among the lowest in the nation.

Dr. Frist has appointed a group of 10 Republican senators to propose
ways of covering the uninsured. The panel, headed by Senator Judd
Gregg of New Hampshire, is considering different options for specific
segments of the population.

Karen M. Ignagni, president of the American Association of Health
Plans, expressed a view that seems to be taking hold in Congress.

"In the last decade," Ms. Ignagni said, "we learned that one size
doesn't fit all. The uninsured are a diverse population. Many are
working but cannot afford the insurance that's offered to them. Some
are working but not offered insurance. Others are temporarily
uninsured because they're between jobs. Others fall through the cracks
of public programs."

Health economists say that one-fifth of workers who are offered
insurance do not take it. A recent study by the Urban Institute
estimates that at least half of uninsured children are eligible for a
government health insurance program, but not enrolled.

Employers, alarmed at the increase in the number of uninsured, have
been lobbying for tax credits and other assistance to make insurance
more affordable. They see health benefits as a way to attract and
retain workers, and they say they fear that a continued rise in the
number of uninsured will increase pressure for national insurance or
other big government programs.

Republicans are divided over proposals to help small businesses band
together to buy insurance through their trade associations. In June,
the House passed a bill to encourage such "association health plans."

Two members of Dr. Frist's task force, Ms. Snowe and Senator Jim
Talent of Missouri, have introduced a similar bill, with strong
support from President Bush. "It makes sense to give small businesses
the same bargaining power that big companies enjoy," Mr. Bush said.

But another member of the panel, Senator Don Nickles of Oklahoma,
opposes the idea, saying it would expose consumers to insurance scams.
The association health plans, Mr. Nickles said, would be largely
exempt from state regulation and would attract healthier workers, "the
reby increasing costs for firms that remain in the traditional
insurance market."