Candidates Proposals for Health Insurance

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

Seven of the nine current Democratic presidential candidates (General Wesley Clark, Governor Howard Dean, Senator John Edwards, Representative Richard Gephardt, Senator John Kerry, Representative Dennis Kucinich, and Senator Joseph Lieberman) and the incumbent president (George W. Bush) have each outlined a proposal to extend health insurance coverage to millions of uninsured Americans.

Purpose of health policy or idea

Seven of the nine current Democratic presidential candidates (General Wesley Clark, Governor Howard Dean, Senator John Edwards, Representative Richard Gephardt, Senator John Kerry, Representative Dennis Kucinich, and Senator Joseph Lieberman) and the incumbent president (George W. Bush) have each outlined a proposal to extend health insurance coverage to millions of uninsured Americans.

The proposals range from expanding coverage to one in 10 to all of the 41 million uninsured Americans.  (The 2002 estimate of uninsured Americans is approximately 44 million, but due to the cost/coverage estimates, the proposals reflect the 2001 estimate of 41 million uninsured.)  Most of the proposals plan to build on the existing system of health insurance in the United States rather than fundamentally reforming the health care system.  Some plans follow a public-private strategy, for example combining expansions to public programs with tax credits for private insurance.  Other plans tack to one or the other side of the public-private debate.

Many of the candidates (Clark, Dean, Edwards, Gephardt, Kerry, and Lieberman) propose to finance the cost of their health plans by repealing some or all of Bush's 2001 tax cut legislation, which will incrementally reduce individual income tax rates and create a new bottom rate of 10 percent, gradually eliminate the marriage penalty tax, gradually repeal the estate tax; eventually double the child tax credit to $1,000, and increase contribution limits for individual retirement accounts and 401K plans. Most of the tax provisions won't be complete for at least five years (A Blueprint for New Beginnings: A Responsible Budget for America's Priorities, accessed at the White House website on January 6, 2004. http://www.whitehouse.gov/ news/usbudget/ blueprint/ bud02.html).  Other proposed sources of revenue include elimination of 10% of the non-defense and non-homeland security federal workforce (Edwards) and elimination of selected corporate subsidies or tax loopholes (Edwards and Kerry).  Kucinich would finance his single-payer plan in part with the implementation of a new payroll tax for employers and the elimination of the employee health insurance tax deduction.

Type of incentives

All of the proposals except for Kucinich's rely on tax credits for individuals and/or employers to make purchasing health insurance more affordable.  However, it is not certain whether or not some of the proposed tax credits provide enough "financial incentive" for intended individuals/employers to purchase health insurance, except when mandated.

Groups affected

The Uninsured, Employers, State and Local Governments

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The proposals are still evolving.  Any policies that are drafted and enacted will depend on who prevails in the 2004 Presidential election.

Political and economic background

Change of Government or political direction / Comment:

The topic of expanding health insurance coverage last gained widespread public support during the 1992 presidential campaign when there were growing numbers of uninsured, rapid growth in health care costs, and economic insecurity (D. Yankelovich, "The Debate that Wasn't: The Public and the Clinton Plan," Health Affairs 14(Spring 1995): 7-23).  A number of proposals to expand coverage emerged from presidential candidates, including then Governor Bill Clinton and President George H.W. Bush, as well as from members of Congress, academics, and health care industry leaders (T. Skocpol, "The Rise and Resounding Demise of the Clinton Plan," Health Affairs 14 (Spring 1995): 66-85). The idea of federally mandated universal health coverage dominated national debate when then President Clinton introduced it in 2003, but the proposal famously failed. Now, in 2003, with the 2004 presidential election less than a year away, opinion polls show that health care, once again, is high on the list of public concerns (Stony Brook University Center for Survey Research, "Health Pulse of America," May 2003; D.S. Broder, "High Cost of Inaction on Health Care," The Washington Post (June 1, 2003): B7). The number of uninsured Americans as of 2002 was 44 million, 4 million more than in 1999. In addition, health care expenditures continue to grow at a rapid pace; the U.S. spends 14% of its GDP on health care, more than any other industrialized nation (OECD). This growth, in turn, has led to rising health insurance premiums, which has led to a shift in the financial burden of health care from employers to employees, (K. Davis and B.S. Cooper, American Health Care, Why So Costly?, Invited Testimony, Senate Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies, Hearing on Health Care Access and Affordability: Cost Containment Strategies, Washington, D.C., June 11, 2003; J. Gabel et al., "Health Benefits in 2003: Premiums Reach Thirteen-Year High as Employers Adopt New Forms of Cost Sharing," Health Affairs 22 (September/October 2003): 117-26). Some employers have dropped coverage altogether: the most important factor behind the rise in the number of uninsured in 2001 was the decline in employer-sponsored health insurance coverage (U.S. Department of Labor, Bureau of Labor Statistics, August 2003). The combination of these factors is forcing political figures to confront problems with the health system and propose viable solutions.

A major point of contention between President Bush and fellow Republicans, and Democrats is how health care coverage should be expanded. The most important feature of Bush's proposal is that it would funnel the currently uninsured into the private health insurance market. Democrats see such policy as a threat to the employer group market (healthier individuals might move from group to individual markets, weakening group markets), which they consider to be preferable to private insurance. With a Republican President and a Republican-controlled Congress, it is likely that a greater share of federal health insurance funds will go to private insurers.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

By whom was the idea generated?

7 Democratic candidates, Incumbent President George W. Bush

Who were or are the driving forces behind this idea and why?

2004 Presidential election

Is it an entirely new approach, does it follow earlier discussions, has it been borrowed from elsewhere?

All of the proposals propose to expand health insurance using institutions and policy tools such as public program expansions. Similar proposals were considered in the 1992 Presidential election and by former President Bill Clinton and First Lady Hillary Rodham Clinton in 1993-4.

Small-scale examples for this innovation

The Federal Employees Health Benefits Program (FEHBP), which currently covers nine million active and retired federal employees and their dependents, is the nation's largest employer-sponsored health insurance plan. Dean is using the program as a model for his Universal Health Benefits Plan, which would be a new group option for individuals and small businesses. In addition, Kerry is using the FEHBP as a model for his Congressional Health Plan, which would be open to both large and small employers as well as to individuals.  Similarly, Lieberman also proposes two FEHBP-like group options, one for children (MediKids), the other for individuals and small businesses with no affordable alternatives (MediChoice).

In June, Maine Gov. John E. Baldacci signed a law that proposes to ensure coverage to all residents by 2009, as well as enforcing price caps on providers, hospitals and insurers. California also has a new law that requires employers either to purchase insurance for their workers or pay into a state fund that provides coverage. But it is unclear whether these reforms will withstand legal contest (SB-2, California Legislature website: http://www.leginfo.ca.gov/pub/bill/sen/ sb_0001-0050/sb_2_bill_20030909_proposed.html).

Local innovations in automatic enrollment include California's "Express Lane" pilot program enrolls children in Medicaid through the schools.  The ELE outreach program is unique in that it targets families at the exact point where they are most receptive for information about health insurance benefits for which their children may qualify. In California, Express Lane Eligibility gives parents who sign up for the school lunch program the option to allow their information to be used to expedite health insurance enrollment for their children. During the application process for the school lunch program, parents can authorize their income and other relevant information to be shared with the social services agencies that determine health insurance eligibility. Once the child's eligibility has been determined the child will be quickly enrolled into the program, without having to complete a full insurance application.  Health-e-Arizona, a web-based application process, is also an example of a local innovation in automatic enrollment.

Stakeholder positions

These are new and evolving proposals and very much under debate. The seven Democratic presidential candidates held the leadership role in bringing forward this idea or policy.

Influences in policy making and legislation

This is still to be played out. It remains to be seen whether Bush's 2004 budget proposal, which includes some health care reforms, will be part of his 2005 budget and formally introduced as legislation.

Adoption and implementation

The proposals are still evolving.  Any policies that are drafted and enacted will depend on who prevails in the 2004 Presidential election.  Even when a candidate is elected President, there is no guarantee that all or even part of his proposal will be adopted, as seen with former President Clinton's health plan.

Monitoring and evaluation

The proposals are still evolving, and resulting policies will depend on who prevails in the 2004 Presidential election.

Expected outcome

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The proposals are still evolving.  Any policies that are drafted and enacted will depend on who prevails in the 2004 Presidential election.  At the least, health insurance coverage is expected to be expanded to one in 10 uninsured Americans.

References

Sources of Information

S.R. Collins, K. Davis, and J.M. Lambrew, Health Care Reform Returns to the National Agenda: The 2004 Presidential Candidates' Proposals, The Commonwealth Fund, September 2003 (updated February 2004)

A Blueprint for New Beginnings: A Responsible Budget for America's Priorities, accessed at the White House website on January 6, 2004. http://www.whitehouse.gov/ news/usbudget/ blueprint/ bud02.html

D. Yankelovich, "The Debate that Wasn't: The Public and the Clinton Plan," Health Affairs 14(Spring 1995): 7-23

T. Skocpol, "The Rise and Resounding Demise of the Clinton Plan," Health Affairs 14 (Spring 1995): 66-85

Stony Brook University Center for Survey Research, "Health Pulse of America," May 2003

D.S. Broder, "High Cost of Inaction on Health Care," The Washington Post (June 1, 2003): B7

SB-2, California Legislature website: http://www.leginfo.ca.gov/pub/bill/sen/ sb_0001-0050/sb_2_bill_20030909_proposed.html

Author/s and/or contributors to this survey

Phuong Trang Huynh and Olivia Ralston (reviewed by Sara Collins)

Empfohlene Zitierweise für diesen Online-Artikel:

Phuong Trang Huynh and Olivia Ralston (reviewed by Sara Collins). "Candidates Proposals for Health Insurance". Health Policy Monitor, February 2004. Available at http://www.hpm.org/survey/us/c2/3