Presidential Candidates Offer Divergent Health Reform Plans
Last year there were 45 million U.S. residents (15.6 percent of the population) who had no health insurance, up from 43.6 million (15.2 percent) in 2002, according to Census Bureau figures released last month.
The number of insured U.S. residents increased by 1 million to 243.3 million. The Census Bureau attributed the increased number of both uninsured and insured residents to population growth, according to a press release.
Kerry's national health plan would cover 27 million uninsured residents and cost $653 billion over the next decade. The plan would be financed by repealing tax cuts for families whose annual incomes exceed $200,000. Kerry would extend Medicaid or the State Children's Health Insurance Program (SCHIP) to all children and low-income working parents as well as to single and childless adults.
Reimburse Private Plans
To control spiraling health care costs, Kerry proposed that the federal government reimburse employee health plans for 75 percent of their catastrophic costs above $50,000. In return, employers and their insurers would lower workers' premiums, provide affordable coverage for all employees, and encourage disease-management and health care technology to improve quality of care and decrease costs.
Small businesses could receive tax credits to cover up to 50 percent of the health insurance premiums for low- to moderate-income workers.
Individuals and families who need affordable health insurance as well as small businesses could join the Federal Employees Health Benefits Program.
Kerry also promises to sign an executive order to give plan participants with domestic partners the right to family health benefits.
To control spiraling prescription drug costs, Kerry would authorize the secretary of Health and Human Services to negotiate drug prices with pharmaceutical companies for Medicare beneficiaries. He would help states extend the same discount Medicaid gets for its beneficiaries to other populations without prescription-drug coverage.
Kerry would also allow Americans to buy cheaper reimported prescription drugs from Canada approved by the Food and Drug Administration.
Kerry would ensure that medical-malpractice lawsuits are reviewed by a specialist and that states offer mediation services to malpractice-suit plaintiffs before proceeding to trial. Punitive damages could be awarded only in cases where there is proof of intentional misconduct, gross negligence, or reckless indifference to life.
Bush Urges More Modest Changes
Bush's aides reacted to the Census Bureau data last month by stating that the highest number of uninsured occurred during the Clinton administration in 1998 at 16.4 percent.
Bush's health plan would cover an additional 2.4 million uninsured residents at an estimated cost of $90.5 billion over the next decade. To help low-income Americans buy health insurance, he would provide refundable tax credits of up to $3,000 for families and $1,000 for individuals.
Bush also would continue to urge Americans to set up tax-free health savings accounts to cover expenses not covered by their health plans. To promote use of these accounts, he would provide financial assistance to individuals and families to help them pay for health insurance premiums and meet annual deductibles.
Bush has proposed allowing small businesses to band together to negotiate lower health care premiums for workers and their families. He has repeatedly advocated for medical-liability reform to limit the amount of damages that plaintiffs can be awarded in malpractice lawsuits.
The AMA has identified “America's liability crisis as one of the most important health care issues facing our nation.”
Bush has invested significantly in health care information technology (IT). He recently announced he would double spending on demonstration projects for health care IT and launched a 10-year plan to begin using electronic medical records for most Americans (Psychiatric News, June 4).
Bush's statement on health care is posted at<www.georgewbush.com/HealthCare>. Kerry's health care reform plan is posted at<www.johnkerry.com/issues/health_care/>.▪
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Published online: 17 September 2004
Published in print: September 17, 2004
Notes
According to new U.S. census figures, more than 1 million Americans joined the ranks of the uninsured in 2003. Which presidential candidate has a better plan to reduce the number of uninsured?
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