Managing editor’s note: Health care rates high on the list of issues taxpayers and voters want Presidential candidates to address during this year’s campaign. In the April 2003 issue of Health Care News, we offered an analysis of where the Democratic candidates stood on health care issues. Since then, Carol Moseley Braun, Wesley Clark, Dick Gephardt, and Joseph Lieberman have dropped out, and some candidates have more clearly defined their positions. Our update now includes the front-running Republican candidate.
President George W. Bush
In December 2003, the President signed landmark legislation reforming Medicare, creating a prescription drug program and tax-favored health savings accounts and increasing reimbursement rates to private HMOs enrolling Medicare beneficiaries. His current plan calls for additional tax breaks designed to help the insured, uninsured, and under-insured pay for health insurance premiums. Bush also was successful in directing $50 million to the states to help finance high-risk health insurance pools.
Early in his campaign for the Democratic Party’s nomination, Dean proposed a national health care system, funded in part by a repeal of all the tax cuts passed by the Bush administration. As the former governor of Vermont, Dean points to his state as a model for his reform ideas. (This issue of Health Care News offers an in-depth look at the consequences of the reforms adopted in Vermont under Dean’s watch.)
As he did in Vermont, Dean would expand Medicaid to reach more low- and middle-income families and the working poor. He would offer tax credits to help middle-income workers buy insurance, similar to that offered through the Federal Employees Health Benefits Program (FEHBP), and he would pay 70 percent of insurance costs for people temporarily between jobs. He also would mandate employers extend COBRA benefits for an additional two months.
Taking a page from Dean’s book, Clark is promoting tax credits to subsidize insurance for children and young adults in low- and middle-income families. He hasn’t yet explained how his proposal differs from existing State Children’s Health Insurance Plans (SCHIP). Clark also champions access to “fairly priced premiums” in the Federal Employees Health Benefits Program (FEHBP) for Americans without job-based health insurance. He also wants to see a 70 percent tax credit to help the unemployed pay for insurance while they are between jobs.
Edwards wants to provide health insurance for every child in America through health insurance and tax breaks for families earning less than $60,000 a year. Children from infancy through age 21 would be covered by a mandate requiring parents to purchase private health insurance on their children’s behalf or enroll them in a government program. Edwards also would expand eligibility for Medicare to age 55. He, too, supports a 70 percent tax credit to help people pay for insurance while between jobs.
Kerry suggests expanding the FEHBP to private citizens and extending eligibility for the SCHIP program to age 24. The unemployed would get a 75 percent tax credit to help pay for health insurance. Kerry endorses an undefined health insurance tax credit for small business and allowing persons as young as 55 to enroll in Medicare. He also proposes creating a loosely defined “rebate pool” to help businesses pay for the cost of providing catastrophic health care coverage for their employees. He has not addressed how the rebate pool would work in the 30 states that currently have high-risk pools for the medically uninsured and uninsurable.
Kucinich has said little about his health care reform plans, except that he would repeal all tax cuts for “the wealthiest Americans” and create a single-payer health care system of national health insurance.
Unique among the candidates, Sharpton is calling for a Constitutional amendment guaranteeing the right to health care of equal quality for everyone. He says he would establish a global budget of $400 billion a year to spend on a socialized, single-payer health care plan offering standardized benefits to all Americans. Each state would be allocated a share of the global budget, and the states would handle all administrative tasks, including claims processing and premium collection.
Conrad F. Meier is managing editor of Health Care News. His email address is [email protected].