January 2000 • Volume 6 • Number 1
Access to health care
It's one hot potato for presidential contendersBY JANE STOEVER
Health care issues are hot in the 2000 presidential race. Some candidates already argue about the issue of the uninsured; others have access-to-care positions posted on their Web sites.
Yet a few years ago, political analysts pronounced access to care the kiss of death. Why the change?
"The economy is growing, unemployment is at record low levels, but we have more uninsured than ever before -- 44 million uninsured," says AAFP President-elect Richard Roberts, M.D., J.D., of Madison, Wis. "This may be a catalyst for universal coverage."
Robert Reischauer, Ph.D., of the Brookings Institution in Washington, D.C., offers a historical perspective.
"Because President Bill Clinton's effort of 1993-94 was widely viewed as a political disaster, most observers thought the uninsured would not be a focus of presidential candidates for two decades," says Reischauer, who headed the Congressional Budget Office from 1989 to 1995.
"And yet here it is, front and center again," he says. "We can thank Bill Bradley for that. His proposal would get the percentage of the uninsured down from 17 percent of Americans to 6-7 percent. Al Gore's proposal would chip away at the numbers of uninsured, and Republican candidates are also moving in that direction." (See chart below.)
What doomed the 1993-94 effort?
"While Americans believe something should be done to reduce the number of people without insurance and to simplify the health care marketplace, when faced in 1993-94 with the steps that would have to be taken, they feared the insurance protection they had might be threatened," says Reischauer.
Six years later, workers may be coming to grips with the fact that if they lose their jobs, they could end up without adequate health insurance, he says.
The country has no shortage of health care resources, but they are poorly distributed, says Reischauer. Redistribution will mean taking away some resources currently enjoyed by one sector of the population or another. "For example," he says, "in 1994, I was covered by my wife's policy as well as my own at my place of work, at no real additional cost. We had relatively high income and double coverage. That's not right when many have no protection at all."
No pot of surplus gold
Several candidates plan to fund health proposals from the federal surplus. Their plans may not pan out."The notion that somehow the government is awash in money, and therefore there's an opportunity for lots of new initiatives in health care, is probably not accurate," says Marty Gold, J.D., a leader of the Legislative Strategies Group in Washington and former counsel to past Sen. Howard Baker Jr., R-Tenn.
Gold says Congress resorted to smoke-and-mirror gimmicks to be able to claim it passed a budget that maintains a surplus and does not invade the Social Security trust fund. "What gets you through the budget for the year 2000 creates pressures for 2001," he says.
Republicans are suggesting tax breaks for the self-employed, expansion of medical savings accounts and pooling arrangements for small employers. "These are all intended to reduce the number of uninsured," says Gold.
However, he says the climate in Washington since the 1998 elections has been the political equivalent of Stalingrad during World War II. In 1998 -- against all odds -- Democratic and Republican candidates broke even in the Senate, and Democrats won five more seats in the House than Republicans did.
"It is a veritable war," says Gold. "The 1998 elections put the Democrats on the cusp of power, and there is no bipartisanship in the sense of compromise between the White House and Republican leaders in Congress."
That doesn't bode well for access-to-care bills, no matter what the presidential contenders propose.
What FPs can do
The Academy has a 10-year-strong policy promoting universal coverage, and family physicians have the chance to advance the access-to-care debate in local and national political campaigns."AAFP's policy has focused family physicians' efforts at the local level, reminding us we have a responsibility to be sure everyone in our community has a way into the health care system," says Roberts.
"At the national level, those in high positions have more awareness of the Academy because of the consistency and clarity of our position -- and our persistence," says Roberts. "The most palpable example was the September press conference at which Clinton announced his health agenda for the rest of his term. The only organization asked to give an address at that event was the Academy."
Key presidential candidates' access-to-care policies*
Bill Bradley
- Prenatal care fully subsidized for many families
- Health insurance for all children from birth
- Private plans for federal employees also available to other adults
- Medicare prescription drug benefit
- New program helping seniors stay home and assisting care givers
Source: www.BillBradley.com
George W. Bush
- Medicare with more choices, more private-sector alternatives
- Medicare prescription drug benefit
- Medical savings accounts as an option for all Americans
- Protections (similar to those enacted in Texas) for beneficiaries in federally governed plans
- Reforms already enacted by states not to be superseded by federal laws
Source: www.GeorgeBush.com
Al Gore
- Access to health care by 2005 for all children through three steps: expanding the Children's Health Insurance Program, allowing families with incomes above 250 percent of poverty level to buy into Medicaid or CHIP, and giving states incentives to enroll uninsured children
- Federal matching payments for states to provide insurance coverage to uninsured parents of children eligible for Medicaid or CHIP
- New tax credit available for individual health insurance
Source: www.AlGore2000.com
John McCain
- Tax incentives for employers and individuals to gain affordable coverage
- Expanded efforts to enroll in existing programs all those eligible for them
- Resources pooled by individuals and businesses for less costly coverage
- More health plans and care options available to working poor
- Block grant for states to help seniors pay for prescription drugs
- Health coverage for all children
Source: www.McCain2000.com
* For other candidates' policies,, access www.cnn.com/ELECTION/2000/ and, under "candidate bios," click on "White House hopefuls." The Web sites may or may not be as current as daily media reports.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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