George W. Bush; John Kerry

(WOMENSENEWS)–As Republican President George W. Bush and Democratic Presidential candidate John Kerry vie for votes in November, they are recommending very different ways to insure the 42 million Americans who lack health care coverage.

It’s a problem that affects 18 percent of women between the ages 18 to 65 and costs the economy an annual $130 billion in lost wages and other expenses.

“With Bush, you’re providing insurance through the private sector, while with Kerry, you’re doing it through the public sector,” says Alina Salganicoff, director of Women’s Health Policy for The Henry J. Kaiser Family Foundation in Menlo Park, Calif. “Bush plans to spend one tenth as much money, while Kerry plans to insure seven times as many people.”

Over the next decade, Bush proposes spending $88 billion to insure 4 million more Americans (or 10 percent of the uninsured). Kerry–who last week kicked off a four-day national tour that focused on health care–proposes spending $895 billion to cover 27 million Americans (65 percent of the uninsured).

Bush’s plan focuses on tax credits that individuals can use to purchase private insurance and Health Savings Accounts in which income destined for health can be set aside and left untaxed. Kerry’s plan focuses on government intervention: using tax money to expand employer-sponsored coverage and government-sponsored insurance programs.

Bush Favors HSAs and Tax Credits

In the past four years, spending on prescription drugs has tripled and the cost of health care premiums has spiked 40 percent. In response to these changes, Bush recently held several televised meetings in which he promoted Health Savings Accounts that are already available to voters.

Bush’s Health Savings Accounts allow policyholders to pay for medical expenses directly and save any money they don’t use in a tax-free account earmarked for healthcare costs in the future. The accounts resemble Individual Retirement Accounts in that they allow people to plan for the future at no tax penalty today. Available since January 2004, Health Savings Accounts are now taxed when they are purchased. To make these plans more affordable, Bush proposes removing these taxes and making premiums paid through the accounts tax-deductible. The accounts can serve as primary health coverage, or help people fill gaps in their employer-sponsored coverage. If an individual does not have insurance through a job–or if an employer’s plan doesn’t pay for expenses such as out-of-network doctors or diagnostic tests–the accounts can be used to help cover costs.

Bush also proposes a tax credit that would help uninsured Americans purchase private health insurance. Under Bush’s plan, individuals earning $30,000 or less would get $1,000 back in taxes every year and be able to use this money to buy insurance. Families earning $60,000 or less would get $3,000 back in taxes and use this money for family coverage.

In addition, Bush proposes expanding prescription drug coverage offered by Medicare (55 percent of those covered by this federal health program for the elderly are female) and creating 1,200 new public health centers.

Kerry Would Boost Government Programs

Kerry proposes expanding both Medicaid (a federal program that insures low-income Americans–) and SCHIPs (state children’s health insurance programs). By bolstering these programs with more tax dollars, Kerry hopes to cover all uninsured children in households earning up to $55,000 and all parents in households earning up to $37,000.

Currently, 9 percent of American women are insured through Medicaid or SCHIP programs. An additional 14 million adults qualify but have not yet enrolled. Kerry hopes to register them by automatically enrolling children when they enter public school or when they visit public health clinics.

To help more Americans gain coverage, Kerry would allow individuals to buy into federal employee health benefits. During his recent health care tour, he pledged to cut insurance costs by 10 percent for both individuals and families.

Kerry also hopes to make health coverage more affordable for businesses to provide to employees. According to a 2003 survey by The Kaiser Family Foundation, rising medical costs are forcing many employers to cut back on the coverage they offer. Under Kerry’s plan, the government would help employers by absorbing most of employees’ catastrophic health care costs. Small employers would receive a tax credit of up to 50 percent of the cost of health premiums for low to middle-income workers. Small businesses would also be able to participate in the insurance program now offered to members of Congress.

Health Experts Take Sides

Health economists have conflicting views of Bush and Kerry’s proposals. According to Kenneth Thorpe, a health economist at Emory University in Atlanta, Bush’s plan will cost taxpayers only half as much as Kerry’s plan: $1,667 per year for a newly-insured individual, versus $3,315. Some experts believe Bush’s plan is too fiscally conservative; others believe Kerry’s is too expensive.

“With Bush, you have a plan that keeps taxpayer costs under control,” says Devon Herrick, a senior policy analyst at the Dallas-based National Center for Policy Analysis. “But with Kerry, you’re using a lot of money that is going to come straight from taxpayers.” Kerry would pay for his health proposals by canceling the Bush tax cut for people earning more than $200,000.

Others say that Kerry’s plan is well worth the price because it offers across-the-board coverage. “Kerry’s proposal would substantially reduce the number of people who are uninsured, cover all children, boost employer-sponsored coverage, and correct some of the real problems in Medicaid and SCHIPs,” says Ronald F. Pollack, executive director of the Washington-based advocacy group Families USA. “Bush’s plan, on the other hand, is insurance that doesn’t really insure.”

In addition to debating these financial concerns, analysts are arguing about the quality of care that the candidates’ proposals would provide. Some applaud Bush’s plan because it gives individuals more control over their health care.

“If you’re buying an HSA or using a tax credit to purchase private insurance, you’ll be able to shop around and get the best deals for your needs,” says Herrick. “Instead of having a plan that your employer chooses for you, you can buy and benefit from a plan specifically geared to you.”

Others say the quality of care will be harmed–and not helped–by Bush’s proposals: “Most low-income people can’t afford an HSA and won’t really benefit from Bush’s tax credits,” says Pollack. “With a $1,000 individual tax credit, how can you pay for an individual policy that costs an average $3,000? With a $3,000 family tax credit, how can you afford family coverage that averages $9,000? Since these credits won’t really help low-income people, many of them could be forced to go without health care. Bush’s plan is the equivalent of throwing a 10-foot rope to someone in a 40-foot hole.”

As November’s final battle draws near, health advocates, policy analysts and the Presidential candidates themselves will continue wrangling over the pros and cons of the Bush and Kerry proposals.

But there’s one point on which they all agree. “This isn’t just a problem for low-income Americans,” says Kate Sullivan, the director of Health Care Policy for the Washington-based U.S. Chamber of Commerce. “Everyone in the U.S. needs better access to health care.”

Molly M. Ginty is a freelance writer based in New York City.

For more information:

Kaiser Family Foundation–
“Side-by-Side Summary of Presidential Candidates’ Proposals for Expanding Health Insurance Coverage” (Adobe PDF format):

John Kerry for President–
“Affordable Health Care for Every American”:

George Bush for President–
“Health Care: Issue Brief”: