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Health care

Two foes join forces to change policy

While health-care policy mostly looks to be a political combat zone this year, two former antagonists are joining forces on incremental steps to expand health insurance for the poor.

Instead of just fighting over patients’ rights and drug benefits for the elderly, Republicans and Democrats ought to follow the lead of the Health Insurance Association of America and Families USA in trying to solve a chronic problem.

The two groups fought a bitter battle in 1994 over the comprehensive health-reform bill proposed by the Clinton administration. Families USA strongly supported it. HIAA ran the “Harry and Louise” television ads that helped kill it.

Now, however, the two groups are teaming up to develop an incremental approach to providing health insurance for the poor children and adults who make up 58 percent of the 44 million Americans lacking coverage.

Progress on the proposal was unveiled at a conference sponsored by the Robert Wood Johnson Foundation, which the two groups credit with acting as a midwife for their joint action.

Neither HIAA President Chip Kahn nor Families USA Director Ron Pollack expects the plan to become law this year. But they hope it can gain bipartisan momentum for enactment next year, regardless of who controls Congress and the White House.

The idea somewhat resembles but is more ambitious than Vice President Al Gore’s plan to cover 11 million uninsured children at a cost of about $25 billion a year.

The HIAA/Families USA idea would cover 7.5 million children in families with incomes up to 200 percent of the poverty line, plus 16 million adults. HIAA estimated the plan’s cost at $35-$40 billion per year.

Both groups accept that most Americans would continue to obtain their health insurance through their employers and that existing Medicaid and the Children’s Health Insurance Program would be expanded for the poor.

In opting for an incremental approach, Families USA is parting company with other liberals, including former Sen. Bill Bradley, D-N.J., who advocate a comprehensive overhaul of the U.S. health-insurance system.

Bradley proposes that all the uninsured join the Federal Employees Health Benefit System and that premiums for the poor and near-poor be subsidized at a cost of $65 billion a year.

What Pollack referred to as “the difference between the building-block approach and those who want the whole enchilada” is one reason he and Kahn do not expect passage this year.

Another reason is jurisdictional rivalries within Congress. Insure USA contains only elements overseen by the House Commerce Committee and the Senate Finance Committee, leaving little role for the House Ways and Means Committee and the Senate Health, Education, Labor and Pensions Committee.

And yet another factor is the absence of any definite health-policy decisions by Texas Gov. George W. Bush, the front-runner for the GOP presidential nomination.

One of Bush’s top health advisers, lobbyist Deborah Steelman, says she sees merit in Insure USA chiefly the fact that it builds on existing institutions.

“Historically, the biggest mistakes ever made in health policy were failures by the left to take what they could get,” said Steelman.

She added: “In 1972, Richard Nixon proposed an employer mandate for the uninsured. The Democrats killed it, thinking they would win the White House and enact national health insurance. By 1986, the liberals were pushing employer mandates.

“The second mistake was in 1994. Clinton could have got a deal on health care, but he wouldn’t compromise. So nothing got done. This plan represents a decision on the part of some liberals to go for incomes-based gradualism.”

Since the defeat of his 1994 plan, though, Clinton has opted for gradual expansion of insurance programs and this year he reportedly is considering expansions of Medicaid and CHIP, plus tax breaks for individuals who buy their own health insurance.

On other health fronts, there is a small chance for agreement on patients’ rights if House Republicans can settle differences amongst themselves and with Senate Republicans and if President Clinton will support a compromise bill.

But Congressional Democrats and Gore are thought to oppose compromise, preferring to keep patients’ rights as a 2000 campaign issue, portraying Republicans as allies of the unpopular HMO industry.

So the chances for agreements on health policy this year are about as great as for an early peace in Chechnya. But when the smoke clears, perhaps the various adversaries can take cues from the HIAA and Families USA and seek some constructive joint action. (Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill. Copyright 2000 Newspaper Enterprise Assn.)