More Americans Lack Health Insurance

The U.S. Census Bureau reported Tuesday that the number of Americans without health insurance grew to an all time high of 47 million people last year. That is an increase of more than two million people from 2005. The number of children without health coverage also rose. With health care already heating up as a political issue, the new figures are likely to further raise the stakes in the debate.

Drew Altman, president and chief executive officer of the Henry J. Kaiser Family Foundation, says the increase in the number of uninsured is not hard to explain. The average family's income is rising slowly, if at all, while the cost of their employer-sponsored health insurance premiums is going up much faster.

"What the numbers seem to be showing is the slow fraying of the employment-based system, and the fundamental bedrock issue is that insurance is increasingly unaffordable, just not affordable for average working people," Altman says.

As a result, more and more people who have jobs are going without health insurance. Altman says the size of the increase in the number of people who are uninsured is likely to have a major impact on the presidential campaign trail.

"These are very big numbers and you're going to start to see these numbers, these increases in the ranks of the uninsured, appear in the speeches of virtually all of the candidates," Altman says.

The increase in the number of uninsured people is likely to have a political impact on Capitol Hill, as well. Congress and President Bush are currently at loggerheads over legislation to renew the State Children's Health Insurance Program, known as SCHIP. The program is set to expire at the end of next month.

Democrats and some Republicans in Congress want to expand SCHIP, but President Bush does not.

Political scientist Jonathan Oberlander, of the University of North Carolina, says the spike in the number of uninsured children — 600,000 more last year — gives those who want to expand the program new ammunition.

"I think this puts the Bush administration in a very difficult position of arguing against expanding SCHIP," Oberlander says. "And this is the second year in a row that the number of uninsured children has increased."

But supporters of a more market-based health system would prefer to help the uninsured by giving them tax breaks to buy their own private insurance.

"That's really the public policy question," says Grace-Marie Turner, head of the conservative Galen Institute, a non-profit research organization devoted to health policy. "Do we want to put more and more people on taxpayer supported coverage, or do we want to move to a system in which people can have coverage that they own and keep with them as they move from job to job?"

Meanwhile, Oberlander says he is not convinced the new census numbers will actually prompt the next president and the new Congress to fix the health insurance problem.

"This adds fuel to the fire, but the fire's been burning for decades. And we have an amazing ability to walk over it," he says.

In other words, all talk and no action. That is what happened in the 1990s, the last time health care was a major issue in the presidential campaign.

Presidential Candidates Weigh In on Health Care

Health care has emerged as one of the most significant domestic issues facing the presidential candidates this year. In a July Gallup Poll, only the situation in Iraq was cited as a more pressing problem. Nearly 60 percent of those surveyed said their health care costs had risen in the past year.

A separate survey by NBC and the Wall Street Journal found that worries over health care were contributing to an overall gloominess about the U.S. economy. And older voters in the early-balloting states of Iowa, South Carolina, Florida, Nevada and New Hampshire tell AARP that candidates' positions on health care will be important to deciding their votes.

Major candidates from both parties have been offering up proposals to control the cost of health care and provide better coverage for millions of uninsured Americans. Nearly all of the candidates agree that quality could be improved and money saved through greater use of information technology, best medical practices, and consumer information that allows patients to shop around. Here's a sampling of their other proposals:


     Republicans


Rudolph Giuliani

—Deregulate insurance market to encourage lower-priced policies. Where state mandates limit affordable options, Giuliani would allow the purchase of insurance across state lines.

—Change tax law to put insurance purchased by individuals on the same footing as employer plans, for payments up to $15,000.

—Health insurance tax credit to help low-income people buy insurance.

Mitt Romney

—Deregulate insurance market to encourage lower-priced policies.

—Change tax law to put insurance purchased by individuals on the same footing as employer plans.

—Federal subsidies for those who can't afford full-priced insurance (but who make too much money to qualify for Medicaid).

This is similar to the plan Romney helped institute as governor of Massachusetts. But it lacks two elements of the Massachusetts plan: a requirement for larger employers to provide health insurance or contribute to a state system; and a requirement for individuals to obtain health insurance.

John McCain

—Has not outlined a health care proposal.


     Democrats


Hillary Clinton

—Require all individuals to have coverage. Tax credits would be provided to ensure that no one pays more for insurance than a set percentage of their income.

—Provide new choices of public and private health plans. The public plan will be similar to Medicare. Private plans would be similar to those offered to federal workers and members of Congress.

—Require large employers to either cover their workers or else contribute to the costs of those coverage costs. Tax credits would be provided to encourage small businesses (those with fewer than 25 workers) to provide health insurance, but they would not be required to do so. Tax credits would also be provided to large employers with high retiree health care costs.

The estimated $110 billion annual cost would be financed by a variety of mechanisms, including repealing some of President Bush's tax cuts for those earning more than $250,000. It would also be offset through savings from better management of chronic health conditions and streamlined administration of the health care system.

John Edwards

—Employers must provide insurance for workers or pay into government system.

—Change tax law to put insurance purchased by individuals on same footing as employer-provided coverage. Edwards would go farther than Romney by offering a refundable tax credit to those who don't owe income tax.

—Create nonprofit regional purchasing pools to offer a variety of insurance plans to businesses and indivduals. At least one plan would be a government plan, based on Medicare. Over time, this might evolve into a single-payer system, if that's popular.

—Expand Medicaid to cover more people, using additional federal funds.

—New requirements on insurers to prevent them from denying coverage on the basis of age, pre-existing conditions, etc.

—After these other steps are complete, require everyone to buy insurance.

Dennis Kucinich

—National, nonprofit, single-payer health care.

Barack Obama

—Allow individuals and small businesses to buy into national plan in the same manner that federal employees do.

—Provide subsidies to those who can't affored premiums but who earn too much to qualify for Medicaid.

—Create a National Health Insurance Exchange to provide individuals with more options. Participating private insurers would have to offer plans as good as or better than national plan.

—Expand Medicaid and SCHIP to cover more people.

—Require employers to help cover their workers, or pay into national plan.

—Retain flexibility for states that want to continue with their own health care experiments.

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