Let's Come Together

Six years after President Clinton's failed attempt to provide health insurance to all Americans, groups that battled relentlessly over the issue proposed a program Monday to cover millions of the nation's uninsured.

"Political gridlock should no longer be an option in dealing with America's uninsured epidemic," said Ron Pollack, executive director of Families USA, a health care advocacy group that backed President Clinton's plan.

His nemesis back then, the Health Insurance Association of America, agrees. It helped draft the joint plan, which relies on a combination of expanding Medicaid and other government programs for the poor and new tax incentives to encourage businesses to buy private insurance for their low-wage workers.

"In the past, every group interested in extending coverage to the uninsured held out for their favorite approach. As a result, nothing was accomplished," said Chip Kahn, president of the association, which represents nearly 300 insurance companies.

Once opposite poles on the issue, the two groups plus the American Hospital Association were unveiling a proposal they say could provide coverage to more than half of the 43 million Americans who now don't have any health insurance.

The proposal essentially targets an estimated 23 million people in low-wage families that fall below 200 percent of the federal poverty level - or about $28,300 for a family of three. Those are people less likely to be offered health coverage on the job and, even when they are, they often can't afford the employee premium match.

Under the plan, Medicaid - the government's health care program for the poor - would be expanded to cover parents and single adults who often are ineligible for coverage. For instance, in two-thirds of the states, a parent who works full time at $5.15 an hour is considered ineligible for Medicaid due to high income. And in most states, childless adults are ineligible for Medicaid unless they are disabled.

"We've got essentially three different classes of people. Kids are treated the best, parents considerably poorer and childless adults get virtually nothing," said Pollack. "This proposal gets rid of categories."

The plan also would give states the option of providing coverage for parents and childless adults through programs like the State Children's Health Insurance Program, which was created in 1997 for children whose families earn too much to quality for traditional Medicaid.

In a nod to an idea long-backed by the health insurance industry, the plan proposes a non-refundable tax credit aimed at low-income workers who now reject employer-sponsored coverage because they can't afford the employee premium match. A business that now pays 70 percent of the premiums for employees would receive a tax credit to pay all or part of the remaining premium for its low-income workers.

The groups offered no cost estimate of their proposal, but it's sure to be in the billions of dolars annually. They described the plan as a framework that they hope will include other stakeholders as legislation is developed.

Capitol Hill lawmakers were expected to get the proposal Monday. Leaders of Families USA and the health insurance group outlined the proposal in an article to be published in the January-February issue of Health Affairs.

The compromise is a drastic change from the bitter battles waged by two of the most visible foes in the health care debate.

The Health Insurance Association of America, which has pushed to preserve the current system of employer-based coverage, spent $17 million in 1994 on an ad campaign opposing President Clinton's health care plan.

The ad campaign, which featured a fictional couple named Harry and Louise, was high profile and drew strong criticism from supporters of the Clinton plan.

The ads raised concerns that the Clinton proposal would turn health care decisions over to government bureacrats, limit the choice of doctors and lead to the rationing of care.

On the other side, Families USA strongly supported the Clinton health plan and has lobbied for new patient protections, include the right to sue insurance companies over claim denials.

Harry and Louise, with their trademark cups of coffee and free-flowing opinions, made a brief comeback earlier this year, with a battery of commercials rolled out in January to put pressure on presidential candidates.

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