Democrats push Clinton into seeking expanded health insurance coverage

Proposal would add at least 7 million adults to federal programs

January 08, 2000|By Jonathan Weisman | Jonathan Weisman,SUN NATIONAL STAFF

WASHINGTON -- Under heavy pressure from congressional Democrats, President Clinton has agreed to include a major health care proposal in his 2001 budget that, if adopted, could expand insurance coverage to at least 7 million uninsured adults, White House officials confirmed yesterday.

All of the proposals under consideration would face an uphill climb toward passage in an election year, but they could be politically potent in an election season in which health care has become surprisingly prominent. The policy prescriptions would also place White House policy-makers squarely in the middle of the Democratic primary contest, where Vice President Al Gore and former New Jersey Sen. Bill Bradley have sparred for months over health insurance.

If the president proposes a plan that is more generous than Gore's, he would undercut his vice president's claim that Bradley's plan is too expensive and unworkable. If, as is more likely, Clinton proposes a modest plan more in line with Gore's, he opens himself to Bradley's criticism that the administration has been too timid on the problem.

Clinton is considering an array of proposals to expand the federal Children's Health Insurance Program (CHIP) and to induce state governments to lure more working poor Americans into Medicaid, the health insurance program for the poor.

Under one, taken from Gore's platform, the parents of children eligible for the children's health insurance program or Medicaid would be guaranteed health insurance, a plan that would cost about $9 billion a year and could reach 7 million uninsured adults.

The expansion would have an additional benefit: Bringing whole families into federal health programs, policy-makers believe, would lead to coverage for more of the nation's 11 million uninsured children, a senior Senate Democratic aide said.

But White House health policy experts worry that an expansion of the CHIP program could entrench a two-tiered federal system in which working-poor families eligible for the newer CHIP program would get better health coverage than poorer families covered by Medicaid. That has convinced some administration aides that federal money would have to be earmarked to induce the states to expand and improve their Medicaid coverage.

Such an expansion could significantly raise the cost, aides said.

Senate Democrats are also encouraging the president to expand his proposal to offer prescription drug coverage with Medicare. Under the expanded plan, the drug benefit would not be capped annually for seniors with catastrophic illnesses, which drive prescription costs to especially high levels. The president's proposal would cap Medicare drug coverage at $2,500 a year.

White House aides said yesterday that an insurance expansion proposal would be included in the president's 2001 budget, but a final decision on the shape of the proposal could be weeks away.

The final proposal will hinge on revised surplus projections due in the next few days.

The plan will face a battle in Congress. Republican leaders say they support expanding health insurance coverage to the 44 million who are uninsured. But the GOP approach is markedly different. Republicans propose tax cuts or incentives to encourage people to buy private insurance.

"The choice is clear," said Jonathan Baron, a spokesman for House GOP Whip Tom DeLay of Texas. "The president would like to expand the government, expand the tax burden and expand the bureaucracy. We are for empowering the individual and returning money from the bureaucracy to the taxpayers."

But for Democratic leaders in Congress, passing a significant expansion of health insurance coverage may be beside the point. The debate between Bradley and Gore has again propelled the issue of the uninsured into the limelight, and congressional Democrats want the issue alive for this year's campaigns.

"What you've got here is presidential politics at work. You haven't got public policy at work," said Rep. Jim McDermott, a Washington Democrat and an advocate of expanded federal insurance coverage.

Not all Democrats would welcome a White House insurance proposal. McDermott and some other rank-and-file Democrats worry that a new push could undermine efforts to secure powerful rights for managed care patients.

"You've got that one six inches from the goal line," McDermott said. "Why now switch to something that's on your own 1-yard line that you need a Hail Mary to get passed?"

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