Bush's Focus on Health Care
Draws Criticism, New Hope

President Bush's new focus on shrinking the ranks of the uninsured is appealing to Democrats and others who have long hoped for a renewed debate over how to extend health insurance – but Mr. Bush's specific plans still face criticism.

"While the administration's current proposal is deeply flawed, the attention that the president is devoting to the issue could signal real progress in addressing the health-care crisis," said Sen. Edward Kennedy (D., Mass), who has worked many years on health issues.

Mr. Bush's proposal would change how the tax break for health insurance is calculated. Critics said that approach would do little to reduce the ranks of the uninsured and could undermine the employer-based insurance system by shifting many Americans from stable employer-based insurance, where the risk is spread over an entire work force, into the unstable individual insurance market, where people are evaluated and charged based on their individual health and projected expenses.

If workers can get the same tax break for buying insurance on their own as they would get if they got insurance through work, employers may be tempted to drop insurance plans altogether. That could spell trouble for less-healthy workers who would likely pay higher premiums than they would if they were part of a group plan, critics say. "In the individual insurance market, people will be denied coverage because of family history, existing illnesses, or genetic makeup," predicted Rep. Pete Stark (D., Calif.), chairman of the House Ways and Means Committee's health subcommittee.

Critics also argue it would also do little to help those without insurance now. Most of the uninsured have relatively low incomes, meaning the new tax deduction for purchasing insurance on the open market is less valuable for them than for those who earn more. "Since most uninsured Americans pay low or no taxes, they would receive little help from this plan," said the Center for American Progress Action Fund.

Mr. Bush's second proposal would divert dollars that now support hospitals that care for the poor into state-created programs that subsidized basic insurance plans. That, too, came in for criticism and will surely be fought by the hospitals who rely on the existing programs. "The president's proposal pulls the rug out from under safety net hospitals that care for some of our nation's most vulnerable people," the American Hospital Association said.

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