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For the Record

Bush Health Care Plan Seems to Fall Short

Gap Grows Between Hard Data, Projections for Covering 10 Million Uninsured

By Ceci Connolly
Washington Post Staff Writer
Sunday, August 22, 2004; Page A04

If the Republican-controlled Congress enacted President Bush's entire health care agenda, as many as 10 million people who lack health insurance would be covered at a cost of $102 billion over the next decade, according to his campaign aides.

But when the Bush-Cheney team was asked to provide documentation, the hard data fell far short of the claims, a gap supported by several independent analyses.

President Bush holds a discussion in March at the U.S. Chamber of Commerce in Washington about making health care more affordable. His campaign says that his plan would cover as many as 10 million people without insurance. (Charles Dharapak -- AP)

The cost of Sen. John F. Kerry's health care plan without an estimated $300 billion in proposed savings was stated incorrectly in an earlier version of this article. The cost would be nearly $1 trillion. The error has been corrected.

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Projections by the Congressional Budget Office, the Treasury Department, academics and the campaign's Web site suggest that under the best circumstances, Bush's plans for health care would extend coverage to no more than 6 million people over the next decade and possibly as few as 2 million.

"There's little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance," Brookings Institution health policy expert Henry J. Aaron said. "We're swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush's proposals to move against that current is, it seems to me, very, very limited."

In his bid for a second term, Bush is reprising much of the health care agenda he ran on in 2000, including tax credits for individuals who purchase insurance, and the formation of new, largely unregulated purchasing pools for small businesses called association health plans.

His Democratic challenger, Sen. John F. Kerry (Mass.), has released a health care agenda that is more ambitious and more expensive, with plans to expand government health programs, offer tax credits similar to Bush's and reimburse businesses for some of their most costly catastrophic cases.

Forecasting the cost and impact of policy proposals is always complicated, and both presidential campaigns try to spin the numbers to their advantage. Kerry, for example, estimates his health care proposals would cover 27 million people at a 10-year cost of $653 billion. But that assumes $300 billion in "savings" that the Bush team says might prove elusive. Without the savings, the cost of the Kerry package jumps to nearly $1 trillion.

Health experts inside and out of the administration say many of the assertions Bush makes about his first-term health care record and his health proposals for a second term are exaggerated, incomplete or contrary to widely accepted analyses.

On the campaign trail, the president trumpets last year's enactment of a Medicare prescription drug package as his signature health achievement. In monetary terms, the new policy -- estimated to cost $564 billion over 10 years -- goes far beyond the $158 billion proposal candidate Bush ran on in 2000.

"When we came to office, too many older Americans could not afford prescription drugs. Medicare didn't pay for them," he said last month. "Leaders in both political parties had promised prescription drug coverage for years. We got it done. More than 4 million seniors have signed up for drug discount cards that provide real savings."

Left unsaid is that 2.9 million of them had no choice; they were enrolled automatically. And full implementation of the drug benefits will not occur until 2006.

Since Bush took office, the number of Americans without health insurance has climbed by 4 million, to nearly 44 million. On its Web site and at news briefings, the Bush campaign says that through its actions overseeing Medicaid and the Children's Health Insurance Program, the administration has "expanded eligibility to more than 2.6 million people."

The statement gives the impression "they have extended coverage to 2.6 million more, and that is not really true," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. "In reality, only 200,000 of them got coverage" because of Bush administration efforts.

Megan Hauck, deputy policy director for health care of the Bush campaign, did not have figures but said she thought the Kaiser data were "awfully low."

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