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Bush Health Care Plan Seems to Fall Short

Total enrollment in the two government health programs did rise during Bush's tenure -- by about 7.5 million. But for the vast majority, coverage was required by law, not the result of any policy change.

"Part of the reason more people were covered is the economy got so bad that people lost income," Rowland said. "There were more low-income people under Bush than previously, so they became eligible for public programs."

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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Although Hauck generally touts the campaign's projection that the Bush proposals would expand coverage to 10 million Americans, she said it could be as few as 6 million. Of the 10 million, half will use the proposed $1,000 tax credit ($3,000 for families) to buy insurance. The estimate comes from congressional testimony by a Treasury Department official who speculated that the 10-year, $70 billion proposal could result in coverage for 4 million to 5 million people.

One year earlier, the Bush budget set aside $89 billion for the same credit, claiming it would cover 4 million. Analysts say it is impossible to see how spending $20 billion less, at a time when premiums are much higher, could achieve the same level of coverage.

If the tax credit were passed, Jonathan Gruber, an economist at the Massachusetts Institute of Technology, predicts some businesses will drop health insurance. If just 1 percent of people who currently receive coverage from an employer bought individual insurance instead, the Bush policy would result in 1.8 million newly insured, according to Gruber's analysis.

The next-largest element in the Bush agenda is a proposal to allow small businesses to band together to purchase insurance through new association health plans. Hauck said 2 million people would be covered if this were enacted. The figure came from a January 2000 CBO report in which the nonpartisan agency said 10,000 to 2 million people might join association health plans.

But in its July 2003 analysis of the Republican bill, the CBO concluded that 600,000 Americans would likely buy into the pools, at a cost of $254 million. Even the Bush campaign Web site reports that "600,000 would be newly insured," or 1.4 million fewer than Hauck's tally. And a recent study by Mercer Risk, Finance and Insurance Consulting found the proposal could result in a decline of 1 million insured, because small-business insurance premiums would likely rise.

Finally, the Bush campaign projects that 3 million people would be covered through new health savings accounts, which allow people to save money tax-free for out-of-pocket medical expenses. The new accounts, purchased in combination with high-deductible, catastrophic insurance, were created as part of last year's Medicare prescription drug package.

Hauck said an "internal estimate" by the campaign indicates the provision would extend insurance to 1.1 million people, though she could not provide supporting material. The Joint Committee on Taxation estimated the proposal would cost $6.7 billion, but officials there declined to say how many people that figure was based on.

MIT's Gruber and Paul Ginsburg, president of the Center for Studying Health System Change, said the impact would be minimal, because some people likely to purchase the new accounts are currently insured. Democrats say it is unfair for the Bush campaign to include the provision at all, since it is current law, not a proposal.

Bush wants to expand use of health savings accounts by also making the premiums tax-deductible, a proposal Gruber said would increase the number of uninsured by 350,000.

But Hauck said the campaign assumes that making the premiums deductible will result in coverage for an additional 1.9 million people. That figure is based on an article by Dan Perrin and Richard Nadler at the HSA Coalition, a group that has worked for the past decade to pass medical savings account legislation, according to its Web site.

The coalition includes conservative members such as the Christian Coalition, the 60 Plus Association and the Small Business Survival Committee.

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