The budget President Bush unveils next week will propose spending an extra $140 billion over 10 years to expand health coverage to millions more Americans, his top health adviser said yesterday. But many of the proposals are familiar ideas that never made it past the talking stage in Bush's first term.
Health and Human Services Secretary Mike Leavitt said Bush wants to spend more money to enroll children in government-funded health programs, give tax credits to individuals and companies that purchase insurance and build more community health centers.
HHS chief Mike Leavitt said he wants to modernize the Medicaid program.
The administration projects it can squeeze $60 billion over the next decade out of the Medicaid program for the poor and the disabled, and funnel that money into other health projects, Leavitt said. Altogether, Leavitt said, those measures could extend health insurance to an additional 12 million to 14 million Americans.
"That would be a historic step forward to make that much progress within the decade," he told reporters in a leisurely conversation in his new office at HHS headquarters, as he offered a rosy preview of the health-related components of the budget in advance of Monday's release of the actual numbers.
But many of the ideas Leavitt sketched out have been offered by the Bush White House in the past, eliciting little interest on Capitol Hill and deep skepticism about how many more Americans would be covered.
About half of the $140 billion appears to represent Bush's plan to provide refundable tax credits for the purchase of health insurance. Rolled out during Bush's first year in office, the credit would cost $70 billion to $90 billion over a decade, according to administration figures.
Leavitt promised to provide more detailed cost information today. "The job the president has given me is to help Americans live longer and healthier, but to do it in a way that allows us to maintain our economic competitiveness as a nation," the new secretary said.
Since 2000, the number of Americans without health insurance has risen by 5.2 million, according to the latest Census Bureau figures. Independent experts and the Bush presidential campaign have estimated the administration's standing package of health proposals would extend coverage by 2 million to 17 million people.
"The $140 billion is phantom expenditures," said Ron Pollack, head of Families USA, a nonprofit group that advocates health care for all. "These are the same tired and ineffective proposals relating to the uninsured. I don't expect that money to be spent."
Pollack and many governors fear that the administration and Congress will go forward with cuts in Medicaid as part of a larger effort to trim the deficit, regardless of the fate of the other health care proposals.
Leavitt said his goal is to stretch health care dollars further by modernizing the program and eliminating waste, fraud and abuse.
He and Mark B. McClellan -- head of the Centers for Medicare and Medicaid Services, which administers the federal component of both programs -- implied that the administration hopes to drastically loosen the requirement that states provide long-term care in nursing homes. Keeping the elderly out of nursing homes should result in better health and lower costs, they said.
Currently, states must secure a waiver from McClellan's agency to shift elderly patients to home- or community-based care. Changing that would require action by Congress.