Universal Health Coverage Attracts New Support

By Christopher Lee
Washington Post Staff Writer
Monday, January 22, 2007

Harry and Louise have had a change of heart.

Thirteen years after television ads from the insurance industry featuring the fictional middle-class couple helped kill the Clinton health-care plan and make universal coverage politically radioactive, comprehensive proposals for expanding coverage to millions of uninsured Americans are flowering again inside the Beltway and around the country.

And this time, advocates hope, the political climate is right for the best ideas to grow, in large part because many business groups that opposed earlier efforts now agree that rising health-care costs and increasingly tougher access to insurance are unsustainable trends.

Whether Washington will do more than talk about the problem, however, remains to be seen. Money is tight, and some experts say major shifts in federal policy are unlikely until after the 2008 presidential election, in which health care is expected to be a major focus.

Many are not willing to wait. Karen Ignagni, president of America's Health Insurance Plans -- the same industry association that once funded the "Harry and Louise" ads -- was among representatives of 16 business, medical and consumer groups that last week called for Congress to spend $45 billion over five years to extend health coverage to most of the nation's uninsured children. After that, the groups said, lawmakers should direct billions more toward covering uninsured adults, mostly through a mixture of tax breaks and expanded federal programs.

"On this issue, the polls show that Democrats, Republicans and independents want progress," Ignagni said. "The most expensive course is to do nothing."

John J. Castellani, president of the Business Roundtable, an association of chief executives of 160 U.S. companies, issued a similar call at a separate news conference last week with leaders of AARP, the politically powerful seniors organization, and the Service Employees International Union (SEIU). "Our soaring health-care costs put American goods and services at a significant competitive disadvantage, and they slow economic growth," Castellani said. "Policymakers must act."

In recent weeks, proposals for dramatically expanding coverage have been floated by Ignagni's industry group, the Children's Defense Fund and Sen. Ron Wyden (D-Ore.). Sen. Edward M. Kennedy (D-Mass.) and Rep. John D. Dingell (D-Mich.), who lead important congressional committees, plan to pursue legislation to allow Americans under 65 to enroll in Medicare or in the health coverage enjoyed by Congress. And a bipartisan group of two senators and three House members introduced legislation last week to help states fund innovative ways to cover more people.

"Health care has been poked and prodded for years," said Wyden, who wants to replace employer coverage with a centrally financed system of private insurance for all Americans. "I believe it is time for diagnosis and treatment."

Much of the activity in Washington is being spurred by a wave of experiments at the state level, particularly Massachusetts's decision last year to require all residents to obtain health insurance, through state-subsidized policies if necessary. This month, California Gov. Arnold Schwarzenegger (R) proposed a similar plan for all 36 million Californians, funding its $12 billion cost partly through fees on employers, hospitals and doctors.

In Pennsylvania, Gov. Edward G. Rendell (D) last week proposed creating a program of state-subsidized private insurance to help many of the 767,000 uninsured people in his state. The plan would impose taxes on tobacco and on businesses that do not offer coverage, and it would phase in a requirement that people earning more than 300 percent of the poverty level (about $60,000 for a family of four) obtain insurance.

"It is no longer a question of whether we can afford to act," Rendell said, noting that treating Pennsylvania's uninsured costs $1.4 billion annually. "The cost of inaction is far greater in terms of individual health consequences and from the increasing burden on taxpayers."

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