SOME 37 MILLION Americans -- a sixth of the population -- have no health insurance. Two-thirds of them -- about 24 million -- are in families in which at least one person works full-time. Sen. Edward Kennedy has introduced a bill to provide for this latter group by requiring almost all employers to make basic health insurance available to all their employees. Predictably some business groups -- though by no means all -- oppose both the cost and the regulation the bill would impose. But the opponents have a burden. If they don't want to care for these people this way, how do they want to care for them?
The number of uninsured is sharply up; it was only about 30 million in the early 1980s. States have cut their Medicaid programs (in part because of federal budget cuts), and employers have tried to cut their health insurance costs. There has also been a continuing shift in employment from the manufacturing sector, where benefits tend to be high, to service jobs, where they are not. The uninsured are typically lower paid workers in small businesses on the service side of the economy.
The bill sets minimum benefits; an employer could deviate as long as he provided the actuarial equivalent. The employer would have to pay at least 80 percent of the cost, and 100 percent for workers making less than 125 percent of the minimum wage. Employers would also have to provide catastrophic protection limiting annual out-of-pocket costs for covered services to $3,000 per household. Some 53 million people with insurance lack this coverage now, and about 2 million families a year have out-of-pocket costs in excess of $3,000. The bill contains a grace period for new small businesses and a pooling mechanism to cut small-business insurance costs.
Opponents say such an approach would further hobble an economy already struggling to compete. But some of the sectors facing the fiercest foreign competition would gain. Because the cost of charity care for the uninsured is folded into hospital rates, companies that have insurance pay part of the costs of companies that do not. That's one reason Chrysler and American Airlines favor the bill. Premiums for the new insurance required by the bill would be about $25 billion a year, an increase in labor costs of about 60 cents an hour per newly covered worker, the senator's staff estimates. Some of this is already being spent through other avenues -- for charity care, for example. The estimated net cost of the bill is about $12.5 billion.
Critics say that Sen. Kennedy is trying to load the cost on business because there's no way in the present climate to provide so large a benefit increase through the budget. But that's obvious. The more serious charge against the bill is that it is further patchwork, like the catastrophic health insurance for Medicare patients also making its way through Congress. The results are uneven, the process disorderly, as Sen. Kennedy would be the first to concede. He used to advocate national health insurance as the cleanest solution of all, but has been driven back to seeking a chunk at a time. The alternative is to do nothing, and that is least acceptable of al