Budget's Health Care Priorities Detailed

Home Health Columnist / Guide · Feb 4, 2002

By Amy Goldstein

Washington Post Staff Writer

Thursday, January 31, 2002; Page A23

http://www.washingtonpost.com/wp-dyn/articles/A58-2002Jan30.html

The Bush administration yesterday laid out an eclectic strategy for trying to improve access to health care, proposing insurance tax credits, new freedom for states' insurance programs, and bigger subsidies for community clinics and the training of health care workers to go into poor neighborhoods.

The budget President Bush is to release next week calls for $89 billion over the coming decade in tax credits for workers who cannot get insurance through their jobs. It also will recommend a second kind of tax credit, originally embraced by congressional Republicans, that would give temporary help in buying insurance to people who become unemployed.

Taken together, the proposals largely reflect conservative thinking about how to bring the health care system within easier reach of people who lack medical coverage, and is grounded in ideas that Bush adopted during his presidential campaign two years ago.

But the administration also has adjusted many of its proposals from last year, modifying them in ways that take into account Democratic criticisms in the past. For instance, compared with the administration's original tax credit proposal, the new version would grant bigger credits, enable people to get the assistance up front, and try to help them find less expensive coverage through insurance-purchasing pools.

The strategy, announced at a local health center and on Capitol Hill by two of the president's senior health care aides, filled in the details of a theme that Bush touched on in his State of the Union address Tuesday night. "Americans know that economic security can vanish in an instant without health security," Bush said in the one paragraph of his speech devoted to the health care agenda he will pursue this year.

The initiative was announced as the White House has been trying to highlight in advance aspects of its budget that are likely to prove popular with the public -- in a year when Bush will recommend that spending on domestic programs subject to annual appropriations increase more slowly than inflation. With medical costs rising rapidly, 39 million Americans uninsured and the recession swelling the ranks of the unemployed, health care is a key public concern.

"In solving the problem of the uninsured, we must not be bound by the old ideological battles of the left and the right, of private-sector versus public-sector solutions," Health and Human Services Secretary Tommy G. Thompson said during an appearance at the Upper Cardozo Health Center, a nonprofit clinic in the District. "We must take the best of both worlds, and in the end, the reward goes to those who need it most, the American families who lack access to quality health care."

Specifically, the budget will recommend a $114 million expansion next year of subsidies to such community clinics -- which would come on top of a $165 million increase this year. It will include $191.5 million, a $44 million increase, for a long-standing program, the National Health Service Corps, that provides loans and scholarships to train doctors and other health care professionals who promise to work in neighborhoods that are medically underserved.

Expanding on an idea that is popular with conservatives -- and resisted by liberals -- the budget will loosen the rules for medical savings accounts. The changes would make these accounts -- currently allowed under an experiment approved by Congress -- permanent and make them available through all employers, not just small businesses.

Using an approach that is more popular with Democrats, the budget also would allow states to keep $3.2 billion next year that they received -- but have not spent -- under the State Children's Health Insurance Program. That money otherwise would return to the U.S. Treasury, but the administration wants states to use it to expand coverage for the uninsured.

The budget also would continue to offer Medicaid benefits temporarily to people who are moving from welfare into jobs. The $350 million in the budget for that program would not enlarge it but would preserve it for another year, because the 1996 law that overhauled the nation's welfare system is scheduled to expire this fall.