Health Insurance Crisis

Last week President Clinton said he will ask Congress to budget a whopping $76 billion over 10 years to extend health insurance to the parents of children now enrolled in state-based children’s health insurance programs. The plan is aimed squarely at the working poor.

Clinton’s chances of rallying support in Congress are better than one might expect in light of the failure of his sweeping health reform package in 1994. His latest ideas are not far removed from those of Democratic presidential candidates Al Gore and Bill Bradley. Clinton has already received a guardedly favorable reaction from Republican leaders in Congress, and, according to a survey released last week by the Kaiser Family Foundation, half of all registered voters say they favor covering uninsured families even if an expansion would slightly raise their taxes. Even the Health Insurance Assn. of America, whose “Harry and Louise” TV ads helped defeat Clinton’s 1994 reforms, brought the couple back to TV last week to support expanding public health coverage to contain what the commercial called an epidemic of uninsured Americans.

Clinton’s plan, however, should be viewed not as a piece of finished policy but as the starting point for serious, overdue reform. Despite the veneer of agreement in Washington, significant divisions remain. For example, the administration wants to have existing public health insurance programs handle most of the expansion, while the health insurers would prefer to see the money funneled into vouchers that small businesses and the working poor could use to purchase policies from--of course--private insurers.

Congress and the administration at least agree that the problem of the uninsured has grown too big to ignore. According to a study issued last week by health policy researchers at the University of California, despite a thriving economy the number of Californians without health insurance, now at 7.3 million, continues to grow by 23,000 per month. That clip far exceeds the national rate and shows no sign of slowing.

Congress, which goes back into session this week, ought to start by extracting the easy parts of the Clinton plan and passing them. Among them is a 20% tax credit to small businesses that buy health insurance for their workers through purchasing coalitions. That reform is key to California, for the state remains dead last nationally in the percentage of residents who have job-based insurance.

Gov. Gray Davis, who last year signed into law protections for Californians who do have health insurance, should support reforms to help those without it. That means improving and expanding Medi-Cal and the Healthy Families Program, the state’s name for the federal children’s health insurance program. Start by streamlining the application process and combining the two programs so families “graduating” out of Medi-Cal can buy right into Healthy Families. More outreach is also needed, especially to Latinos. According to the University of California report, 40% of California’s Latino population was uninsured in 1998.

The policy details of how to cover the uninsured are a legitimate topic for debate in Washington and Sacramento this year. Given the gravity of the problem, a failure to take action would be inexcusable.