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Back Burner for Insurance

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As a presidential candidate, George W. Bush deemed access to basic health insurance for every low-income, working family in America “a goal worthy of our nation.” Just not as worthy, it turns out, as a $1.6-trillion tax cut or an $18.4-billion increase in defense spending.

Seven months into his term, President Bush has achieved the tax break and is stumping for the defense increase. But the tax cut and a slowing economy have lowered federal budget surplus projections so much that Health and Human Services Secretary Tommy G. Thompson told The Times last week that there would probably not be enough money to expand a popular children’s insurance program as planned.

According to Thompson, the Bush administration still intends to press for new tax credits to encourage people to buy private health insurance. Refundable tax credits of $1,000 for a single person and $2,000 for a couple would help some people afford insurance, especially the middle class and those who are eligible for an employer-subsidized plan but can’t now afford their share of the premium. But with a conventional policy for a family of four costing $5,000 to $7,000 a year, tax credits leave a big gap for low-income families.

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Even the insurance industry, which would welcome tax credits, supports expanding government programs for the poor such as the Children’s Health Insurance Program. Aside from humanitarian reasons, the industry knows that providing government subsidies for those too poor to afford private premiums makes economic sense. Without health insurance, many people wait until health problems become emergencies and are more difficult--and expensive--to treat. When already overcrowded emergency rooms are used as the doctor’s office of last resort, the public bears the cost, whether in higher premiums or delayed care. And everyone bears the costs when the poor, denied access to health care, continue working while sick, often in the food service industry or other jobs in which contact with others can spread illnesses.

An estimated 44 million Americans, or 18% of the population, lack health insurance. In California, 23% of the population is uninsured, and in Los Angeles County, 31%. According to surveys by the Kaiser Family Foundation, an independent national health care philanthropy, three-quarters of the uninsured are not, as stereotype has it, unemployed but in families with at least one family member working full-time. Low-wage workers and workers employed by small companies--Los Angeles has an abundance of both--are the most likely to be uninsured.

Finding a way to provide basic health care for these hard-working people is important to public health and to social well-being. Expanding the Children’s Health Insurance Program would cover more people in a more efficient manner. It shouldn’t be lost to the shrinking surplus and a careless tax cut.

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