Earmark Insurance Money Now

In their almost obsessive focus on designing a tax cut package, Washington legislators are missing the emerging bipartisan consensus in most statehouses for helping the nation’s 43 million uninsured people. Last week in California, for instance, one of the state’s most liberal health reform advocates, Sen. Liz Figueroa (D-Fremont), signed on to a bill by conservative Assemblyman Keith Richman (R-Northridge) that would spend as much as $1.8 billion in state funds annually on health insurance for some of California’s 7 million uninsured. With the power crisis putting the state surplus in jeopardy, it’s clear that bills like Richman’s will be possible only if President Bush adequately funds state-based expansions of health care for the working poor.

In the budget he proposed as a candidate last year, Bush promised to set aside $132 billion over 10 years to help people not covered by private or public health insurance. So far, however, he has not committed any of the federal surplus for this purpose. Unless funds are promptly earmarked, the money will vanish into tax cuts and other priorities. The issue is more critical in California than elsewhere, in part because of its high immigrant population and proliferation of small-business jobs that don’t offer insurance.

Health and Human Services Secretary Tommy G. Thompson can help California in the short term by approving last month’s request by Gov. Gray Davis to use funds from the federal Children’s Health Insurance Program, called Healthy Families, to cover working-poor parents as well.

On Wednesday, the influential House Ways and Means health subcommittee will meet to set spending priorities for the budget bill that Congress hopes to send the president later this year. Republicans, who advocate a $1,000 tax credit to help the lowest-income Americans buy health insurance, disagree with Democrats, who advocate expanding existing public health insurance programs like Medicaid and the children’s program. The tax credit is attractive in its simplicity, but $1,000 a year would not begin to insure a family; the average employer-purchased plan costs $6,300.

Democrats and Republicans will have to remain flexible about the design of federal funding, seeking compromises like state choice on the use of federal dollars. What’s critical now is that enough money be set aside to make a credible start on the insurance crisis.