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Barack Obama has already argued a lot with Hillary Clinton about their respective health-care plans. Now he’s shifting the debate to John McCain, with whom he has much broader policy differences.

Obama and rival Hillary Clinton are both pushing universal health-care plans that would expand government’s responsibility while also keeping a role for private insurance. McCain wants to shift health insurance tax breaks from employer-sponsored insurance to individuals and families, who could apply a tax credit to insurance they buy on an open, less-regulated market.

McCain’s also alluded to taking steps to make it easier for the sick to get coverage in that market. (See more here on how both sides are making compromises that make their plans more centrist.)

Campaigning in Oregon this past weekend, Obama said not so fast on the Republican’s plan. McCain, Obama said, “wants to give you the failed Bush health-care policies for another four years,” according to the Chicago Tribune. And what has Bush done on health care? Nothing, Obama said, “except offer a few tax breaks to some folks who don’t really need them.”

Obama added that McCain would “shred” employer-based health care and leave every American to “fend for yourself” in the free market, according to the Tribune.

A McCain spokesman responded that Obama and Clinton “want to insert government bureaucracy into your medicine cabinet, while John McCain is committed to keeping America’s top-quality doctors, and reforming the system so that health-care plans would be made available, accessible and affordable for families.”

Health Blog McCain Bonus: In an opinion piece in the Dallas Morning News, Jonathan Cohn questions whether the sick would be able to get coverage under McCain’s plan, even if provisions are enacted to try to make it easier. The problem remains that insurers “generally won’t offer coverage directly to people with ‘pre-existing conditions,’ since they represent such bad financial risks.”

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Monthly private health insurance premiums for healthy young people “vary by hundreds of dollars” in US cities, according to a study released last week, the Wall Street Journal reports. They researched premium health insurance quotes for 30-year-old nonsmoking men and women without pre-existing medical conditions in the 50 most populous U.S. cities. All types of health insurance policies were examined, including HMOs and PPOs. Policies had a maximum $1,000 deductible and 20% coinsurance. Long Beach, Calif., residents paid the lowest premiums, with the least-expensive monthly premium at $54. New York City was the most expensive city, with premiums of $334 for similar coverage. Long Beach, Calif., was the least-expensive city for women, with $54 monthly premiums, while policies offered to men in Columbus, Ohio, were as low as $52. Cost disparities for men and women were found in states where there is no requirement for equal rates for both sexes.
Reprinted with permission from http://www.kaisernetwork.org.

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The Wall Street Journal on Monday examined “what is shaping up to be a shaky earnings season” for health insurers in the face of the current economic recession.

The Journal reports that “[e]conomic woes had little effect on health insurance profits” during the last two recessions — in the early 1990s and the early 2000s — because the industry was able to raise prices more quickly than health costs were rising.

Last month, however, several large health insurers issued “a surprise string of profit warnings,” the Journal reports. WellPoint, the nation’s largest insurer, said that rising medical costs, premium pricing miscalculations and the current recession would lead to lower-than-anticipated profits this year, resulting in “the sector’s worst selloff in a decade,” according to the Journal. As a result, investors will “scour” first-quarter earnings reports from UnitedHealth, WellPoint and Aetna for “signs that health insurers’ near-decade of expanding profit margins is about to be thrown into reverse,” the Journal reports.

The Journal reports that the “weak economy is exacerbating a longer-term and more troubling trend” of coverage becoming “too expensive” for employers and workers. UnitedHealth and WellPoint have experienced declines in the number of members, which is partially a result of small businesses reducing coverage for workers due to costs, according to WellPoint CEO Angela Braly.

“What we’re seeing is a market that’s gotten so mature and beyond its customer that people can literally no longer afford to buy the product,” Sheryl Skolnick, an analyst with CRT Capital Group, said. She added, “The number of uninsured is growing faster than any player in the game, and it’s getting bigger at the expense of the Uniteds, the WellPoints.”

According to the Journal, insurers have been “cushioning problems” by expanding into new markets, including offering plans to Medicare beneficiaries and creating health information tools that allow employers and individuals to better contain health care costs (Fuhrmans, Wall Street Journal, 4/21).

Reprinted with kind permission from http://www.kaisernetwork.org.

Advisers to all three major presidential candidates on Friday discussed proposals to address health care disparities at an event sponsored by the National Hispanic Medical Association, CQ HealthBeat reports. About one-third of U.S. Hispanics do not have health insurance, according to NHMA President Elena Rios. HHS data indicate that Hispanics also face the largest disparity in health care of all ethnic and racial groups, according to CQ HealthBeat

Douglas Holtz-Eakin, senior health care adviser to presumptive Republican nominee Sen. John McCain (Ariz.), said that health care is “America’s biggest domestic policy problem” and that McCain would focus on making care more affordable. He said, “If we don’t address the cost issue, any other victory … will be short-lived.” McCain would replace a tax break for employees who receive health insurance from employers with a refundable tax credit for the purchase of private coverage, as well as focus on preventive care and quality improvement, Holtz-Eakin said.

Chris Jennings, an adviser to Democratic candidate Sen. Hillary Rodham Clinton (N.Y.), said, “You cannot ensure access to quality if you don’t have access to coverage.” He added, “You’ve got to have everyone in the same system so everyone can contribute to it and everyone gets covered when they are sick.” Clinton would mandate that all residents obtain health insurance, Jennings said. He added that health education should include more cultural and linguistic competency to make Hispanics more comfortable when they speak with health care professionals. In addition, he suggested increasing mandatory spending for public hospitals and community health centers that provide care for undocumented immigrants. “We just can’t pretend those populations don’t exist,” Jennings said.

Kavita Patel, an adviser to Democratic candidate Sen. Barack Obama (Ill.), said that Obama would seek to diversify the health care profession. The background of health care professionals “influences what they choose to do and where they choose to practice,” according to Patel. She added, “Primary care and prevention are not rewarded in the system … When there’s no incentive in place, it’s hard to do right by patients.” Obama would seek to make health insurance more affordable to allow more residents to purchase coverage, Patel said. She added that Obama would seek to expand programs that help students interested in health care professions pay for school (Nylen, CQ HealthBeat, 4/21).

Reprinted with kind permission from http://www.kaisernetwork.org.

The Wall Street Journal on Saturday examined how health care will produce “some of the sharpest differences” between Democrats and Republicans in the presidential election as the candidates “respond to increasing economic anxiety about many issues.”

According to the Journal, Democratic candidates Sens. Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.) “want to use government as a lever” to expand health insurance to more U.S. residents. Both candidates would use the federal government to establish a marketplace in which residents could purchase private or public health insurance, with subsidies for lower-income residents, and would prohibit health insurers from rejecting applicants because of pre-existing medical conditions. The most significant difference in the proposals involves the question of whether to mandate that all residents obtain health insurance. Clinton would implement such a mandate, but Obama would require coverage only for children.

Meanwhile, presumptive Republican nominee Sen. John McCain (Ariz.), who “doesn’t think it is up to government to ensure that all citizens are insured,” would seek to “give people more control” over their health insurance through the free market, the Journal reports. “The centerpiece of his plan is severing the link between health insurance and employment,” according to the Journal. McCain would replace a tax break for employees who receive health insurance from employers with a tax credit of $2,500 for individuals and $5,000 for families for the purchase of private coverage. He has said that Clinton and Obama “want government to take over the health care system” (Meckler, Wall Street Journal, 4/19).

Campaign Ads
The Obama campaign has begun to air a television advertisement in Pennsylvania that claims Clinton might garnish wages to enforce the individual health insurance mandate in her health care proposal, the Journal reports (Calmes, Wall Street Journal, 4/21). According to the ad, “Hillary Clinton is attacking, but what’s she not telling you about her health care plan? It forces everyone to buy insurance, even if you can’t afford it” (Kornblut/Murray, Washington Post, 4/20). In response, a group that supports Clinton has begun to air a TV ad in Pennsylvania that claims the Obama health care proposal would not provide health insurance for all residents (Wall Street Journal, 4/21).

During a speech on Saturday in Bethlehem, Pa., Clinton said that Obama has “misrepresented” her health care proposal. She said that “the last thing we need is somebody spending as much money as he has downgrading universal health care.” In addition, Clinton said, “We need to achieve universal health care — not create political opposition to universal health care,” adding, “That’s what Republicans do” (Fitzgerald/Infield, Philadelphia Inquirer, 4/21).

Links to these and other ads on health care are available on dedicated candidate pages on the Kaiser Family Foundation’s health08.org Web site.

Editorial, Opinion Pieces
Summaries of an editorial and two opinion pieces that address health care issues in the presidential election appear below.

• Gov. Ed Rendell (D-Pa.), Christian Science Monitor: “It is vital that we select a candidate who is both ready to win and ready to start addressing” health care and other issues “beginning on the very first day,” and “I have no doubt the best person” is Clinton, Rendell writes in a Monitor opinion piece. He writes, “Can there be any doubt that she is the best person in this country to make sure everyone — no exceptions — has affordable high-quality health care?” According to Rendell, “Hillary was fighting to fix America’s health care system and cover everyone long before it was popular.” He adds, “And now, Hillary is the only candidate in this race to truly offer universal health care that covers everyone” (Rendell, Christian Science Monitor, 4/21).
• Clinton, Philadelphia Daily News: “I’m offering solutions to finally provide health care to every man, woman and child in America” as part of an agenda to address a number of important concerns, Clinton writes in a Daily News opinion piece. Clinton writes, “Under my plan, if you have insurance you like, you keep it. Nothing changes. But if you’re uninsured or underinsured, you’ll have access to the same health plan that members of Congress have.” She adds, “And we’ll offer tax credits to make sure everyone can afford it.” Clinton writes, “After seven years of President Bush, we know we have our work cut out for us” on health care and other issues, adding, “Today, we need a president with the strength and knowledge to tackle” these challenges starting on day one. … I’m ready to be that president” (Clinton, Philadelphia Daily News, 4/21).
• Washington Post: McCain “deserves credit” for his proposal last week to require higher-income Medicare beneficiaries to pay higher monthly premiums for the prescription drug benefit, but the “rest of McCain’s economic plan” remained at the “other end of the spectrum of responsibility” and “put political advantage over telling unpleasant truths,” a Post editorial states. According to the editorial, the proposal would affect only 5% of Medicare beneficiaries and save the program “only about $2 billion over five years,” but “it is one sensible step in the battle to control Medicare spending.” The proposal, although “minor, as far as dollar amounts go,” is “politically risky,” and the “howls of outrage with which it was greeted by Democrats illustrate the difficulty of dealing with entitlement spending,” the editorial states (Washington Post, 4/21).

Reprinted with kind permission from http://www.kaisernetwork.org.