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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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The San Francisco Board of Supervisors voted unanimously Tuesday to approve a plan that would give adults access to medical services regardless of their immigration or employment status.

Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, prescription drugs and X-rays to ambulance rides, blood tests and operations.

Unlike health insurance, however, it would not pay for any services participants seek outside San Francisco. Instead, residents would receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.

With backing from both Mayor Gavin Newsom and all 11 supervisors, the so-called Health Access Plan proved to be a politically popular concept in liberal San Francisco despite unmitigated opposition from the business community.

“What feels very good is the full board and the mayor getting on board,” said Supervisor Tom Ammiano, who first championed the idea of making employers pay for some part of their workers’ medical costs. “That says the political will is there to make it happen.”

To offset the estimated annual price tag of $200 million, firms with 20 or more workers would be required to spend $1.06 for each hour worked by an employee, and those with more than 100 workers would have to pay $1.60 per hour up to a monthly maximum of $180 per worker. Companies that already offer health coverage would still have to pay if their insurance contributions did not meet the city’s funding levels.

The Board of Supervisors still needs to vote on the plan once more for it to become final. The ordinance adopted Tuesday calls for businesses with more than 50 employees to start participating starting next July, while it would take effect for enterprises with 20 or more workers in April 2008.

Michael O’Connor, a nightclub owner who serves on the San Francisco Small Business Commission, predicted that the “noble burden” of the mandate would keep businesses from locating in the city and make goods and services here more expensive as employers pass on the costs to customers.

O’Connor said many business owners were disappointed by Newsom’s backing of the plan since the mayor got his start in business as the owner of a wine shop and several restaurants.

“One would think that someone who has owned and opened restaurants would be pretty clear on what the profit margin is, and how hard it is to get them open. A $5,000 licensing fee is difficult. A new $60,000 (health care) fee is disabling,” he said.

Before the board vote, Newsom defended the proposal as a creative solution to the problem of securing decent health care for uninsured residents, noting that businesses would not be alone in defraying the costs. Of the $200 million, the city would provide $104 million and participants would contribute about $56 million.

“This is a moral debate as much as a political debate,” Newsom said.

The initiative adopted Tuesday developed as a compromise between Newsom and Ammiano, who last year introduced legislation that would have required businesses to create health savings accounts for uninsured workers. In a nod to concerns from business, the final plan requires employees to work at least 12 hours a week to be eligible and has an opt-out provision for workers who are insured through their spouses.

Because fees would be adjusted on a sliding scale, city officials did not expect to see a rush of residents canceling their existing health insurance to take part in the city program.

For a free health insurance quote in California, visit http://www.healthbenefitsdirect.com/

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.