Health Care Tables

Health care proposals

1	Kerry	Expand Medicaid and state Children’s Health Program (apparently through MMIS federal participation) to cover almost al children, as well as working parents up to 200% of poverty level, and uninsured adults up to the poverty level/
2	Bush	Enroll eligible children in state Children’s Health Insurance Program and expand community health centers
3	Bush	Tax-credits for low income people to buy health insurance ($1000 for individuals, $3000 for families); could use for health savings accounts underlying high-deductible insurance policies
4	Kerry	Help small employers by subsidizing 75% of costliest employees expenses
5	Bush	Enable professional and trade associations (as opposed to unions) to form group plans, with federal licenses exempt from state laws
6	Bush	Give small employers tax credits ($200 for individuals and $500 for families) for contributing to employee’s medical savings accounts
7	Kerry	Create a Congressional Health Plan, a pool already in the federal system, for anyone to join (with some tax credits)
8	Bush	Allow people to shop for health insurance across state lines (this would help #5 since many associations can form group policies only in certain states)
9	Kerry	Allow importation of prescription drugs from Canada and allow federal government to negotiate with foreign suppliers for lower drug prices
10	Bush	Limit pain-and-suffering and punitive damages for malpractice suits; general tort reform
11	Kerry	Administrative review to accomplish tort reform and prevent frivolous medical lawsuits, without actual limits on awards

Primary source: Amy Fagan, “Health Care at a Crossroads: Bush, Kerry plans diverge over coverage, costs” The Washington Times, Oct. 11, 2004, somewhat paraphrased and re-interpreted here.

Candidate	Estimator	Newly insured increase	Reduction in uninsured	Cost to taxpayer	Cost per household per year	Effectiveness index	Date
Bush	Lewin	8,200,000	17%	$227.5 billion, 10 yrs	$227	1.0	9/21/2004
Kerry	Lewin	25,200,000	51%	$1.249 trillion, 10 yrs	$1249	0.56	9/21/2004
Bush	AEI	6,700,000	14%	$128.6 billion, 10 yrs	$128	1.45	9/13/2004
Kerry	AEI	27,300,000	18%	$1.5 trillion. 10 yrs	$1500	0.51	9/13/2004
Bush	Bush	17,000.000 high	35%`	$145 billion 10 yrs	$145	3.07	10/1/2004
Kerry	Kerry	26,700,000	52%	$953 billion 9 yrs ($300 from upper income tax rollback)	$1000 approx	0.62	10/1/2004

Links: Lewin Group; American Enterprise Institute (some calculations are mine)

President Bush mentioned the Lewin Group in the debate on 10/24/2004 in Tempe AZ. It seems that President Bush’s plan would insure more people per taxpayer dollar, even if less “ambitious,” but that is partly because President Bush is more interested in helping those who already have a head start on helping themselves. Neither candidate has looked at the health care financing (and especially eldercare) issue with complete intellectual freedom, especially in light of falling birthrates.

Individual Health Insurance for the Self-Employed, Unemployed, or employed without benefits:

Table of types of individual health plans available to the unemployed or self-employed. The source for this table is the article, “Full Coverage: Insurance Journalist Goes Shopping,” Christopher J. Gearon, The Washington Post, Health, p F1, Oct. 26, 2004. The worst-off may be those individuals who depend upon hourly jobs without benefits, including seniors who may be supplementing pensions or 401K’s. Those who want to use self-employment plans may have to earn most of their income from true self-employment as opposed to wages (not a good situation for freelance writers, perhaps).

Kind of plan	Pro	Con
COBRA	Available for 18 months after layoff	Expensive; only for 18 months
HIPAA Eligibility	Helps those with pre-existing conditions	Very expensive in many states
Self-employment policies	Guaranteed in some states	Not in all states, and you must actually show earning from the self-employment on its own
Associations	In some states, may help you buy individual policies later	Not in all states yet (Bush wants to fix), and you must actually derive income from your association-defining activity; prone to scams
Last resort and Blue Cross and Blue Shield Plans	The Blues supposedly will take anyone	Very expensive in some states for seniors or where anti-selection is expected

Some examples of individual spending account plans.

These strategies help those who are steadily employed at high incomes and with health benefits. Note that the HSA, especially, might reward conscientious health maintenance by middle-aged and senior employees, even at the expense of having cash available for other purposes. The source is “The ABC’s of Health Insurance,” in the article by Francesca Lunzer Kritz, “Selection Time: Health Savings Accounts Are Tempting But Mostly Untested,” The Washington Post, Oct. 26, 2004, p. F1.

Name	Description	Business or Individual	Tax-exempt	Requires (high-deductible) policy?	Portable?	Pro	Con
Flexible Spending Account (FSA)(and the predecessor Medical Savings Account, MSA)	Account set up by employers for non-covered employee expenses	I	Y	Y (not necessary high deductible)	N	Common	Unspent funds are forfeited; mutually exclusive with HSA
Health Savings Account	An example of a “consumer-driven health plan.” Where employer usually matches contributions for fund for uncovered medical expenses	I	Y	Y (the point of the arrangement)	Y	After age 65, withdrawals for non-medical purposes allowed without tax or penalty; tends to encourage preventative care well before retirement	Mutually exclusive of FSA and MSA’s; tend not to work well for young people with catastrophic events like accidents
Health Reimbursement arrangement	Essentially self-insurance by businesses	B	Y	N	N (for employer only)		Available only if your employer has it.

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(When I have “time” or $$$ I’ll see if I can come up with a C# (Visual Studio .NET) application to generate these!! Maybe SAS (data statement and procs), no FORTRAN please! ) Bill Boushka