Some Analyses Find Bush’s Health Care Plan Would Help Fewer Than 10 Million Uninsured

Several independent analyses of President Bush's proposal to extend health care to 10 million uninsured U.S. residents at a cost of $102 billion over 10 years found that the "hard data fell far short of the claims," the Washington Post reports. The Congressional Budget Office, the Treasury Department, academics and the Bush campaign Web site "suggest that under the best circumstances, Bush's plans for health care would extend coverage to no more than six million people over the next decade," according to the Post.

It also is possible that the proposal would only result in two million additional insured people, the Post reports. Henry Aaron, health policy expert at the Brookings Institution, said, "There's little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance. We're swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush's proposals to move against that current is, it seems to me, very, very limited." According to the Post, Megan Hauck, deputy policy director for health care in the Bush campaign, "generally touts" that the proposal would expand coverage to 10 million uninsured through tax credits, association health plans and health savings accounts. However, she agreed that it could expand coverage to as few as six million.

Based on testimony by a Treasury Department official, the Bush campaign estimates that about five million people would use a $1,000 tax credit to purchase health insurance. However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology, says some businesses could drop coverage as a result and that his analysis shows the Bush policy could result in 1.8 million newly insured.

Hauck said that the Bush campaign's plan to allow the formation of association health plans would result in an increase of two million insured residents. The figure comes from a January 2000 CBO report that estimated the plans would attract 10,000 to two million members; however, a July 2003 CBO analysis of such plans found that about 600,000 U.S. residents would join.

Mercer Risk, Finance and Insurance Consulting estimated that association health plans could lead to an increase of one million uninsured U.S. residents because of an increase in small business insurance premiums.

The Bush campaign also has said it could expand health coverage to three million people through health savings accounts. Hauck said an internal campaign estimate found the accounts would extend coverage to 1.1 million people, and that an additional 1.9 million would receive coverage through a Bush proposal to make premiums for such coverage tax-deductible.

Gruber and Paul Ginsburg, president of the Center for Studying Health System Change, said HSAs would have a minimal impact on the rate of uninsured because some people who are likely to open such accounts are already insured. Gruber said that expanding use of HSAs by making premiums tax-deductible would increase the number of uninsured by about 350,000 when combined with Bush's tax credit policy.

According to the Post, the "assertions Bush makes about his first-term health care record" are exaggerated. For instance, he speaks about more than four million seniors who previously lacked prescription drug coverage as enrolling in the new Medicare drug discount card program. However, he fails to note that 2.9 million of those seniors were signed up automatically as a result of their participation in a Medicare managed care plan. Further, the Bush campaign Web site states that the administration has expanded eligibility under Medicaid and SCHIP to more than 2.6 million people.

Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said that the statement "is not really true," adding, "In reality, only 200,000 of them got coverage" because of policies enacted by the Bush administration. Rowland said, "Part of the reason more people were covered is the economy got so bad that people lost income. There were more low-income people under Bush than previously, so they became eligible for public programs." Hauck said the figures cited by Rowland are "awfully low" (Connolly, Washington Post, 8/22).

In related news, the Los Angeles Times on Monday examined Bush's domestic agenda -- including his plan to expand use of health savings accounts, which the paper says "may not appear that weighty or new" but "still add[s] up to something big."

Articulating his vision for an "ownership society," Bush said, "During the next four years, we'll help more citizens to own their health plan, to own a piece of their retirement, to own their own home or their own small business" (Vieth, Los Angeles Times, 8/23).