Expanded health care draws support

WASHINGTON – Harry and Louise have had a change of heart.

Thirteen years after television ads from the insurance industry featuring the fictional middle-class couple helped kill the Clinton health care plan and make universal coverage politically radioactive, comprehensive proposals for expanding coverage to millions of uninsured Americans are flowering again inside the Beltway and around the country.

And this time, advocates hope, the political climate is right for the best ideas to grow, in large part because many business groups that opposed earlier efforts now agree that rising health care costs and increasingly tougher access to insurance are unsustainable trends.

Whether Washington will do more than talk about the problem, however, remains to be seen. Money is tight, and some experts say major shifts in federal policy are unlikely until after the 2008 presidential election, in which health care is expected to be a major focus.

Many are unwilling to wait. Karen Ignagni, president of America’s Health Insurance Plans – the same industry association that once paid for the “Harry and Louise” ads – was among representatives of 16 business, medical and consumer groups that last week called for Congress to spend $45 billion over five years to extend health coverage to most of the nation’s uninsured children. After that, the groups said, lawmakers should direct billions more toward covering uninsured adults, mostly through a mixture of tax breaks and expanded federal programs.

John Castellani, president of the Business Roundtable, an association of chief executives of 160 U.S. companies, issued a similar call at a separate news conference last week with leaders of AARP, the politically powerful seniors organization, and the Service Employees International Union. “Our soaring health care costs put American goods and services at a significant competitive disadvantage, and they slow economic growth,” Castellani said.

In recent weeks, proposals for dramatically expanding coverage have been floated by Ignagni’s industry group, the Children’s Defense Fund and Sen. Ron Wyden, D-Ore. Sen. Edward Kennedy, D-Mass., and Rep. John Dingell, D-Mich., who lead important congressional committees, plan to pursue legislation to allow Americans younger than 65 to enroll in Medicare or in the health coverage enjoyed by Congress. And a bipartisan group of two senators and three House members introduced legislation last week to help states finance innovative ways to cover more people.

Much of the activity in Washington is being spurred by a wave of experiments at the state level, particularly Massachusetts’ decision last year to require all residents to obtain health insurance, through state-subsidized policies if necessary. This month, Republican California Gov. Arnold Schwarzenegger proposed a similar plan for all 36 million Californians, funding its $12 billion cost partly through fees on employers, hospitals and doctors.

In Pennsylvania, Democratic Gov. Edward Rendell last week proposed creating a program of state-subsidized private insurance to help many of the 767,000 uninsured people in his state. The plan would impose taxes on tobacco and on businesses that do not offer coverage, and it would phase in a requirement that people earning more than 300 percent of the poverty level (about $60,000 for a family of four) obtain insurance.

Vermont enacted legislation last year that seeks to expand coverage so that at least 96 percent of residents will have insurance by 2010. Illinois began a major expansion of coverage for children in 2005. That same year, Maine began implementing a plan whose goal is to cover all of the state’s 130,000 uninsured residents by 2009.

Other states considering expanding coverage include Connecticut, Indiana, Iowa, Louisiana, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina and Wisconsin, according to the National Conference of State Legislatures.