Subcommittee on Health
Committee on Energy and Commerce U.S. House of Representatives
February 28, 2002
Mary R. Grealy, President, Healthcare Leadership Council:
“The members of the HLC also support the President’s inclusion of more than $90 billion in his recent budget to begin mapping the way to coverage for a significant number of the uninsured. The majority of this funding would provide a refundable health tax credit that could be advanced to families to help them purchase insurance plans in the non-group insurance market. The HLC believes this is an important step toward providing easier access to health care coverage for the millions of working Americans who are without it.”
Judith Feder, Ph.D., Dean of Public Policy, Georgetown University:
“Although seemingly addressing the same problem, two different policy mechanisms can have very different impacts. Tax credits reach a large number of people, but most of them are not uninsured. Indeed, only a small proportion of the uninsured population-disproportionately young and healthy-are likely to participate in the new program and those who do will receive only modest benefits. And, at the same time it expands coverage, the pursuit of tax equity actually undermines coverage already in existence. As a result some of its coverage gains are offset by coverage offsets. In large part, this outcome reflects the fact that tax credits are not simply aimed at expanding coverage; they also aim at greater tax equity-that is, equalizing tax preferences wherever health insurance is purchased.
“The sole purpose of a public program is to expand coverage. It concentrates a comprehensive benefit on a narrowly defined population, the vast majority of whom are uninsured. If the nation’s primary goal is to expand meaningful coverage for those who need it the most, the public program is by far the more effective mechanism.”
Comment: This hearing was significant because it heard testimony from several individuals on one of the most important subjects in health care today: providing coverage for the uninsured.
Much of the testimony on behalf of tax credits was based on political ideology as is exemplified by Mary Grealy’s comment that, “HLC believes this is an important step.”
Other testimony objectively defined the problem of the uninsured and provided solid evidence of the potential impact of various policy approaches on expanding coverage. Judith Feder’s testimony reveals that tax proposals are poorly targeted, whereas public programs such as Medicaid and S-CHIP are much more effective in expanding coverage for the uninsured.
In approaching health care reform through incremental steps, there is no question as to the proper approach. By defining the problem and analyzing the impact of various health policy approaches, it is clear that expanding public programs would work, and using tax credits wouldn’t. Ideology for the sake of ideology must be dismissed.
But the most disconcerting feature of the hearings is that testimony was limited to incrementalisim. The consensus, if you believe it, is that any single program of universal health care coverage must be left off of the agenda. All parties have entered an implied agreement that we will meet in the center through incrementalisim. But this is absolutely untrue. The Robert Wood Johnson coalition on the uninsured demonstrates this. The dozen organizations involved are spending $10 million to publicize the plight of the uninsured, but they are in agreement that they are not in agreement on what we should do about it. The only agreement that they have reached is that they will keep single payer advocates out of the process.
The preliminary results of the California Health Care Options Project demonstrate that single payer proposals would provide comprehensive care to everyone and reduce health care costs. The other proposals that build on our current, flawed system are not universal, nor comprehensive, and they would all increase health care costs.
It’s long past time to open the door and allow single payer advocates to place their models on the table. We should be looking at all policy approaches. And the only precondition to the process that we should insist on is that everyone would agree to place the interests of the patient above that of their own special interests.