As the November presidential election approaches, Americans weigh the merits of Barack Obama versus John McCain.  They form preferences based on innumerable and sometimes inscrutable rationales.  Some Americans will vote along party lines.  Others will vote according to economic issues, stances on abortion, or the war in Iraq.  But those who work in the trenches of US health care delivery will have a particular interest in the senators' proposed revisions of our failing health care system.  Is the answer universal coverage?  Or improved access to private insurance?  Here is a brief overview, according to Kevin Sack's New York Times article "McCain Health Plan and That High-Risk Pool", of a key reform component: insuring the "medically uninsurable".

Too many of our patients are among the 47 million Americans who live without health insurance.  Within that group are certain so-called high-risk applicants whose pre-existing medical conditions present unmanageable obstacles to the procurement of affordable health insurance.  The total number of Americans who do not meet the qualifications for Medicaid or Medicare and have medical histories which preclude commercial insurance coverage is unknown.  But in order to insure some of them, state-run high risk pools have been created in 13 US States. 

While these state-coordinated high-risk pools do level premiums at twice standard insurance rates, they allow some people to access coverage they otherwise could not afford.  The state of Maryland, for example, assumes 40 percent of the costs necessary to pay off claims for high-risk clients. Sadly, these programs are not financially sustainable in light of client demand and state budgeting constrictions.  Maryland has been forced to restrict enrollment and implement enrollment delays in order to continue with its high-risk pool. 

Economists argue that if similar high-risk pools are initiated federally, as McCain recommends in his Guaranteed Access Plan, the expense will greatly exceed his estimated 7 to 10 billion dollar price tag.  This could become problematic for McCain, who hopes to balance the federal budget by the year 2013.  However, just about everyone agrees that a solution must be found for high-risk, uninsured applicants; currently, 75 percent of national health care dollars are spent caring for them. 

In addition to proposals for nation-wide high risk pools, McCain suggests other options for extending coverage to uninsured Americans. As Sack writes, Mr. McCain recommends instituting "refundable health care tax credits of $2,500 per person and $5,000 per family in the hope of driving consumers into the individual insurance market." 

In contrast, Senator Obama believes that instead of widening high-risk pools, all insurance companies should accept all applicants, regardless of prior or current health complaints.  He would also require all parents to insure their children.  To help offset families' costs, he would introduce subsidies.  These subsidies would, in part, be generated through a repeal of Resident Bush's income tax cuts for the wealthy.

The bottom line is that both John McCain's and Barack Obama's health care proposals will increase federal spending. But, hopefully in so doing, the election winner will increase the availability of affordable health insurance to those who most need it.

Reference:

Sack, K. (2008, July 9). McCain Health Plan and That High-Risk Pool. The New York Times. 

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