Source: http://www.realcities.com/mld/krwashington/13730516.htm
Posted on Fri, Jan. 27, 2006
Bush's health care plan
proves controversial before it's been
offered
By Kevin G. Hall and Tony Pugh
Knight Ridder Newspapers
WASHINGTON - President Bush is expected
to use his State of the Union address
Tuesday to propose using the tax code to
create incentives for more Americans to
seek health care coverage.
The president calls it
"consumer-driven" health care,
and it's part of his vision for an
ownership society, where individuals, not
the government, take greater
responsibility for their health, wealth
and retirement income.
Critics call it a fig leaf that will
allow employers to further push the
rising cost of health care onto
employees.
Few topics are more controversial, and
more resplendent with conflicting
interest groups, than health care. It's
sure to be a top issue in this year's
congressional elections and during the
next presidential race.
The White House has signaled that it
would propose that all, or at least more,
of out-of-pocket health-care spending be
tax deductible. Currently, only medical
spending exceeding 7.5 percent of income
can be deducted.
Bush sees this as a fairness issue
because employers get tax deductions for
providing health plans - a break that was
worth $188.5 billion in 2004, according
to a study by the Lewin Group, a
Virginia-based consultancy.
Meanwhile, covered employees aren't taxed
on the value of their health plans and
often can set aside pretax dollars for
flexible spending programs. But the
working poor and uninsured must often pay
out of pocket for insurance and they get
little tax relief.
The centerpiece of the president's
proposal will be expanding the use of
tax-free Health Savings Accounts, which
are growing in number.
HSAs are patterned after the
flexible-spending accounts allowed in
many employer-sponsored health plans. An
HSA allows an enrollee to put pretax
dollars in interest-bearing accounts
that, unlike flexible-spending accounts,
can be rolled over each year and used for
future medical, vision and dental care
needs. If a contributor stays healthy,
the account keeps growing.
Americans' spending on health care
increased 7.9 percent to almost $1.9
trillion in 2004, the latest full-year
figures available. That easily outpaced
inflation and wage growth, and it
accounted for a record 16 percent of the
nation's gross domestic product - the
broadest measure of the nation's economic
activity.
An estimated 45.5 million Americans were
uninsured in 2004, up 6 million since
2000, according to the Kaiser Family
Foundation, a nonpartisan research
organization. And the number of employers
providing health plans to their workers
fell from 69 percent to 60 percent since
2000. For a family of four with
employer-sponsored health plans, premiums
have risen to an average of $10,800, or
73 percent, since 2000.
Against that backdrop, Bush is also
expected to push anew for proposals that
he failed to get through Congress, such
as "association health plans"
which would allow small businesses to
join together and leverage the cost of
providing health plans to employees.
He'll also call again for caps on medical
malpractice lawsuits. Bush wants to cut
down on "defensive medicine" -
the practice of doctors ordering
excessive medical tests to minimize the
chance of being sued later for
negligence.
"I don't think any seasoned health
economist believes that if you lower
malpractice (settlements), it's going to
cut down on defensive medicine,"
said Uwe Reinhardt, a Princeton
University economist.
But debate is likely to center on Bush's
push to expand HSAs, which can be set up
in banks, credit unions and with Wall
Street brokerage firms.
HSAs are already open to adults under 65,
and they're required to work in tandem
with high-deductible insurance plans.
Participants accept deductibles of at
least $1,000 for individuals and $2,000
for families, compared with average
deductibles of $300 and $600,
respectively, for conventional
employer-provided health plans. In
exchange, they pay lower monthly
premiums, which is appealing to younger,
healthy workers.
For 2006, pretax HSA contributions by an
individual or an employer on his behalf
are capped at $2,700. Contributions for
families are equal to the medical plan's
family deductible, or $5,450, whichever
is less.
HSAs were introduced in 2004. By March
2005, 1 million were established.
America's Health Insurance Plans, a trade
group, said Thursday that at least 3
million consumers are enrolled in HSAs.
"I think everyone is surprised by
the robustness of this number. We had a
sense, but we had no data," said
Karen Ignagni, the group's president.
It will be another month before details
are offered on age, income, demographics
and how many participants in HSAs were
previously uninsured. Research last year
suggested that 38 percent of those
enrolled were previously uninsured.
That's something the White House is
touting.
"Forty-five million Americans are
uninsured, and that's too high,"
said Trent Duffy, a White House
spokesman.
Critics such as the National Coalition on
Health Care argue that HSAs won't do much
to significantly reduce the number of
uninsured. Instead, they say, HSAs offer
employers a chance to pass on to
employees the rising cost of health care.
Higher-deductible plans are now offered
in a menu of choices, but over time they
could be one of fewer options given
workers.
"I think employers are going to be
looking for cover, and by expanding the
use of HSAs, it may provide some
incentive to switch employees into
high-deductible programs," said Joel
Miller, a senior vice president for the
coalition.
The White House rejects that charge.
"This has nothing to do with trying
to undermine the employer-provided health
care system. This is to build on it, to
complement it," Duffy said.
No one disputes employers' interest in
HSAs.
Philadelphia-based consultant Mercer
Health and Benefits found in its annual
survey of large companies last year that
35 percent offered HSAs.
UnitedHealth Group, one of the nation's
largest health insurers, reports 1.5
million enrollments of individuals or
employer groups in its high-deductible
plans. About 654,000 of those were tied
to HSAs at the start of 2006. Some 11,526
employers now offer HSAs through
UnitedHealth Group, more than 10,000 of
them smaller companies.
Large employers with 5,000 or more
employees are interested, too.
"Entering 2006, fully one-third of
our large employer clients are offering a
(high-deductible plan) ... and we're
hearing a lot more interest in total
replacement strategies," said
UnitedHealth Group spokesman Daryl
Richard.
DiamondCluster International, a
Chicago-based management consultancy,
estimated that 15 million Americans will
enroll in HSAs and high-deductible health
plans before the decade's out.
"We see in this phase of the
market's evolution the growth of HSAs is
driven by small businesses, the uninsured
and large employers that are just testing
the waters," said Aamer Baig, a
partner. "In the future, we see
high-deductible plans and HSAs becoming
quite mainstream" because employers
are seeking ways "of reducing the
health care burden themselves." |