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BRADLEY HEALTH CARE PROPOSAL CRITIQUED BY U OF I ANALYSTS
At the request of Sen. Bill Bradley's presidential campaign, an independent team of University of Illinois health policy scholars has dissected the Bradley health care proposal, finding it praiseworthy for being simple and comprehensive - but also cautioning that it is unclear on key details, including its cost and how it would relate to current statutes and laws.
The analysis, which is available online, was presented and discussed at the University of Illinois at Chicago on Thursday at a closed forum of leaders from public health agencies, health care providers, organized medicine, academe and industry. Bradley is scheduled to deliver a major health policy address in Chicago today, Nov. 8, at the American Public Health Association's annual meeting.
The analysis was authored by Robert Rich, professor in the University of Illinois College of Law and Institute of Government and Public Affairs; Noreen Sugrue, senior research specialist in the UIC College of Nursing's Nursing Institute; and Larry Debrock, professor of economics at the University of Illinois at Urbana-Champaign.
The Bradley proposal seeks to provide access to health insurance coverage for the 46 million Americans - 18 percent of the population - who are uninsured. Eight out of 10 of these uninsured are full-time workers and their dependents. Bradley's plan would attempt to assist these individuals in securing financing and access to health care while preserving the current system of employer-based health insurance.
The cornerstone of Bradley's proposal is the assertion that health care coverage is a legal right. If enacted, the Illinois scholars note, it would be the first time in American history that this was so. The Bradley plan would seek to guarantee health care for every child and access to affordable coverage for adults.
To guarantee health care for children, Bradley would require parents to have health insurance for their 18-and-under children either as dependents on employer-provided health plans, or in a federally-approved system of private health plans. For children in low-income households the government would pay the full premium; partial subsidies would be paid on a sliding income scale. The proposal does not specify how this mandate, the only one in the plan, would be enforced.
To guarantee access to coverage for adults, the Bradley plan would allow everyone to participate in the Federal Employees Health Benefit Plan, which currently insures 9 million government workers, or any federally-approved private plan. Full or partial government subsidies would be based on income up to $32,800 for a family of four. All premium subsidies would be excluded from income, offering the same tax advantages as employer-provided coverage. The Bradley plan would retain Medicare coverage for seniors and expand it to include social services, such as transportation and housekeeping.
The U of I analysis says a positive element of the Bradley proposal is that it uses economic incentives of subsidies and tax breaks - rather than federal restrictions - to encourage participation in risk pools. The analysts also like that the plan is a "bolt-on" addition to the current health care system, noting that the Clinton health care plan was rejected in part because of concerns for the survival of the private health care market. The analysts note that because the Bradley proposal would offer subsidies to workers, even if they do not choose FEHBP, there would be little inducement for employers to drop health benefits, which would force employees to the government option.
The Illinois health policy experts are skeptical that all aims of Bradley's plan are mutually compatible. The proposal aims to provide access to health insurance coverage to the millions of Americans who do not now have it, without altering health care for the majority who have insurance.
"This cannot be the case," the Illinois analysts contend in their report. "If access is improved for anywhere from 18 to 46 million Americans, the current delivery system will be strained and there will be changes to the way health care is delivered to all Americans."
A key focus of criticism of the Bradley plan has been its estimated cost. Bradley puts the price tag at $65 billion per year. The Illinois team notes that this assumption depends on people choosing coverage from plans offering the lowest premiums. It also assumes that the health care costs incurred by the new enrollees will be no greater than the costs for people already covered.
The Bradley plan would actually limit the scope of health care reform, the analysts note. While it assists individuals in securing financing and access, "in real terms it also supports and ensures that the current system of employer-based health insurance continues to be the norm for how Americans are insured." The Bradley plan precludes any proposals that would take health insurance out of the employment arena and thus "defines the boundaries of the health care debate in such a manner that universal coverage is not a viable option."
The Illinois analysts
applaud Bradley for making health care a "prime focus" in the
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