How They Would Fix It

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h 1 in 6 Americans uninsured, you might expect the presidential candidates to avidly court this large constituency. Not so. Bush and Kerry have plans out to extend medical coverage to some uninsured, but they were pitching their health plans last week to seniors and middle-class voters, who are upset about rising health-care costs. In Michigan, Bush went on the attack, calling Kerry's plan a "government takeover," while in Albuquerque, N.M., Kerry said Bush had spent four years as President with "no real plan" to deal with America's health-care problems.

A look behind the rhetoric: in general, Kerry's plan relies on existing government programs like Medicaid along with new tax breaks for employers, while Bush would expand new health savings accounts (HSAs) that give more control (and responsibility) to individuals.

Kerry's innovation: small businesses and their employees would receive tax credits to cover as much as 50% of the premiums for low- and moderate-income workers. The government would also pay 75% of employers' costs for catastrophic health care, removing a huge expense and trimming employees' family premiums. Hoping to extend coverage to 27 million uninsured, Kerry would also offer tax credits for individuals and expand existing programs for low-income people.

The cost: $700 billion to $1 trillion over 10 years. To pay for it, Kerry would roll back Bush's tax cuts for people earning more than $200,000, which would probably fall short of the final bill.

Bush's innovation: low-income families who set up HSAs would get up to $1,000 to put in these tax-free savings accounts to help meet high deductibles and a $2,000 tax credit to help cover the premiums. Through these savings accounts, along with tax credits for low-income families and small businesses that make contributions to their employees' HSAs, Bush would insure 6 million to 10 million more people.

The cost: unclear. Bush aides say the plan's costs are in the President's budget for next year, but critics say he hasn't laid out a specific way to finance the $102 billion to $128 billion plan over the next decade without increasing the deficit.

Despite these plans, it is unlikely that the ranks of the uninsured will be reduced much. Kerry's agenda would be difficult to get through a Republican Congress; during his presidency Bush has put little funding behind his ideas. In the campaign, look for the candidates to focus on those who are already insured, like the 42 million seniors enrolled in Medicare. On Nov. 2, the elderly are likely to be out in fuller force than the uninsured.