Aides struggle to sort out his promises
John McCain, framed yesterday at a rally in Pensacola, Fla., by a photo of himself in his 20s, says he wants access to healthcare for all citizens while also diminishing the government's role. (MARY ALTAFFER/ASSOCIATED PRESS)
EmailPrintSingle Page Text size – + By Michael Kranish
Globe Staff / April 3, 2008
WASHINGTON - When Senator John McCain unveiled his healthcare proposal last fall, a journalist asked whether the Arizona senator's battle against skin cancer would make him sympathetic to the idea of requiring that insurance companies provide coverage to people with preexisting conditions.
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McCain flatly rejected the idea. "That would be mandating what the free enterprise system does," McCain said.
McCain's response highlights the challenge he faces as he prepares to try to sell his healthcare plan in the fall campaign. He says the country must provide access to healthcare for all our citizens, and that "we need to help people who need it." But McCain also wants to shrink government's role in healthcare and doesn't want to impose regulations on insurance companies.
As a result, McCain's aides have been scrambling to come up with ways to satisfy those who want more coverage without violating what they call McCain's conservative principles on the issue.
McCain, for example, has spoken in general terms about how he might help people with preexisting conditions. He has said he favors what he calls a "special provision including additional trust funds for Medicaid payments." The comment left even some of his aides unsure of his meaning. Medicaid funds are generally used to help lower-income Americans.
Lately, some of McCain's aides have said he might try to divert some Medicaid funds into a program that would help people with preexisting conditions, but his advisers can't yet say how such a program would work or how many people would be covered.
"These are real questions, and I think there will be answers, and there better be, but they are not there yet," said McCain adviser Thomas P. Miller, a resident fellow at the American Enterprise Institute. "A lot more remains to be hammered out."
Indeed, while McCain talks about having a comprehensive healthcare plan, many of the details are being debated within the campaign as aides try to determine how to pay for McCain's promises.
The crux of McCain's healthcare plan is to end a tax break for employers who provide health insurance premiums now utilized by many workers. That would be replaced with a tax credit worth as much as $5,000 per family for the purchase of health insurance. McCain would also promote cost controls and competition among insurance companies. He has also joined with Democrats to support legislation that would allow the purchase of prescription drugs from Canada.
But McCain's plan has no guarantee that people could get insurance, and no requirement for people to do so. McCain believes his plan would make insurance more affordable, which would bring it within reach of many more families. But many critics say that failing to require insurance companies to provide coverage could leave millions of people without affordable medical care.Continued...
The McCain plan has come under attack from Democrats, who say it mostly benefits the wealthy and the healthy. "It's fine except for the poor and the sick," said Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology, who has worked on Democratic healthcare plans.
Still, Gruber said, McCain's plan "has a lot to recommend it," particularly the tax credit to buy health insurance.
The question of how to provide insurance for people with preexisting conditions is increasingly a focus of scrutiny in McCain's plan. Shortly after McCain unveiled his proposal last October, Dr. Timothy Johnson, the Boston-based medical editor of ABC News, pressed McCain at a forum to explain why he felt no need to "prevent insurance companies from cherry-picking" healthier customers and denying coverage to some people with preexisting conditions.
McCain responded that the idea of imposing mandates on insurance companies was a simple answer, but one that he was not sure would be effective. McCain then spoke of the need for Americans to improve their physical condition and suggested some people with preexisting conditions could be put in what he called "high-risk pools." But McCain's bottom line was that he would not put requirements on insurance companies.
But even some pro-business voices have said McCain's plan falls short of helping enough people in need. Fortune magazine said earlier this month that McCain had the best health insurance plan, but then criticized his handling of people with preexisting conditions.
"The problem with McCain's approach - and it is a huge problem - is that McCain ventures so far toward total laissez-faire liberty that he risks leaving the poor and sick behind," the magazine said. "Anyone with cancer, diabetes, or other preexisting conditions will see their premiums multiply, too."
Grappling with such criticisms, some of McCain's aides have floated the idea that people with preexisting conditions could get an extra tax credit to help pay for insurance, funded by savings in the Medicaid program. But the amount of the credit hasn't been determined, the possibility of extracting enough savings from Medicaid is debatable, and it is unclear whether a credit would be enough to persuade an insurance company to accept a person who would be likely to have large medical expenses.
"We are working on it," said Douglas Holtz-Eakin, McCain's top policy adviser. "We'll put out more details. As we do, it will be clearer to people."
McCain has frequently sought to downplay the oft-cited statistic that 47 million people do not have health insurance. He has said that a very large portion of them are healthy young Americans who simply choose not to get insurance. However, the American Medical Association has said that 8.3 million of the 47 million are between ages 18 and 24. A McCain aide said the senator was referring to a study that found about half of adults without health insurance are between 19 and 34. Democratic critics said that many younger Americans don't have health insurance because they can't afford it and their employers don't provide it.
McCain's plan is starkly different from those put forward by the Democratic presidential candidates. Hillary Clinton wants to mandate that all Americans get health insurance, while Barack Obama would require that all children have insurance. McCain has criticized their programs as "government-run healthcare," while the Democrats say their plans will offer choice from private plans.
McCain compared health insurance to buying a home, saying it was desirable but not required. "I think that one of our goals should be that every American own their own home," he said. "But I'm not going to mandate that every American own their home. If it's affordable and available, then it seems to be that it's a matter of choice amongst Americans."
© Copyright 2008 Globe Newspaper Company.
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John McCain, framed yesterday at a rally in Pensacola, Fla., by a photo of himself in his 20s, says he wants access to healthcare for all citizens while also diminishing the government's role. (MARY ALTAFFER/ASSOCIATED PRESS)
EmailPrintSingle Page Text size – + By Michael Kranish
Globe Staff / April 3, 2008
WASHINGTON - When Senator John McCain unveiled his healthcare proposal last fall, a journalist asked whether the Arizona senator's battle against skin cancer would make him sympathetic to the idea of requiring that insurance companies provide coverage to people with preexisting conditions.
MORE POLITICAL COVERAGE
McCain camp working out healthcare details
Pa. rally unites 2 political wives
McCain developing list of possible running mates
Clinton, Obama pledge allegiance to union workers
Clinton unveils new TV spot
Kennedy taps ex-legislator as adviser
POLITICAL OPINION
Joan Vennochi The return of Monica Lewinsky
Dan Payne So, you want to be a McCain Democrat?
more stories like this
McCain flatly rejected the idea. "That would be mandating what the free enterprise system does," McCain said.
McCain's response highlights the challenge he faces as he prepares to try to sell his healthcare plan in the fall campaign. He says the country must provide access to healthcare for all our citizens, and that "we need to help people who need it." But McCain also wants to shrink government's role in healthcare and doesn't want to impose regulations on insurance companies.
As a result, McCain's aides have been scrambling to come up with ways to satisfy those who want more coverage without violating what they call McCain's conservative principles on the issue.
McCain, for example, has spoken in general terms about how he might help people with preexisting conditions. He has said he favors what he calls a "special provision including additional trust funds for Medicaid payments." The comment left even some of his aides unsure of his meaning. Medicaid funds are generally used to help lower-income Americans.
Lately, some of McCain's aides have said he might try to divert some Medicaid funds into a program that would help people with preexisting conditions, but his advisers can't yet say how such a program would work or how many people would be covered.
"These are real questions, and I think there will be answers, and there better be, but they are not there yet," said McCain adviser Thomas P. Miller, a resident fellow at the American Enterprise Institute. "A lot more remains to be hammered out."
Indeed, while McCain talks about having a comprehensive healthcare plan, many of the details are being debated within the campaign as aides try to determine how to pay for McCain's promises.
The crux of McCain's healthcare plan is to end a tax break for employers who provide health insurance premiums now utilized by many workers. That would be replaced with a tax credit worth as much as $5,000 per family for the purchase of health insurance. McCain would also promote cost controls and competition among insurance companies. He has also joined with Democrats to support legislation that would allow the purchase of prescription drugs from Canada.
But McCain's plan has no guarantee that people could get insurance, and no requirement for people to do so. McCain believes his plan would make insurance more affordable, which would bring it within reach of many more families. But many critics say that failing to require insurance companies to provide coverage could leave millions of people without affordable medical care.Continued...
The McCain plan has come under attack from Democrats, who say it mostly benefits the wealthy and the healthy. "It's fine except for the poor and the sick," said Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology, who has worked on Democratic healthcare plans.
Still, Gruber said, McCain's plan "has a lot to recommend it," particularly the tax credit to buy health insurance.
The question of how to provide insurance for people with preexisting conditions is increasingly a focus of scrutiny in McCain's plan. Shortly after McCain unveiled his proposal last October, Dr. Timothy Johnson, the Boston-based medical editor of ABC News, pressed McCain at a forum to explain why he felt no need to "prevent insurance companies from cherry-picking" healthier customers and denying coverage to some people with preexisting conditions.
McCain responded that the idea of imposing mandates on insurance companies was a simple answer, but one that he was not sure would be effective. McCain then spoke of the need for Americans to improve their physical condition and suggested some people with preexisting conditions could be put in what he called "high-risk pools." But McCain's bottom line was that he would not put requirements on insurance companies.
But even some pro-business voices have said McCain's plan falls short of helping enough people in need. Fortune magazine said earlier this month that McCain had the best health insurance plan, but then criticized his handling of people with preexisting conditions.
"The problem with McCain's approach - and it is a huge problem - is that McCain ventures so far toward total laissez-faire liberty that he risks leaving the poor and sick behind," the magazine said. "Anyone with cancer, diabetes, or other preexisting conditions will see their premiums multiply, too."
Grappling with such criticisms, some of McCain's aides have floated the idea that people with preexisting conditions could get an extra tax credit to help pay for insurance, funded by savings in the Medicaid program. But the amount of the credit hasn't been determined, the possibility of extracting enough savings from Medicaid is debatable, and it is unclear whether a credit would be enough to persuade an insurance company to accept a person who would be likely to have large medical expenses.
"We are working on it," said Douglas Holtz-Eakin, McCain's top policy adviser. "We'll put out more details. As we do, it will be clearer to people."
McCain has frequently sought to downplay the oft-cited statistic that 47 million people do not have health insurance. He has said that a very large portion of them are healthy young Americans who simply choose not to get insurance. However, the American Medical Association has said that 8.3 million of the 47 million are between ages 18 and 24. A McCain aide said the senator was referring to a study that found about half of adults without health insurance are between 19 and 34. Democratic critics said that many younger Americans don't have health insurance because they can't afford it and their employers don't provide it.
McCain's plan is starkly different from those put forward by the Democratic presidential candidates. Hillary Clinton wants to mandate that all Americans get health insurance, while Barack Obama would require that all children have insurance. McCain has criticized their programs as "government-run healthcare," while the Democrats say their plans will offer choice from private plans.
McCain compared health insurance to buying a home, saying it was desirable but not required. "I think that one of our goals should be that every American own their own home," he said. "But I'm not going to mandate that every American own their home. If it's affordable and available, then it seems to be that it's a matter of choice amongst Americans."
© Copyright 2008 Globe Newspaper Company.
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