Health care costly, regardless of blueprint

The patients who crowd the waiting room of Good Shepherd Clinic have a common ailment: no health insurance.

The clinic, a small building behind First Baptist Church of Morrow, provides the working poor with treatment, checkups and medicine.

Volunteer physicians keep it open just eight hours a week, and thus can’t serve every uninsured person in Clayton County. And it doesn’t offer specialist care or hospitalization —- standard coverage under health insurance. That’s why Good Shepherd patients interviewed recently said they welcome the presidential campaign spotlight on health care.

Shanta Head, 39, of Conley has diabetes, hypertension and high cholesterol. Her employer insurance is too expensive, she says, and would exclude coverage of her conditions for a year. “I tried to get [insurance] on my own, but a lot of companies wouldn’t take me as soon as I said I was diabetic,” Head said.

Health care ranks as a leading topic for voters, polls show, and both Republican John McCain and Democrat Barack Obama have offered reform plans. Their ideas on revamping health insurance have striking differences.

The McCain plan would make major changes to the job-based insurance system, starting with removing an income tax exclusion on employer health benefits. He would replace that with a tax credit —- $2,500 for individuals, $5,000 for families —- who buy insurance.

Many workers who now have employer or individual coverage would come out ahead, at least initially, with the McCain tax change, said Bill Custer, a Georgia State University health insurance expert. Winners would include people who keep their existing coverage and whose tax credit exceeds the new benefits tax.

But Custer points out that younger, healthier employees may abandon a company health plan for a cheaper policy in the individual market, leaving the company pool with an older, sicker group that becomes more expensive to cover.

The McCain plan also may induce some employers to jettison health insurance, experts say, leaving workers to find individual policies using the new tax credit. More than 60 percent of Americans under age 65 get their health benefits through their jobs.

A recent employer survey by consulting firm Miller & Chevalier and the American Benefits Council found about 75 percent of respondents said repealing the employee tax exclusion would have a ”strong negative effect” on their work force.

Joseph Antos, a health policy expert at the conservative American Enterprise Institute, said the fear of companies dropping coverage is overblown, adding that employers would not pay an extra tax for health insurance under McCain.

Yet the individual insurance market, where many people might land under the McCain plan, has flaws. Older, sicker workers without job coverage could run into trouble finding an affordable individual policy, said Ken Thorpe, an Emory University health policy expert who has advised Democratic candidates.

To address this problem, McCain would inject billions in funding into a pool for ”high-risk” individuals with medical conditions. Such state risk pools cover about 200,000 people nationally, far short of the millions with chronic problems, and a bigger pool would be very costly.

Obama’s health blueprint builds on the current insurance system. He would create a federal benefits plan that would be offered along with competing private plans in an “insurance exchange,” in which individuals and firms could shop for coverage. No one would pay a higher premium for an existing condition.

Large businesses under the Obama proposal would be required to offer health benefits or pay a penalty; smaller firms would get a tax credit to provide insurance.

Obama also calls for expanding eligibility in Medicaid and State Children’s Health Insurance Plans, such as PeachCare in Georgia. An estimated 300,000 Georgia children are uninsured.

Dr. Sivan Hines, a Cobb County pediatrician and an Obama supporter, said, “The pediatricians whom I work with want to see more kids insured. They don’t want to see any more kids not getting care.”

Antos of the American Enterprise Institute said the Obama plan contains too much regulation and promotes overly generous benefits. While he ”slightly prefers” the McCain plan, Antos noted that it, too, is very expensive.

According to the nonpartisan Tax Policy Center, the Obama plan would cost $1.6 trillion over 10 years and would reduce the number of uninsured by 34 million. The McCain plan would cost $1.3 trillion and would reduce the uninsured by a maximum of 5 million, the center said.

Another study, by health care consulting firm Lewin Group, put the McCain price tag at $2 trillion vs. $1.17 trillion for the Obama plan. The Lewin study projects that 21.1 million more Americans would be insured under McCain, compared with 26.6 million under Obama.

Georgia’s ”free” medical clinics can’t keep up with the increasing load. Dr. Charles G. Johnson, medical director of Good Shepherd Clinic and a McCain supporter, said to meet patient demand, the clinic would have to operate five days a week.

“We can’t see them all,” said Johnson, 83, who volunteers as a physician. “We have to turn them away. And that’s bad.”

THE McCAIN PLAN WOULD:

> Require workers to pay income taxes on the value of health insurance as part of their compensation.

> Replace that tax exclusion with a refundable tax credit for buying insurance: $2,500 for individuals, $5,000 for families.

> Allow individuals with multiyear insurance policies costing less than the tax credit to deposit excess funds into a health savings account.

> Subsidize high-risk pools for people who can’t get coverage because of pre-existing medical conditions.

> Allow consumers to buy insurance across state lines.

THE OBAMA PLAN WOULD:

> Create a government-run health plan and an ”insurance exchange” in which private insurers would compete with the government plan.

> Require insurance companies to provide coverage to everyone, including those with pre-existing medical conditions, and prohibit insurers from charging premiums based on a person’s health status.

> Require parents to cover their children.

> Expand eligibility for Medicaid and the State Children’s Health Insurance Program.

> Require larger employers to cover workers or contribute to the cost.

> Allow tax credits for small businesses to offset their premium costs, and give low-income workers tax credits to buy insurance.

Source: Kaiser Family Foundation

> This is the third in a series of stories examining what the policies of the two main presidential candidates might mean for Georgia.