President George W. Bush, Administration
Achievements/Goals
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Plan StatusChanges enacted by Bush Administration and some proposals.Number of People CoveredDoes not aim for universal coverage.Estimated CostU.S. health care costs have continued to rise steeply, reaching approximately $2.1 trillion in 2006. The cost of the Medicare prescription drug program alone is estimated to be $1.2 trillion over ten years. Payment Scheme Bush favors expansion of individually purchased private insurance over public programs. |
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Plan in Brief
- Medicare prescription drug benefit introduced.
- Health Savings Accounts introduced.
- Proposed law allowing states to redirect federal funds for uncompensated health services toward private insurance subsidies (currently done through waivers).
- Deficit Reduction Act (DRA) gave states more flexibility to tailor their Medicaid programs.
- Expanded "cash and counseling" programs giving more control over personal and custodial care funds to individuals on Medicaid.
- Proposed a standard health deduction – i.e., individual tax "break" (not yet in place).
- Latest budget would trim Medicare and Medicaid but slightly expand State Children’s Health Insurance Program (SCHIP).
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Impact on Federal Government
- Higher costs for prescription drugs for seniors.
- SCHIP expansion controlled.
Impact on States
- More flexibility in how they use private health insurance to tackle problem of the uninsured.
Impact on Insurers
- Introduction of Health Savings Accounts.
- Ability to offer prescription drug coverage to seniors.
- Subsidies for Medicaid Advantage.
- Controlling expansion of SCHIP kept more families in the private insurance market.
Impact on Providers
- Recommended cuts to providers that were thwarted by Congress.
Impact on Employers
- Able to shift more responsibility/control of health care costs to employees, through HSAs.
- Relief from promises to pay for retirees’ prescription drug coverage.
Impact on Individuals
- Those with HSAs (a small percentage) have greater control over how their health care dollars are spent.
- More people joined the ranks of the uninsured.
Proponents/Opponents
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Proponents say that Bush has taken rational steps that should eventually lead to lower costs. Pushing individuals into the private market, and giving them more influence over their own health care costs, will eventually lead to a more rational system where the incentives – e.g., lower premium costs – are in line with the overall goal of containing costs while providing quality care.
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Opponents point out that Medicare Advantage coverage by private insurers is not more efficient -- it is costing about 12 percent more than the public plan. Critics also contend that the Bush Administration is lining the pockets of pharmaceutical companies by not permitting either drug reimportation or negotiation of drug prices under Medicare Part D.
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Key Targets for InvestmentMedicare drug benefit.
Medicare Advantage (private insurance plans for seniors).
Notable Feature
- Main goals are to push more people from public programs to private insurance, and to make individuals have a stake in controlling costs.
Experts' Comments" President Bush's health care proposals would help remove some of the distortions that have plagued the health insurance market for nearly 60 years. As a result, more people would be insured, the insurance they have would better suit their needs, and fewer people would rely on the social safety net."
John Goodman,
President
National Center for Policy Analysis, writing in Brief Analysis No. 578 .
" Health care advocates slammed President Bush’s latest health care proposals as free-market fantasy that would dismantle employer-provided health coverage, enrich insurance companies and worsen the nation’s health care crisis."
PoliticalAffairs.net Feb.9, 2007,
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For Further Information
Bush's Proposal for Health Care Reform: January 2007
The Bush Health Plan: NCPA Brief Analysis
Congressional Budget Office on Growth of Health Care Costs, Jan 2008
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