Insuring All Children — The New Political Imperative

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Abstract
Efforts by the 110th Congress, which is commanded by Democrats eager to reduce the record number of people without health insurance, coupled with other federal and state initiatives,1-3 have thrust health care reform into the political limelight for the first time in 12 years. Not since 1994, when the comprehensive proposal of the administration of President Bill Clinton was rejected, has the erosion of private insurance coverage and the continuing rise in health care expenditures aroused such intense interest among policymakers. Adding an impetus to this renewed interest are other proposals that have been unveiled by an unusual collection of private interests — big business, organized labor, health plans, health care providers, and consumers — which have coalesced around a belief that new steps must be taken to expand coverage and slow the growth of expenditures.4-7 In his 2007 State of the Union address, President George W. Bush introduced his own proposal, which is based on a restructuring of tax incentives designed to encourage people to purchase private health insurance.8 Two weeks later, however, when the administration's 2008 budget was released, it called for marked reductions in the growth of the two largest public insurance programs — Medicare and Medicaid — underscoring the divide between Democrats and Republicans over the role government should play in extending coverage to people without health insurance.