WASHINGTON - After six months of work, Senate Republicans yesterday proposed a wide range of tax credits, subsidies and discounts to provide health insurance to millions of Americans and to improve health care for those who remain uninsured.
The proposals, though less ambitious than plans advanced by Democrats, suggest that Republican leaders have heard the calls of many families and small businesses alarmed at the soaring costs of health insurance and health care.
Sen. Judd Gregg of New Hampshire, the chairman of a 12-member panel that developed the proposals, said, "The uninsured are not a monolithic group. They are diverse." Accordingly, the panel offered an assortment of proposals tailored to the needs and preferences of different groups.
Gregg said the Republicans opposed "nationalizing the health care system" because that could lead to the rationing of care. But the panel did suggest that private insurers offer certain standardized products to individuals and small businesses in all states.
Today, House Democrats plan to introduce a three-part plan to cover the uninsured. Under the proposal, the federal government would provide $50 billion to states to cover parents of children in Medicaid or the Children's Health Insurance Program. People ages 55 to 64 would be allowed to buy Medicare coverage, and the government would pay up to three-fourths of the cost. In addition, the government would offer tax credits to help defray the cost of insurance for small businesses and self-employed individuals.
Senate Republicans endorsed a proposal by President Bush to provide tax credits to help low-income workers buy insurance on their own if coverage is not available from their employers. The Republicans said the tax credits would help at least 5 million of the nation's 43 million uninsured.
The panel was divided on another Bush proposal, which would let small businesses band together and buy insurance through their trade associations. The panel listed such "association health plans" as an option but did not explicitly endorse them.
"We did basically punt on that issue," Gregg said.
Two panel members, Republican Sens. Olympia J. Snowe of Maine and Jim Talent of Missouri, said such health plans would allow small businesses to pool their purchasing power and buy coverage at reduced rates, as large employers and unions do.
But Gregg said he had two concerns about those health plans. They would be largely exempt from state insurance regulation, he said, and they might attract healthier people, thus driving up costs for those who remain in the traditional insurance market.
The National Association of Insurance Commissioners and the Blue Cross and Blue Shield Association oppose association health plans for the same reasons.
The Senate Republican panel also said that Congress should make it easier for clinics run by religious groups to qualify as community health centers, eligible for federal grants.
Susan Nestor Levy, senior vice president of Ascension Health, the nation's largest Catholic health system, said, "Clinics for the poor owned by Catholic hospitals cannot qualify as community health centers because they do not meet the ownership and governance requirements of federal law." Under the law, a majority of a center's board members must be patients, and the center generally cannot be owned or operated by another entity.
Democratic Sen. Edward M. Kennedy of Massachusetts dismissed the Republican package as "a sham" and said it would do little to help the uninsured.
The Republican panel also advanced these proposals, some of which might appeal to Democrats and advocates for the poor:
A tax deduction for medical specialists who provide charity care to patients referred by community health centers and nonprofit clinics. The maximum deduction would be $20,000 a year.
Government-negotiated discounts for low-income people and the uninsured to buy prescription drugs. The discounts are already available to federal agencies and some clinics that receive federal grants.
Aid to colleges and universities that make health insurance available to full-time students.
Government forgiveness of student loans or deferral of interest payments for college graduates who establish health savings accounts.
Deferral of interest payments on student loans for health professionals who work in nonprofit clinics serving large numbers of the uninsured.
In addition, the panel said that the government should provide medical malpractice insurance for doctors volunteering in community health centers.