Healthcare 'crisis' grows for middle class

"Basically, we're in a downward spiral, and we sort of have a perpetual-motion machine that's going in the wrong direction," says Henry Simmons, of the National Coalition on Health Care in Washington, an alliance of business and social organizations. "Costs are rising at the fastest rate in our history. We know that for every percentage increase, you probably add a half million people to the ranks of the uninsured."

In the past, however, efforts to find a solution have been thwarted by at least one of the key players in the healthcare industry. Each group – doctors, hospitals, insurance companies, and consumer advocates – came to the table with what they believed was the best solution, whether it was mandating that businesses provide insurance or expanding existing government programs, like Medicaid. But inevitably, the player who lost out in negotiations went onto the airwaves and spent millions of dollars to scuttle the plan with the public.

"Everyone's second choice was always the status quo," Mr. Pollack says. "But now there's a realization that won't work anymore."

A year and a half ago, the Robert Wood Johnson Foundation brought together some of the fiercest opponents in the healthcare debate in what came to be known as the "strange bedfellows" coalition. They all agreed that covering the uninsured was key to any successful healthcare reform. While there's still disagreement over solutions, their efforts – along with a recent public-service campaign called "Covering the Uninsured" – have reignited the debate in Congress.

Right now, it's centered around whether to provide tax credits to individuals to allow them to buy health insurance, or to expand existing programs like Medicaid to cover more low-income workers.

Advocates of tax credits, like the Heritage Foundation's Stuart Butler, say they will allow individuals – instead of employers – to make their own decisions about healthcare. They also say Medicaid – the nation's health policy for the poor – has too much negative stigma to attract middle-class people.

But critics of that approach argue that the tax credits being proposed – up to $3,000 for a family – are inadequate. The average cost of a policy for a family of four is about $7,000 a year.

They also believe tax credits to individuals would further erode the nation's employer-based insurance system. They'd prefer to give tax incentives to businesses to provide insurance, and expand Medicaid to cover workers that are still uninsured. For their model, they point to the Children's Health Insurance Program, known as CHIP. Created in 1997, it's based on the Medicaid model. But each state fashions the program to its specific needs and gives the program its own name. The federal government then gives states an enhanced matching grant. About 3.3 million children were covered by CHIP in 2000. But due to budget constraints, some states plan to cut back on their programs.

That's raised alarms with healthcare advocates, who are worried not only about the children who will lose coverage, but also about the impact that similar budget constraints in Washington could have on the larger effort to cover all the uninsured.

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