Ever since President Clinton's campaign for comprehensive health-care reform foundered in 1993, Washington has taken a more gradual approach, attempting to aid particular groups instead.
This year, Congress and the President have turned their attention to the approximately 10 million or more American children without health-care insurance coverage. About 3 million of these are already eligible for Medicaid health assistance for the poor. But for some reason, possibly because their parents don't realize they are eligible, these children are not receiving benefits.
The bipartisan budget deal agreed to by Mr. Clinton and Congress calls for the federal government to spend $16 billion over five years to extend children's health-care coverage to an additional 5 million children. The agreement says the money could go to Medicaid or be used for block grants.
Medicaid money could help find and enroll eligible children and restore coverage to disabled children. Block-grant money would go to finance individual state' 'children's health programs. Clinton, congressional Democrats, and some Republicans favor expanding Medicaid. Most Capitol Republicans and governors prefer block grants.
* Money. It would give the states $14 billion in block grants and $2 billion in increased Medicaid funding.
* Criteria. States would get money depending on the number of uninsured children whose family incomes are below 300 percent of the poverty level.
* Use. States could use the funds to expand coverage through Medicaid or private insurance, or to provide health-care services directly.
* Status. Passed by the House Commerce Committee, chaired by Rep. Thomas Bliley Jr. (R) of Virginia, the bill reaches the House floor this week.
* Money. States would have a choice between more federal Medicaid money or block grants.
* Criteria. States would get money depending on the number of uninsured children whose family incomes are below 200 percent of the poverty level.
* Use. Money would provide health insurance coverage. And states would have to use 1 percent of the money to find and enroll children eligible for Medicaid who are not receiving it.
* Status. Passed last week by the Senate Finance Committee, chaired by William Roth Jr. (R) of Delaware, the bill reaches the Senate floor this week..
If the Bliley and Roth proposals pass in their present form, the differences would then have to be ironed out in a House-Senate conference committee.
* Money. It would give states $12 billion in matching Medicaid funds, and $4 billion in grants to find and enroll children eligible but not receiving Medicaid.
* Criteria. States would get money if: (1) they agree to provide Medicaid coverage to children in families earning below 133 percent of the federal poverty level - a family of four at 133 percent of the poverty level earns $21,000 a year, and (2) they immediately cover all children under age 19 with incomes below the poverty level and guarantee them continuous coverage for one year.
* Status. Sens. John Chafee (R) of Rhode Island and Jay Rockefeller (D) of West Virginia offered their "Children's Health Insurance Provides Security," or CHIPS bill as an alternative. It was defeated by the Senate Finance Committee, 11 to 9. The senators have not brought up the measure again in the Senate.
According to the budget agreement, the $16 billion Congress laid aside for child health care will only cover 5 million uninsured children, leaving 5 million without coverage.
The Child Health Insurance and Lower Deficit (CHILD) bill introduced by Sens. Orrin Hatch (R) of Utah and Edward Kennedy (D) of Massachusetts would cover the rest.
* Money. Senator Hatch got the Senate Finance Committee to adopt a 20-cent-a pack cigarette tax, providing $8 million more in children's health care.
* Criteria. States would get federal grants for child health care based on the number of uninsured children in the state.
* Use. The states would voluntarily contract with private companies to provide child only coverage, with the states contributing up to 20 percent of additional costs.
* Status. Senator Kennedy says he will try for more funding when the tax bill reaches the Senate floor this week.
CHILD HEALTH CARE
* Percent of children who visit a doctor at all in a year:
* Average number of doctor visits per 1,000 children per year:
* Uninsured children are twice as less likely as insured children to visit hospital emergency rooms - often the most expensive place to receive care.
Source: Families USA