Is universal health insurance on the horizon?

But while Smith supports SCHIP, he’s not ready to back a universal plan.

“The way we’ve structured it (SCHIP), I don’t think that it is a vehicle for national government-provided health care,” said Smith. “I’m not for that. I don’t see much that the government does that I want it do more of for me — and certainly not when it relates to the health of my family. But the government can set some rules and the government can provide a safety net.”

Anything more far-reaching than expanding SCHIP would be unlikely to get Smith’s vote and those of like-minded centrist senators and would stand little chance of becoming law.

Some Republicans are wary of expanding SCHIP because, according to the non-partisan Congressional Budget Office, it induces people who are not below the federal poverty level to switch from private coverage to the government program.

“For every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children,” a CBO report concluded in May.

A Trojan horse for national insurance?
Critics see SCHIP as a Trojan horse opening the gate to national health insurance. The Senate bill, for example, would permit states to offer SCHIP coverage to families with income up to three times the federal poverty level, which would include a family of four earning $61,332.

Senate Republican Whip Sen. Trent Lott, R- Miss., said, “When you’re talking about getting free health care, for a family of three, and parents making $60,000, $70,000, maybe in some states that’s low income, but that’s upper income in my state.”

Slide show Perspectives on health care A Daryl Cagle editorial cartoon roundup on the state of the U.S. health system. msnbc.com

He said, “If people want socialism, if they want the federal government to pay for all of our health care needs, let’s just go ahead and become a socialist government.”

Some members of Congress are thinking of a different approach.

Sens. Ron Wyden, D- Ore., and Robert Bennett, R- Utah, are proposing a bill to phase out employer-provided insurance and replace with it with mandatory universal coverage, provided not by the federal government, but by private insurance companies.

“The model is the coverage that members of Congress get, a delivery system like members of Congress get, choices like members of Congress get and benefits like members of Congress have,” Wyden said.

Even if you are now working for a large firm and have a blue-chip health plan, “you’re going to have a better deal” under his plan, said Wyden. “We’ll put more cash in your pocket because we require at the outset the employer to take your salary, plus the value of your benefits, and give that to you in compensation and we adjust your tax brackets. You’ll have more choices for your health care. Right now even with good coverage, you get one plan.”

Coverage 'melting like a Popsicle'
And he said “you’ll have lifetime security with our proposal. Today, even at good companies, coverage is melting like a Popsicle on the summer sidewalk. Every year because premiums continue to go up, you have people getting less coverage at higher prices.”

The Wyden-Bennett bill also would subsidize low-income people so they could purchase insurance.

“I think we’re right on the cusp of being able to move forward in a bipartisan way,” Wyden said.

But a powerbroker in the House on health care, Rep. Pete Stark, D- Calif., chairman of the Ways and Means health subcommittee, called the Wyden-Bennett idea “a lousy plan.”

“Experienced legislators have learned that you don’t make wrenching changes to the habits that Americans are used to: 160 million people get their medical payment plan through their employer,” Stark said. “To suddenly tell all of them that that’s going to end would be politically unacceptable.”

Instead Stark envisions a build-out towards universal insurance.

Republican governors talk about mandates
“For the first time in our history we have two Republican governors who have used the word ‘mandate,’” as in mandatory coverage, said Stark, alluding to Romney and California Gov. Arnold Schwarzenegger.

Under a law signed in 2006 by Romney, Massachusetts requires firms to either provide health insurance for their workers or pay into a state fund for the uninsured. Massachusetts requires almost all adults in the state to purchase insurance and imposes financial penalties on those who do not.

California legislators are now considering proposals similar to the Massachusetts blueprint.
“You’ve got Republicans saying to individuals you must have insurance; you have Republicans telling business you must pay," Stark said. "That’s a major transition, but we have long way to go from there.”

He added, “If we get four or five more states with universal coverage plans, then it’s much easier for us (in Congress) to come together and set minimum benefit and set federal assistance to the states and build a package.”

In other words, while universal health insurance coverage may yet happen, it will be achieved by incremental means.

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