In the year 2000 election cycle, health care issues are capturing the attention of the candidates, the media and the public. Leading the way are proposals to strengthen Medicare and provide prescription drug coverage for the elderly. This is an area where demographics and a national consensus on universal health coverage for seniors seem to be pushing the leading presidential candidates in a kind of "bidding war" for the elderly vote. But when it comes to addressing the health care needs of children, and broadening their access to health coverage, voters will find that the candidates offer starkly contrasting proposals.

Agreeing on a Destination...
Of the 44 million or so people living in America without health insurance, about 10 million are children. In 1997 Congress created the State Children's Health Insurance Program (CHIP), giving states the opportunity to dramatically expand health care coverage for children living in low and moderate-income families— defined as families making up to 200 percent of the official poverty level or $34,100 (the 2000 poverty level is $17,050 for a family of four). As of June 2000, 2.5 million children had been enrolled in CHIP programs across the country, but many children eligible for CHIP or Medicaid coverage are not enrolled, with states varying widely in their success in reaching and enrolling these children.

There is little argument this election year over the goal of broader health care coverage when it comes to kids. Both major presidential candidates agree that families should be able to afford health care coverage for their children. Vice President Gore and Governor Bush differ dramatically, however, in how they would go about making comprehensive health care coverage for America's children a reality. They differ in how they would set the balance of power between the federal government and the states. And they disagree on the relative roles of government and the free market for achieving more comprehensive health care coverage for children.

...But Choosing Different Roads
Governor Bush's agenda on children's health coverage casts health care as a consumer issue—a private family responsibility. His proposals rely on supporting families' efforts to pay for private health insurance coverage. Seeing the federal government as a "roadblock," he would give states greater responsibility to fashion state-specific systems for public health coverage for children left out of the private market.

Vice President Gore's health care agenda for children casts universal health care coverage for all children as a public responsibility. He would expand the publicly funded Medicaid and CHIP programs, setting a national standard of CHIP eligibility for children in families with incomes of up to 250 percent of the federal poverty level. He would also allow parents above that level to buy into the CHIP coverage for their kids, and provide a 25 percent tax credit if they don't have job-based health coverage.

Governor Bush's keystone proposal is to make private children's health insurance affordable for families of moderate means by offering a $2,000 refundable tax credit to such families and by changing regulations to allow small businesses to find lower-cost insurance options for their employee benefits packages. Instead of using federal authority to expand CHIP eligibility thresholds, Bush would expand state flexibility by removing federal restrictions in the CHIP program.

Under Gore's plan, the "typical" family of four earning $30,000 would be eligible for health insurance coverage through the CHIP program because the household would fall below the 250 percent of poverty eligibility threshold. Under Bush's plan the same family would be eligible for a $2,000 tax refund to help pay for private health insurance premiums.

Governor Bush's proposals emphasize incentives for the private sector to expand health coverage for children by allowing small businesses to purchase association health plans through such trade associations as the Chamber of Commerce. Vice President Gore's proposals would strengthen the public health care infrastructure by supporting community health centers, public hospitals and other safety-net health service providers in the community.

In pushing for more power to the states, Governor Bush argues that the states' efforts to insure more children should not be hampered by "red tape" from All Over the Map a review of CHIP and Medicaid implementation across the states by the Children's Defense Fund, several states have been very successful in crafting effective outreach and enrollment procedures to boost the numbers of kids in their states that are insured. But others have not fared so well. Two jurisdictions—the District of Columbia and Texas—have actually seen declines in the number of children covered by Medicaid and CHIP.

The "health care crisis" dominated political discourse and played a significant role in the rhetoric, promises and outcomes of the 1992 election. When President Clinton's task force on reforming the nation's health care system unraveled, health care issues temporarily became a taboo topic for elected officials. Now that health care coverage is back on the table, Gore and Bush's differing positions on how to broaden health care coverage for children present a clear choice for voters. Related Links:

• The U.S. Census Bureau [1]offers data on health insurance coverage.