When Will Congress Address the Issue of the Uninsured?

By Carolynn Race

By the end of 2002, the U.S. Census Bureau found that 43.6 million Americans were without health insurance coverage for the entire year, an increase of 2.4 million people over 2 years. Alarmed by the increasing number of uninsured Americans, rising health care costs, and declining employer-based coverage, the Institute of Medicine’s Committee on the Consequences of Uninsurance concluded that:

“The lack of health insurance for tens of millions of Americans has serious negative consequences and economic costs not only for the uninsured themselves but also for their families, the communities they live in, and the whole country. The situation is dire and expected to worsen. The Committee urges Congress and the Administration to act immediately to eliminate this longstanding problem.” (IOM Insuring America ’s Health Report, 1/04, p. 1)

Yet Congress and the Presidential Administration do not appear to be pushing for immediate action on a comprehensive plan to eliminate this problem. Why? The IOM Committee noted,

“Past campaigns have yielded both incremental changes and major reforms but not universal coverage, due to the challenges to major structural changes posed by American political arrangements and the lack of political leadership strong and sustained enough to forge a workable consensus on coverage legislation. In addition, the opposition of provider, insurer, and business groups with economic interests potentially adversely affected by specific reform proposals has blocked universal coverage even though many have agreed with the general need for reform.” (p.3)

Understanding political realities, the IOM Committee recommended that the President and Congress “develop a strategy to achieve universal insurance coverage and establish a firm and explicit schedule to reach this goal by 2010” (p. 156) and until the goal is reached, the Committee recommended that “federal and state governments provide resources sufficient for Medicaid and SCHIP [State Children’s Health Insurance Program] to cover all persons currently eligible and prevent the erosion of outreach efforts, eligibility, enrollment, and coverage.” (p. 157)

General Assemblies of the Presbyterian Church (U.S.A.) have long called on the United States government to provide health coverage and access for all.

Administrative and Congressional Proposals

In his State of the Union address, President Bush announced his proposals to deal with the cost of health care. His suggestions include calling for:

• Refundable tax credits to help low-income residents purchase health insurance;
• A provision to allow small business to join together to form association health plans to negotiate lower health insurance premiums; and
• A tax deduction for the cost of premiums for high-deductible health coverage to encourage the use of health savings accounts, which allow individuals to save tax-free funds for future medical expenses.

He also reiterated his opposition to a government-run health care system, noting, “A government-run health care system is the wrong prescription. By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world.”

CQ Weekly analyzed the President’s proposals and offered an outlook for their likelihood of passage through Congress noting, “The House has passed an association health plans bill (HR 660), but the Senate has been cooler to the idea because it would exempt small businesses from state laws requiring coverage of specific diseases. Health care tax credit proposals have not generated widespread interest in Congress, and experts say they would have to be generous and costly to make a difference.” (1/24/04 p. 205)

In 2002, the 214th General Assembly passed a resolution “On Advocacy on Behalf of the Uninsured,” which, among other things, directed the Presbyterian Washington Office to encourage members of Congress to recognize the importance of Universal Health Care – that is, equal, accessible, affordable, and high-quality health care for all persons residing in our nation, to oppose federal tax credits as a method to address the health needs of the uninsured, and to urge the expansion of Medicaid and the Children’s Health Insurance Program (SCHIP).

Health Proposals Offered by Democrats in Congress

In the Democratic response to the State of the Union, Senate Minority Leader Tom Daschle (D-SD) addressed the issue of the increasing number of uninsured and rising health care costs and opposed President Bush’s suggestions. Senator Daschle noted that Mr. Bush’s suggestion of including more tax cuts “will do little to make health care more affordable or reduce the number of people without insurance, and they will weaken health coverage for those who now have it.” However, neither Senator Daschle nor House Minority Leader Nancy Pelosi, offered a solution to the problem of the uninsured in their Democratic response. However, Democratic Senators and Representatives have offered legislation to address these issues. Proposals by Senator Edward Kennedy (D-MA) and Representative John Conyers (D-MI) are outlined below.

Health Security and Affordability Act: Senator Kennedy unveiled legislation entitled the “Health Security and Affordability Act” on January 22 at a speech at the Families USA conference in Washington, DC. His legislation would require some employers to offer health insurance to employees. According to the Kaiser Daily Health Policy Report, under his plan, employers with 50 or more employees would be required to provide health coverage to employees, with the federal government paying costs that exceed 12% of their payrolls. For employers with between 5 and 50 workers, they could either offer health coverage or contribute to the national plan and employees in firms with less than 5 employees could use the national program. Senator Kennedy noted that his plan would be based on the Federal Employees Health Benefits Program. The plan is estimated to cost $100 billion annually. CongressDaily noted that aides for Kennedy said that the proposal could lower overall health spending by as much as $130 billion because of higher productivity and increased access to preventive care for uninsured individuals.

Health Care Access Resolution: Advocates continue to work to gather co-sponsors for the Health Care Access Resolution (H Con Res 99 and S Con Res 41), sponsored respectively by Rep. Conyers (D-MI) and Senator Kennedy (D-MA). Both would direct the Congress to enact legislation by October 2005 that provides access to comprehensive health care for all Americans.

2004 Outlook for Improving Health Care Access

What are the prospects for the proposals of President Bush and Democrats in Congress to become law in 2004? The issue of increasing costs and limiting any further increases to the federal deficit (which the Congressional Budget Office had been projected to be $477 billion this year and which the White House forecast will be $521 billion this year), it will be extremely difficult for either side to pass legislation to increase federal spending or to decrease federal revenue (as tax-free savings accounts and refundable tax credits would do). However, as more and more people living in the United States lose their health coverage or are faced with higher out-of-pocket costs for health care, Congress and the Administration will be forced to respond. Already, polls are showing that health care is a major election issue for voters.

Action: Contact your Members of Congress and share your concerns about the need Members to address the issue of health care access for all this year.

By Elenora Giddings Ivory

Incarceration has become a profitable business. It is seen as a means of regional economic development. Elected officials are under pressure to pass laws that support the industry, and are in a position to pass harsher laws that provide more prisoners for this growing system.

According to The Washington Post (1/24/04), "Since 1980 the U.S. prison and jail population has quadrupled in size to more than 2 million. In the process, prisons have embedded themselves into the nation's economic and social fabric. A powerful lobby has grown up around the prison system that will fight hard to protect the status quo."

In some communities, prisons are the top employer. Prisons and jails need helmets, guns, batons, chemical agents and protective vests. Entire industries have grown up around this billion-dollar industry.

In 1999 the Presbytery of Greater Atlanta presented an overture about privatizing prisons. The Presbytery of Eastminster also offered an overture. They called attention to our dependency on privatization. As private facilities increase across the nation, they are removed from public oversight and are often not regulated for health and safety. We are also troubled as we see that non-citizen prisoners are gathered under the Homeland Security Act and 'disappear' without access to constitutional protections.

The 1999 General Assembly voted to: "Oppose the privatization of prisons as an abdication of responsibility on the part of governments and an abhorrent way of making profit." It "calls upon Presbyterians to consider...the issues surrounding corrections policies at the federal, state, and local levels; to engage in fact-finding about correctional facilities in their own localities; to encourage visits with prisoners and their families; to explore alternatives to incarceration as a response to nonviolent crime; and to encourage legislators...to promote rehabilitative rather than punitive policies in our prisons."

The 2003 General Assembly took up the issue. It approved the "Resolution Calling for the Abolition of For-Profit Prisons," a resource for congregations in cities and states where there is a growing prison industry.

The same article also noted: "Major companies such as Wackenhut Corrections Corp. and Corrections Corp. of America employ sophisticated lobbyists to protect and expand their market share. With 2.2 million people engaged in catching criminals and putting them behind bars, 'corrections' has become one of the largest sectors in the U.S., employing more people than the workforces of General Motors, Ford and Wal-Mart, the biggest corporate employers in the country."

We are moving closer to increased privatization of many formerly public endeavors, public education and Medicare to name just two. As citizens, we are being challenged to decide which services should remain in public hands for the public good.

Even in communities trying to provide educational opportunities and social service outlets — that could thwart the need for future prisons — they are losing out to powerful forces calling for punishment, and not prevention.

Recidivism has been a factor where there are few jobs open to former inmates. The Bureau of Justice Statistics notes that two-thirds of those released from prison on parole are re-arrested within three years. Ex-offenders face dire future possibilities. Many cannot receive welfare. Ex-felons and their families are banned from federal housing. Student loans are not permitted to anyone convicted of a drug offense. Being restored to the privileges of society once you have atoned for your sins is not reflected in current law.

Congress is not currently dealing with this issue, but it is considering prison labor. HR 1829, by Peter Hoekstra (R-MI) and 142 co-sponsors, would enhance inmate accessibility to remedial and vocational training and rehabilitative services. Some private correctional systems are undercutting the local labor markets because they are not paying prisoners at the going rate. Hoekstra's bill is attempting to address that part of the problem, but it does not support ending privatization.

By Catherine Gordon

As 2004 begins, hopes for a just peace for Israel and Palestine are receding, as the cycle of violence continues to spiral out of control. Along with it go the hopes of both Israelis and Palestinians to have a life free of violence.

Israelis continue to face security threats, and Palestinians look ahead to another year under Israeli occupation; daily survival for them is more and more difficult. With people being prevented from moving between towns in Occupied Territory, the Palestinian economy has been devastated. It is estimated that 50 percent of the people are out of work, and 62 percent are “vulnerable” because they have inadequate access to food, shelter, and health services.

Sixty percent of the Palestinians in Gaza and the West Bank now live below the poverty line; almost 2.5 million subsist on under $2 per day. The normal means of surviving periodic closures — like relying on credit, selling assets, and reducing spending—are collapsing.

Palestinians face daily humiliations at checkpoints. On a recent trip to the region we were told by an Anglican priest about the ordeal another priest went through. He was traveling from one village to another. At a checkpoint a young Israeli soldier stopped him, and told the priest, “I will not speak to you until you take off your cross.” The priest refused. His wife was forced out of the car, with their young child left crying inside. The priest still refused. Finally, he told the soldier that he would go home rather than remove his cross. The soldier told him he could not go either way until he took off his cross. The priest acquiesced and finally took it off.

This is not an isolated incident. Abuses at checkpoints are documented by the Israeli human rights group, B’tselem.

The “Security Wall” continues to go up. Israel claims it is building the wall between Israel and the West Bank, but only 10 percent will be on the Green Line, Israel’s 1967 border. The rest stretches into the West Bank, isolates huge amounts of land and affects the lives of many thousands of Palestinians. This year some 210,000 people will be economically and socially cut off from their neighborhoods.

Many believe that the route of the wall has been determined not by security, but by the political goals of maintaining the settlements and impacting future peace talks. (A wall built along the Green Line would be half the length of the current wall and much easier to patrol.) The current wall ghettoizes the Palestinians and forces them onto what can only be called reservations.

Palestinians’ physical and mental health has declined, and they are more dependent on emergency aid. UNRWA estimates that it will need $305 million to meet the needs of Palestinians this year. Mitri Raheb, a Lutheran minister with a Bethlehem arts center, informed our delegation that now they are struggling to keep their humanity, for they are being treated like animals.

In the absence of any peace process, people are getting desperate. Desperate people go to extremes, and a few resort to terrorism. The Palestinian Authority is out of touch and has lost almost all means of policing and control. Yassir Arafat works in a bombed-out compound and does not go outside because of Israeli death threats. He eats, sleeps, and has meetings in the same room where his oxygen machine is always running, because of failing health.

In the post-9/11 world, peace is being pushed aside in the interest of security. This is a mistake. The U.S. Ambassador to Lebanon, Vincent Battle, emphasized to our group the need to influence the debate and reminded us how the peace process can improve security. As he noted, “We must find the nexus of peace and prevention of terror.”

But in a recent meeting with the King of Jordan, President Bush said he would not push the Road Map until the Palestinians stopped all violence. It is understood in the region that the U.S. administration has disengaged and will withhold initiatives until after the 2004 elections.

Making your voice heard on Capitol Hill and in the White House is vital. Even when it seems fruitless, we must continue to voice our concerns for both the Israelis and Palestinians and their mutual suffering. We must bring attention to the inhumanity of the current “security wall” and stress the increasingly dire humanitarian situation in the West Bank and Gaza. As Christians, it is our responsibility to oppose the occupation of the West Bank and Gaza, abhor the violence on both sides, and support U.S. involvement in a peace process. We must educate our politicians and emphasize that peace will lead to security.

I am occasionally asked how the Washington Office staff keeps up with all of the news; so much happens in the world every day. Like so many others, we read the newspapers and catch the news broadcasts on radio, television and Internet. We also talk with staffers on Capitol Hill and advocates around the world.

With regard to the news outlets, I pay close attention to C-Span and CNN at home and in the office. I try to listen to National Public Radio (NPR) in my car. I was especially interested in the results of a study released in October 2003, entitled “Study Finds Widespread Misperceptions on Iraq Highly Related to Support for War.” Conducted by COPA, the Center on Policy Attitudes and the Center for International and Security Studies at the University of Maryland (CISSM), School of Public Affairs www.puaf.umd.edu/CISSM. The subhead read, “Fox Viewers More Likely to Misperceive, PBS-NPR Less Likely.”

This study was based on a series of seven nationwide polls conducted between January and September 2003, just before and after the Iraq war. The press release about the study stated, “…a majority of Americans have had significant misperceptions and these are highly related to support for the war with Iraq. Frequency of these misperceptions varies significantly according to the individuals’ primary source of news.”

The actual polling was done through the Program on International Policy (PIPA) of the University of Maryland. The pollsters stated that, “Those who primarily watch Fox News are significantly more likely to have misperceptions, while those who primarily listen to NPR or watch PBS are significantly less likely.”

According to the study, only 23% of those who did not have the above mentioned misperceptions supported the war. Also, 83% of the responders who held all three misperceptions were in support of the war; 78% who held two misperceptions supported the war, while 53% of those holding one misperception supported the war.

Specifically, the study found that 60% had at least one of these misperceptions. Furthermore, “48% incorrectly believed that evidence of links between Iraq and al Qaeda have been found; 22% that weapons of mass destruction have been found in Iraq, and 25% that world public opinion favored the U.S. going to war with Iraq.” These misperceptions supported responders’ support for the war. A key finding of this study is that, “Only those who mostly get news from print media have fewer misperceptions as they pay more attention.”

I would conclude that it is best for all of us to vary our sources of news. Our office gets Congressional Quarterly, the Wall Street Journal, the New York Times, the Washington Times and the Washington Post. Two of these newspapers are perceived to be conservative, while the others are seen as liberal. We look at other national papers online. Public policy partners also call to our attention key stories from newspapers from around the world.

The next time we have a fast-breaking event, it may be worth the time to flip our channels regularly and pick up an extra newspaper.