The New York Times
May 29, 2005


By Robert Pear

At a time when Congress has been torn by partisan battles, 24
ideologically disparate leaders representing the health care industry,
corporations and unions, and conservative and liberal groups have been
meeting secretly for months to seek a consensus on proposals to
provide coverage for the growing number of people with no health

The participants, ranging from the liberal Families USA to the
conservative Heritage Foundation and the United States Chamber of
Commerce, said they had made progress in trying to overcome the
ideological impasse that has stymied action on the problem for eight

The group, which first came together last October, has not endorsed
any specific plan, but has discussed a range of options, including tax
incentives for the purchase of insurance, changes in Medicaid to cover
more low-income adults and the creation of insurance purchasing pools
at the state level.

"This effort holds as much promise as any I've participated in over
the last decade, probably more," said Kate Sullivan Hare, the
executive director of health care policy at the United States Chamber
of Commerce.

Historically, such efforts have failed because of profound
disagreements over the proper role of government. The group is far
from any final agreement, but persists in seeking common ground, even
as the problems of the uninsured have been eclipsed on Capitol Hill by
Social Security and other issues.

The group also includes top executives from AARP, the A.F.L.-C.I.O.,
the American Hospital Association, the American Medical Association,
America's Health Insurance Plans, the Blue Cross and Blue Shield
Association, Johnson & Johnson, the National Conference of State
Legislatures, the National Governors Association, Pfizer and the
Service Employees International Union.

The group's overarching goal is to agree, by the end of this year, on
proposals that expand coverage to as many people as possible as
quickly as possible. By meeting in secret, the group has tried to
shield itself from political pressures. Some of the proposals under
discussion could lead to increases in federal spending or regulation,
at a time when the government already faces large deficits and
Republicans generally oppose further expansion of government.

Though federal policymakers talk little about the issue these days,
the problems of the uninsured have been gaining urgency among people
who provide and pay for health care, including employers.

Increasingly, business executives say, health care costs hurt the
global competitiveness of American companies. "This is a crisis,"
General Motors said in its latest annual report, noting that its
health costs -- $5.2 billion last year -- had "a tremendous impact" on
its profitability.

The Census Bureau says that 45 million people lacked health insurance
in 2003, up by 1.4 million from 2002 and by 5.2 million from 2000. The
National Academy of Sciences estimates that 18,000 adults die each
year because they are uninsured and cannot get proper care. The number
of uninsured may rise further as states like Tennessee and Missouri
cope with soaring health costs by ending Medicaid coverage for tens of
thousands of low-income people.

Health policy has become a flash point of American politics, defining
fundamental differences between Republicans and Democrats. The
differences have widened since the collapse of President Bill
Clinton's proposal for universal health insurance coverage in 1994.

The latest quest for consensus grew out of talks between Ronald F.
Pollack, the executive director of Families USA and Dr. William W.
McGuire, the chairman of UnitedHealth Group, one of the nation's
largest insurers.

The 24-member group takes a pragmatic approach, members said, looking
for incremental steps.

"People are uninsured for different reasons," said Dr. Mary E. Frank,
the president of the American Academy of Family Physicians and a
participant in the talks. "No one solution will work for everyone. We
need different solutions for different groups of the uninsured."

E. Neil Trautwein, assistant vice president of the National
Association of Manufacturers, said the consensus group was "not biased
in favor of big government solutions," and assumed that health care
would continue to be provided through a mix of private insurers and
public programs.

Mr. Trautwein said the talks reminded him of a medieval alchemist
stirring together disparate and volatile ingredients. "It could
produce some wondrous proposal, or could blow sky-high," he said.

Members of the group acknowledge that cost could constrain their
ambitions. They will retain budget analysts to estimate the costs of
various options, from which their final recommendations will be

The group will present its recommendations to Congress and the Bush
administration. Several members said they hoped to stick together and
use their collective power to fight for the proposals.

The group is applying lessons learned in the battle over the Clinton
health plan. Members said they were listening carefully to one
another, trying to build the trust. They are not trying to remake the
health care system or guarantee insurance for every American through
one big program, they said.

The group is considering these options:

** The federal government could require parents to arrange health
insurance for their children up to a certain age, say 21. If the
children were not eligible for public programs like Medicaid, the
parents could obtain tax credits to help meet the cost.

** If an employer does not offer health benefits to employees, the
workers could designate amounts to be withheld from their paychecks,
along with taxes. These amounts would eventually be forwarded to
insurers to pay premiums.

** The federal government could provide tax credits to low-income
individuals and families or small businesses to help them pay for
insurance. The full amount of the credit would be sent directly to the

** Medicaid could be expanded to cover any adult with income below the
official poverty level (about $9,600 for an individual). Each state
would decide for itself whether to do this, and the federal government
would provide financial incentives for states to take the option.

** The federal government would offer small grants to states to help
them establish insurance purchasing pools. Individuals and small
businesses could buy coverage through these pools.

Asked what had prompted the initiative, Stuart M. Butler, the vice
president of the conservative Heritage Foundation, said: "It's a
coalition built of frustration. True believers on the left and the
right have been stymied on this issue."

Copyright 2005 New York Times