Fifty percent of adult Americans are “uneasy” about President Bush’s approach to reforming the nation’s health care system, according to a poll taken shortly after his State of the Union speech earlier this year.

Count Kansas Insurance Commissioner Sandy Praeger among the uneasy half.

“I am a Republican, and he is my president,” Praeger said. “But I’m not going to support something I don’t think is good policy.”

Less surprisingly, Gov. Kathleen Sebelius’ Democratic administration doesn’t like the Bush plan, either. Sebelius was insurance commissioner before becoming governor.

“It doesn’t solve the problem,” said Bob Day, director of the governor’s Office of Health Planning and Finance.

The plan of Democratic presidential aspirant John Kerry makes more sense, Praeger said, both for Kansas and the nation. In fact, a Kansas reform Praeger and Sebelius are working on, which is slated to be in place next year, is similar to Kerry’s proposal for the country.

“It would be expensive,” Praeger said of Kerry’s plan. “But I don’t see an easy solution out there short of nationalizing at least a portion of the (health care) costs, which is what his plan does.”

Kerry’s plan

Kerry has proposed having the federal government reimburse employers 75 percent of a worker’s medical bill that exceeds $50,000 a year.

Campaign site: George W. Bush on health care Campaign site: John Kerry on health care

In exchange for the government becoming a secondary insurer, employers would be required to offer insurance to every worker and participate in programs designed to promote good health.

At the same time, Kerry would expand Medicaid and the federal State Children’s Health Insurance Program to cover children and adults who cannot afford health insurance.

The federal government would pay for expansion of the State Children’s Health Insurance Program. The states would share the tab for expanding Medicaid.

Projections show Kerry’s plan would cover an additional 26.7 million people, costing $653 billion in the next 10 years. In Kansas, according to recent surveys, an estimated 250,000 to 300,000 Kansans lack health insurance.

Bush’s plan

In comparison, the Bush plan calls for spending $90.5 billion in the next 10 years, insuring an additional 2.1 million people.

Bush wants to let employer groups launch unregulated, self-insured plans — called association health plans — that would be free to exclude high-risk workers. Those eligible for an association health plan probably would see their premiums reduced; those not eligible would remain with their current carriers. These plans, according to the Bush administration, would increase competition and drive down costs.

But Praeger and Day disagree with that assessment. And so does the National Association of Insurance Commissioners.

“We see them as very problematic,” Day said. “They would disrupt the small-group market significantly.”

In testimony last year before the U.S. Senate Committee on Small Business and Entrepreneurship, Praeger warned against deregulation.

“We have all kinds of financial requirements in place to make sure that if a company goes under, there will be enough money in reserve to pay any outstanding claims, and to protect consumers against being sold a bill of goods,” Praeger said last week. “I wouldn’t want to see those go away. That’s not something you’d want to leave up to the company.”

Praeger said a recent Congressional Budget Office report found that, as proposed, association health plans would cause 80 percent of those affected to pay more, 20 percent to pay less.

“To me, the first rule has to be ‘do no harm,'” Praeger said. “There isn’t any doubt that (association health plans) would create some winners, but it would be at the expense of so many others. We can’t, in process of creating winners, be creating losers.”

‘Year of Health Care’

Kerry’s plan, Praeger said, “isn’t all that much different” from the “business health partnership” Praeger and Sebelius are trying to start in Kansas.

“We’re working on it,” Praeger said. “It’s going to happen.”

In a business health partnership, employer groups are eligible for tax credits and subsidies designed to add and keep low-wage workers in their pools of insured workers.

“Access to health care is driven by access to insurance,” Day said. “And insurance tends to be employer-based, so the goal is to come up with a way to help employers insure more workers.”

In 2000, state lawmakers agreed to allow business health partnerships in Kansas but did not put up any money.

Praeger and Day said their offices were working on ways to have partnerships up and running within a year.

“The governor has made it clear that she wants this to be the ‘Year of Health Care,'” Day said. “And I think it will be.”

Praeger said she expected to “really catch it” from her GOP colleagues for not backing Bush’s health care plan.

“But you know what? I think it’s time to tell it like it is,” she said. “I’m tired of partisan politics getting in the way of finding solutions. I’m not going to be part of that.”

Plans compared

Mike Fox, a health policy and management professor at both Kansas University and KU Medical Center, has studied the Kerry and Bush plans.

Fox agreed with Praeger’s and Day’s criticism of the Bush plan but warned that Kerry’s plan could overwhelm states.

“Maryland already has a program that’s a lot like what he’s proposing, and it has reduced costs overall,” Fox said. “But it’s not been tried on a national level, and I’m not sure all 50 states could make it work. It would be incredibly costly.”

Under the Kerry plan, states would have to raise their Medicaid eligibility to include adults with incomes below 200 percent of the federal poverty guideline.

In Kansas today, Medicaid for adults is limited to those below 42 percent of the poverty guideline.

Day did not deny the Kerry plan would increase the state’s costs.

“But the other way to look it at is — if we’re really doing something to fix the problem, this is a good buy for the state because 60 cents out of every dollar spent on Medicaid come from the feds. Forty cents come from the state.

“If we don’t do something like this, the question becomes ‘OK, would you rather pay the full dollar for dollar?'” he said.

The state spends $1.1 billion per year on Medicaid, the fastest growing portion of the state budget.