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As Expenses Rise, Primary Voters Focus on Health Care

Shortly before he went off to vote in the Missouri Democratic primary on February 3, 68-year old Carl Moskowitz learned that the premium for his retiree health plan was doubling to $250 a month. Suddenly the issue of health care became integral as he listened to the candidates present their case.

“I hadn’t thought about this in previous elections,” said Mosko-witz, who lives in Creve Coeur, Mo. “Now it was an out-of-pocket expense, and it became a top issue for me.”

Exit polls from the early Democratic primaries show Moskowitz’s attention to health care to be far from unique. In almost all states that have voted so far, 25% to 30% of the voters have named health care the most important issue influencing their votes — second only to the economy.

In a campaign that initially was dominated by the war in Iraq, the fight against terrorism and the struggling economy, health care reform has shown itself to be the sleeping giant.

Health care is not new as a hot topic in American elections, but the number of people like Moskowitz with a personal interest in reform has risen swiftly. Last year a study by the Kaiser Family Foundation — a nonpartisan, nonprofit research center — found that 54% of Americans with medical insurance faced increasing premiums during the previous year. The rising costs have pushed many off the insurance rolls altogether; the number of uninsured Americans increased 10% during the first two years of George W. Bush’s presidency, to 43.6 million.

These statistics were borne out during interviews with Jews from the early primary states, who have been at the epicenter of public discussion on these issues.

Gene Gurevich, a 24-year-old law school student at the University of South Carolina in Columbia, chose to go without health insurance last year because the price of the university’s coverage, on top of tuition, was prohibitive. “If something terrible is to happen, I will be screwed,” Gurevich said, “but so far, so good.”

Gurevich’s constant uncertainty has left him receptive to presidential candidates who provide concrete proposals for reform. “There is need for drastic change in this country,” he said.

The number of people without health insurance has become a concern far beyond just those who are themselves uninsured. In a nationwide poll conducted last October, 79% of those surveyed supported raising taxes to provide health insurance for all Americans.

The Jewish Council for Public Affairs, which represents 13 national and 122 local Jewish agencies, has repeatedly adopted resolutions declaring its support for universal access to health care.

All of the Democratic candidates have put forward proposals to expand coverage to include a majority of those currently uninsured.

Even among those who do have health insurance, reform is proving an important issue thanks to the problem of rising health care costs faced by people like Amy Gelfman, 33, of Grand Forks, N.D. Since her husband lost his full-time job last July, they have been paying $600 a month for a COBRA health plan that covers them and their three children. In addition to the rising premiums, she has found that each time she sees a specialist or fills a prescription, her co-payment has risen.

Last year private health premiums rose 13.9 % — the third consecutive year of double-digit increases, according to a Kaiser Family Foundation study.

As the election approaches, Gelfman said, “I would definitely be more inclined to look at the candidates and consider what their stand on health care is.”

With so much public concern, though, it is notable that no candidate had emerged as the clear favorite among the voters who discussed their health care concerns with the Forward. In the early campaigning former Vermont governor Howard Dean and Missouri Rep. Richard Gephardt put the most attention on their health care platforms, but it did not make for any noticeable success.

“If this was a winning issue, Gephardt would still be in the race,” said Mollyann Brodie, director of public opinion and media research at the Kaiser Family Foundation. She said the difficulty confronted by the campaigns is the complexity of the reforms on the table: “It’s just too hard for individuals to distinguish between everyone’s plans.”

Among the presidential contenders, only Dennis Kucinich has proposed universal health care, which an October poll conducted by ABC News showed that 62% of Americans supported. Since the failure of President Clinton’s attempts at reform in 1993, policy analysts say, most candidates have shied away from broad solutions and relied instead on a combination of private and public solutions.

But a study by Kenneth Thorpe, a professor at Emory University and former deputy assistant secretary of Health and Human Services during the Clinton administration, highlights the large differences between the candidates’ proposals. The least expensive, Bush’s plan, would cost $70 billion over 10 years and bring 4 million more people onto the insurance rolls. The most expensive, Dean’s plan, would cost $932 billion over the same time span, and extend coverage to 32 million people who are currently uninsured.

The continuing difficulty in distinguishing between these specific plans is evident in the way Abe Bucksner, an 82-year old World War II veteran in Kansas City, chose Dean on an issue “that needs an awful lot of help.” He said, “It stuck in my mind that Dean was a physician — that impressed me.”

Massachusetts Sen. John Kerry has put forward the unique idea of opening the health insurance program for federal employees to all Americans, and he has pledged to make it his first major piece of legislation if he takes office.

Mark Mellman, a Democratic pollster, said Kerry has shown this could be a winning issue. “Kerry is the only candidate that has a plan that reduces health care costs,” he said, “and he has won over voters most concerned about health care costs.”

Exit polls found that Kerry did garner the votes of 38% of those most concerned with health care in Iowa, but in South Carolina, Dean won this contingent, while in Oklahoma, retired general Wesley Clark scored with the largest chunk of people who cited health care as their top concern in a candidate.

Brodie says that because of the arcane nature of health care reform, the most candidates can hope to do is show they are aware of the problems faced by Americans — an argument that is supported by Lauren Reece, 43, a school board president in Iowa City, Iowa.

Reece said, “I just want them to recognize that we have a serious problem on our hands and are in need of a solution.”

Bush seems to have caught on. In the week after the first primary, he brought up health care reforms in three separate speeches, and in one speech devoted solely to the topic, he said, “We want health care to be affordable and accessible.”

With the Medicare reforms in December, Republicans served notice that health care will no longer be the reliable Democratic issue it once was. Bush has distinguished himself from the Democratic candidates, though, in his reliance on private market solutions. At the center of his current proposals are health savings accounts, which allow for the creation of tax-free savings accounts for medical expenses.

In general, the public has not been overly impressed with Bush’s legislation. A Washington Post poll in mid-January found that 51% of those surveyed nationally disapproved of the way Bush had handled Medicare, while only 36% approved. Of those polled, 52% said they trusted Democrats in Congress to handle the cost and availability of health insurance, while only 33% said they trusted Bush.

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