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Candidates Split on Health Care Coverage

March 14, 2008 -- Should everyone in America have access to health insurance? If so, should you be required to get it?

Beneath all the complexities, the presidential health care debate really boils down to those two big questions. And how you feel about the answers might tell you a lot about which candidate you think can solve the nation's mounting health care problems.

As for question one, Democratic candidates Hillary Clinton and Barack Obama both answer "yes." Each has a plan leading to "universal health care," a system in which everyone has medical coverage. For McCain, the answer is both "yes" and "no."

McCain says everyone should have access to coverage in principle, but his plan doesn't guarantee it and won't try to. He believes that market-based forces can work to bring down health care costs so that eventually people can afford to buy it.

But before you think it's just Clinton and Obama vs. McCain when it comes to health care, think of question two. Clinton says that making sure everyone is covered is a critical ingredient to reforming the way insurance companies cover health care. That's why she says that everyone should be required to get coverage.

Obama agrees, but only up to a point. He says parents should be required to make sure their kids are covered. Then once insurance reforms help bring down costs, everyone else will eventually have to get coverage too.

Obama has attacked Clinton for calling for an insurance mandate. While that is often a dirty word in politics, Clinton and her advisors say it's necessary.

"It's important from the start to make sure that coverage is universal," says Katherine Hayes, a vice president at Jennings Policy Strategies, which advises Clinton's campaign on heath issues.

Unless everyone has coverage, insurance companies can still seek out the healthiest people to cover. That leaves older and sicker people -- the ones who need coverage the most -- out of the loop, Hayes said at a Capitol Hill forum on the candidates' health plans sponsored by the Alliance for Health Reform.

The practice is called "cherry-picking," and both Clinton and Obama say it needs to be done away with.

"Both call for individuals to acquire coverage when it becomes affordable," says Gregg Bloche, a professor of law at Georgetown University and an advisory to Obama's campaign.

But Obama wants to give reforms time to work before requiring coverage. Both he and Clinton want to form purchasing pools to make insurance cheaper, and to work to decentralize health care from hospitals and traditional clinics so that it's easier to access.

They both also want to provide tax credits to help small businesses buy coverage for workers, and provide subsidies to help people get coverage if they can't afford it themselves.