A source in Gore's office says he will offer a plan to provide health insurance coverage to all children by the year 2005. Gore also will propose efforts to lower the cost and improve the quality of coverage. Details of the plan, including how it would be financed, were still being worked out late Monday as Gore flew from Iowa to California.
But Gore plans to make it clear that, if elected president, he would pursue the same incremental approach to changing managed care that President Clinton adopted after his attempt to revamp the system failed to win congressional approval in 1994.
"We have all learned that we cannot overhaul the system in one fell swoop," Gore said in remarks prepared for a speech at a hospital here Tuesday. "Experience has taught us that there is a way to keep what is right, while fixing what is wrong with American health care."
The Children's Health Fund, an advocacy group for disadvantaged children, estimates some 11 million children have no health insurance and almost as many have inadequate plans or live in places without enough doctors.
To help insure more children, Gore would expand the Children's Health Insurance Program, which helps states provide coverage to children in working families. Currently, states can use the federal CHIP money to cover children in families that earn up to 200 percent of the poverty level. Gore would raise that cap to 250 percent.
Gore also would allow families that do not qualify for the program, and do not receive health benefits through their jobs, to buy into the program. He would give financial bonuses to states that meet enrollment targets for CHIP and Medicaid, programs he believes are not fully utilized.
Gore said the fastest-growing group of uninsured Americans are those between 55 and 65. Currently, Americans are eligible for Medicare at 65. Gore proposed allowing "vulnerable Americans" to buy into the program as early as age 55 and he promised a 25 percent tax credit to help defray the cost.
Gore also would:
- Let people with disabilities keep Medicare or Medicaid when they returned to the workplace.
- Encourage small businesses to band together to negotiate rates for their workers' coverage by providing a 25 percent tax credit to the firms.
- Press for a "real, enforceable" Patients' Bill of Rights, similar to legislation that Congress will consider when it returns this month from recess. Gore didn't explicitly say in his remarks whether he favors allowing patients to sue their health maintenance organizations and collect damages when care has been denied. But, he has promoted Democratic legislation this year that would do so.
Gore's "bill of rights" would guarantee patients the right to see a specialist, and ensure doctors can tell paients all their medical options. It would guarantee that pregnant women and cancer patients wouldn't have to change doctors in the middle of treatment.
He suggested that it also would require managed care companies to cover mental illness.
"I want to make sure that a patient with depression is given access to care on terms no different from a patient who has diabetes," he said. "And I will begin by improving mental health services for those who receive Medicaid."
Gore's proposal staked out ground between that of his Democratic rival, former Sen. Bill Bradley, who has said he will propose something approaching universal coverage, and Republicans, who fear that imposing too many mandates on private health-care firms will drive up costs.
"Others will argue against reforming our health care-system carefully, realistically, and step-by-step. Some of them will tell you that the only acceptable answer is a one-size-fits-all solution," Gore said, in an apparent reference to Bradley.