Health care emerges as a major issue in 2004 election

Washington -- The affordability and availability of health care is promising to be a top issue in the coming presidential election as Americans increasingly worry about the possibility of losing their health insurance.

A recent survey by the Commonwealth Fund found that 87% of Americans say the presidential candidates' views on health care will be an important factor in how they vote this year.

"Health care has emerged as a major concern in the 2004 presidential election," said Karen Davis, PhD, president of the fund. "Both Sen. John Kerry and President Bush have advanced proposals to expand health insurance coverage and to improve affordability."

Overall, survey respondents were equally supportive of proposals from both parties, including tax credits, expansion of public health programs and a mandate that employers help pay for workers' insurance.

The fear of losing health coverage is becoming a strong motivator for many Americans, experts said. It is driving them to say yes to pretty much any approach that holds hope of keeping insurance costs within reach.

"The fact that we get this broad support across income groups, across political parties and across insurance status suggests people really do want something done on the issue," said Sara R. Collins, senior program officer with the fund.

"It also suggests that maybe people are interested in multiple approaches or multiple options. A reorganization of the health care system might not be what people are looking for," she said.

The survey revealed that 62% of respondents would be willing to give up the Bush tax cuts if the revenue were to be used for improving the availability of health insurance for everyone. That support rose to 69% when the survey respondents were asked about a partial repeal of the tax cuts, as has been proposed by Kerry.

Concerns over reduced benefits and rising out-of-pocket costs appear to be driving these views. Nearly half of respondents reported one or more type of erosion in health benefits -- 43% were paying higher premiums, 21% experienced benefit cuts and 28% were paying higher co-pays and/or deductibles.

Those benefit reductions might help explain why people also reported experiencing increased difficulty getting a prescription filled; having a medical problem but not going to a doctor or clinic; skipping a medical test, treatment or recommended follow-up visit; or not seeing a specialist when referred. Whether insured or not, 37% of respondents said they had experienced one or more of these problems in 2003, compared with 29% in 2001.

The trend is not new but has been slowly inching up the income scale, said Carol Pryor, research associate for Brandeis University's Access Project. The project has documented access problems faced by uninsured and, increasingly, by insured Americans.

Despite concerns over gaps in the system, Americans still prefer that it be funded through shared responsibility of individuals, employers and government, the Commonwealth survey showed.