Another Clinton/Gore Legacy: More Uninsured Children

The centerpiece of Democratic presidential candidate Al Gore’s health care agenda is his promise to make sure every child in America has health insurance by 2005.

For voters who want to give the Vice President a mandate to achieve this goal over the next five years, it seems only fair to examine the record about what the Clinton/Gore administration has done for uninsured children during the last eight years.

It doesn’t look good.

When President Clinton and Vice President Gore were elected in 1992, 8.7 million children were uninsured ? or 12.7 percent. But by 1998, the most recent year for which Census Bureau figures are available, 11 million children were uninsured, or 15.4 percent. That’s a 21 percent increase in the number of uninsured children during just their first six years in office.

All uninsured rates rise

To be fair, it is not only the number of uninsured children that has increased during the last eight years, but also the number of Americans overall. In 1992, 38 million Americans lacked health insurance. By 1998, 44 million were uninsured.

The fact is that children are uninsured for the same reasons their parents are: They are in lower income families, they are Black, Hispanic or foreign-born, and they are in households where the breadwinner moves frequently between jobs. All of these demographics point to an increased risk of being uninsured, whether children or parents. You can’t fix one without the other.

The health care reforms that the Clinton/Gore administration offered and implemented appear to have backfired. That is particularly alarming because Mr. Gore says he plans, with one refreshing exception (more on that later), to continue the major programs of the Clinton administration on health care.

He says, for example, that he wants to expand the struggling State Children’s Health Insurance Program (S-CHIP) so that it covers not only uninsured children, but their parents as well. He wants to allow millions more people to buy into Medicaid, the government health program for the poor. He wants to allow early retirees as young as age 55 to buy into Medicare, the government health program for the elderly. And he wants to tack a hugely expensive and misguided government-run prescription drug benefit onto this already failing program.

Major expansion of government programs

These are not just small steps but major steps to lure millions more Americans into some form of government run health program.

When Mr. Gore first announced his health program, he said he would institute a mandate that all children MUST be covered by health insurance. But a children’s mandate is no more likely to work than the employer mandate that was a centerpiece of Mr. Clinton’s failed plan to institute universal coverage for everyone.

Who’s to blame?

It is difficult for Mr. Gore to blame the Republican Congress for the rising number of uninsured. In 1996, Congress passed the Kennedy Kassebaum bill, imposing major federal regulation on the health insurance industry in an effort to increase access to coverage. Then in 1997, Congress enacted the $48 billion S-CHIP program ? the largest new government entitlement program since Medicare and Medicaid ? to provide health insurance for children with joint federal-state spending.

The administration actively supported both bills and has been even more active in implementing associated regulations to get their agenda in place. For example, when governors began to implement S-CHIP, the Clinton administration virtually insisted that they use the new program to expand Medicaid. While many governors resisted, most ultimately gave in and now are trying to make the rules as simple as possible to get kids enrolled.

Resisting bigger government

But parents themselves are resisting signing their children up for a welfare program ? which is what Medicaid is ? just as they rejected the sweeping government-dominated plan that Mr. Clinton proposed in 1993.

The solution to the rising number of uninsured lies not in expanding government programs but in liberating the private, competitive health sector to create more attractive, more affordable health insurance for American families.

A fresh idea

The bright spot on the Democratic horizon is the refreshing exception to expansion of big government programs, namely Mr. Gore’s support of tax credits for the uninsured.

Amazingly, Mr. Gore and Gov. Bush of Texas are on the same track in proposing this fundamental change ? a change that also has broad bi-partisan support in Congress.

Both are embracing the fresh idea of providing tax credits for the uninsured to purchase health insurance. The candidates’ two approaches are different: Bush would offer a $2,000 credit to families while Gore would offer a credit worth 25% of the cost of a policy. But while they disagree on the technique, the idea is right.

As a first step, instead of putting more children into Medicaid, the S-CHIP money could be used to provide refundable tax credits or vouchers to families to help families purchase private health insurance. That is a directive the Clinton/Gore administration could take care of right now ? if their interest is genuinely in doing the right thing for children, and not using the issue for political gain.

Grace-Marie Arnett is president of the Galen Institute, a not-for-profit health policy research organization in Alexandria, VA. She edited Empowering Health Care Consumers through Tax Reform, University of Michigan Press, 1999. She can be reached at


About the author