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The American Medical Association recently became the latest participant in the growing debate over how to provide adequate health coverage for some 47 million uninsured by launching an ambitious multimillion dollar ad campaign. The 250,000-member AMA, based in Chicago, Ill., aims to use the campaign to pump up its own version of health care reform. The plan dubbed “Voices for the Uninsured” offers up a package of private-public solutions to the health insurance quagmire through a mix of tax credits and subsidies, which the AMA hopes will result in higher, more affordable health coverage and reduce the ranks of the uninsured.

“The AMA is enlisting doctors and medical students in our campaign,” said AMA’s president-elect Nancy Nielsen, MD at a Washington, DC press conference in August.
 
Under the AMA’s proposal, all employed individuals would qualify for a federal tax credit if they purchase health insurance. They could subtract the credit from their annual tax bills and receive the difference in the form of a refund.
 
The amount would be determined by personal income, but at the lowest income levels, the credit would approach 100 percent of the premium cost, the AMA said. The credit would be refundable even if the enrollee owes less in taxes than the tax credit.

Under the current system, employment-based health benefits are excluded from taxable income. According to the government, the cost of health coverage is viewed as income, which would normally be taxed.
 
The AMA says the current system is obsolete due to the rise in health care cost. The system also discriminates against higher wage earners, the group said. The annual amount of the subsidy reaches well over $125 billion, an AMA spokesperson said.
 
The proposal also gives employees greater choice in choosing coverage. Workers could keep or change their plan regardless of where they work.
 
“Empowering people with tax credits and freedom of choice will dramatically transform today’s health insurance markets,” the AMA said in a published statement. Theoretically, the AMA said, the tax breaks would ultimately lead to higher enrollments, which in turn would make health insurers more responsive to consumers, lower their operating costs, and lead to better coverage.
 
Critics say the proposal is all too familiar and doesn’t go far enough.
 
“The approach is not new and is fundamentally flawed,” says Todd B. Taylor, MD, an EP in Nashville, TN. Regulatory policies can only go so far, Taylor adds. Without changing both the marketplace and patients’ behavior regarding their own health responsibility, there can be no true health care reform. “Ultimately, we have to change the (whole) health care environment,” Taylor says.

The AMA proposal is one of the latest in a series of voices clamoring for reform. Most of the calls have been timed to the upcoming presidential elections. The raft of candidates from both major parties calling reform has raised the specter of a single-payer or universal health care program, which the AMA has steadfastly opposed. 

In late August, the American Cancer Society unveiled its own $15 million ad campaign decrying the miserable state of health care coverage. The nonpartisan effort was designed to raise public awareness of the need for change and to push candidates toward some workable solution, according to the group.  

Candidates on both sides of the aisle have publicly expressed their views on the issue.  Last month, Democratic presidential candidate Hillary Clinton unveiled her healthcare plan, one similar to the 1993 Republican plan proposed by Rep. Chafee. Clinton claims that the plan is similar to the individual-mandate plan passed in Massachusetts by former Governor Mitt Romney. That’s an about face. In 1993, supporters of the Clinton plan railed against any mandate that required individual insurance because it would encourage businesses to dump their employee plans.

Rudy Giuliani proposes an income exclusion of up to $15,000 for those without employer coverage. He also proposes a Health Insurance Credit to low-income Americans that can be coupled with other revenue sources such as Medicaid and employer contributions to make coverage more affordable to millions of the uninsured. Mitt Romney’s approach is to boost efforts to sign up those eligible for Medicaid, create an insurance buying pool for individuals and small businesses, have the government purchase health insurance policies for those with incomes up to 300% of the poverty line. Senator Obama supports the creation of a National Health Insurance Exchange to oversee the private health insurance marketplace and sell insurance. Employers who do not make a “meaningful” payment toward health insurance will have to contribute to the national plan -- with certain small employers exempt.
 

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