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BUSH CAMPAIGN HEALTH POLICY FOCUS IS ON MEDICAID BUY-IN concept to improve health care delivery to segments of the population with inadequate health care coverage, Bush/Quayle campaign domestic policy advisor Deborah Steelman explained at a Nov. 2 press briefing. Steelman outlined the Vice President's proposed health care policy, noting that the top priority for Bush is to provide access to health services for infants and children of low income families who are currently uninsured or underinsured. Steelman said that Bush would provide about $ 200 mil. in the first year of his administration to begin to extend coverage to pregnant women, infants and children up to seven years of age at the lowest end of the income scale. "The priority is on the children's coverage. We have split out the cost to devote about $ 200 mil. to the children's coverage." Steelman identified prenatal care as the most important service that would be extended to low income women. According to Steelman, the Vice President is proposing that the federal government provide incentives to state Medicaid agencies to pick up optional coverage for children. She explained that the program would be implemented in stages, beginning with people with the lowest income in states identified as having the poorest health care delivery systems. "We want to work with states that have the most inadequate Medicaid programs -- that is both for infant care and for children under seven -- concentrating on those states with the highest infant mortality rates and the least adequate programs as far as immunization and preventive care is concerned, and work through incentives to pick up more of that coverage," Steelman stated. Asked how many of the estimated 5 mil. children below the poverty line who are not now covered by Medicaid would be reached by the Bush program in its first year, Steelman said that "we have not put a number on it." However, she said, "we would like to think we could reach at least a quarter of them in the first-year effort." Also in the first year of the program, Bush would provide an additional $ 200 mil. to be applied to a population of uninsured or underinsured low income adults. "That is where you have heard George Bush refer to the Medicaid buy-in. What we mean by that is a way to provide subsidized coverage for low income adults." She said that although the mechanism for the buy-in has not been studied in detail, the Vice President has identified several possible programs. One option, she explained, is a "Medicaid wrap-around where you would combine employer coverage with a Medicaid core to lessen the cost to both parties." Other possibilities, Steelman noted, include "a direct contract with Medicaid through an idemnity plan or a prepaid plan to provide care as cheaply as possible, or to do just a direct buy-in to the state program through some sort of payroll deduction." Early in the process, a Medicaid buy-in system was considered as one possible approach to catastrophic health care coverage. However, the buy-in was opposed on Capitol Hill as being too narrow in scope, and a comprehensive system was adopted in the final legislation. Steelman emphasized that Bush's proposal would take a long time to fully implement, and she noted that the health system already has in place several "good building blocks" through the catastrophic coverage law and welfare reform. "We do not see this as a short term goal." She added that "to do this properly is going to take a long time, as long as 10 years." She said, for example, that the Medicaid buy-in plan would be implemented in stages "on a state-by-state plan for the four years of the term to get that coverage both improved and the reach of it expanded."