Health care a major theme in Carnahan-Talent race

WASHINGTON -- About half a million Missourians have no health insurance, and new estimates show the number is growing.

Debate over how to make insurance affordable has persisted during the U.S. Senate campaign in Missouri. So has disagreement over how the government should pay for older people's prescription drugs, making health care a major theme of the race between Democratic Sen. Jean Carnahan and Republican challenger Jim Talent.

The health insurance debate has focused mainly on Talent's proposal for expanding coverage to more small business employees and self-employed workers. About 60 percent of the nation's uninsured fit into these categories.

Controversial because it would pre-empt state laws on patients' rights, the measure would let small businesses join together to buy health insurance in plans called Association Health Plans. The point is to push down costs so employers can afford to offer insurance.

"I've been saying for some time that pressure on small businesses, and health care costs going up 25 percent to 30 percent a year, are going to cause more people to be uninsured," said Talent, a former congressman who pushed the legislation as chairman of the House Small Business Committee. "I think AHPs would reduce that number by millions."

Nothing prevents small companies from pooling together to offer coverage, but they are governed by a series of different rules and regulations in each state. Granting an exemption like the one available to big corporations and labor unions could push down premiums by 13 percent, according to the Congressional Budget Office.

Backed by White House

The idea is backed by the Bush White House along with farm groups, business groups and several labor unions.

But it is opposed by governors and state insurance commissioners, as well as big insurance companies, who argue the exemptions could expose consumers to fraud and mismanagement.

Carnahan called the opposition damning.

"That ought to raise a red flag to anybody," she said. "He's just trying to evade the state patient protection laws we have, and I don't think that's right."

But Carnahan agrees with the ultimate goal of expanding health insurance, and in July, she added her sponsorship to a bill creating federal grants to help set up purchasing groups under state agencies and certain nonprofit groups and cooperatives.

"You know, we can have it both ways here," she said. "We can have the advantage of pooling, and we can also have the advantage of having these state protections."

Talent counters that this approach keeps groups too small to reduce premiums and costs taxpayers money, too.

Talent and Carnahan have been pitching their ideas on how to create a prescription drug benefit under Medicare the government health insurance program for older and disabled Americans.

Their disagreements mirror debate between Republicans and Democrats on Capitol Hill: Talent has proposed that the government rely on private insurers, while Carnahan wants the government to administer the benefit.