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Cindy Fox Aisen
IU School of Medicine

Last modified: Monday, October 6, 2008

Health insurance and the presidential election

Oct. 6, 2008

INDIANAPOLIS -- Q and A with Dr. Aaron Carroll director of the Center for Health Policy and Professionalism Research and associate professor of pediatrics at the Indiana University School of Medicine. Carroll is a Regenstrief Institute research scientist and a pediatrician who sees patients at Riley Hospital for Children.

Q: Why is health care playing a bigger role in this election than in any presidential contest in the past?

A: There are now more than 45 million people in America without health insurance for the entire year; almost twice that lack coverage for at least a month out of the year. Over the last few years, most of the newly uninsured are from the middle class. As unemployment rises, along with gas and food prices, more and more people will be unable to afford health insurance, especially as it gets more expensive each year. The combination of a sagging economy, increasing numbers of uninsured, and a disproportionately affected middle class may make this a tipping point.

Q: Is the health-care issue part of the larger financial issue that is dominating this campaign? Or is it separate or separable?

A: I think the two will become more intertwined. We have already seen health care and taxes merged in the vice presidential debate, and as the campaign continues, I expect that one or both candidates will make the point that reforming the American health-care system is essential to improving the economic outlook for average Americans.

Q: How would you describe Senator McCain's perspective on health-care reform? What is your take on his plan?

A: Senator McCain is looking to make big changes to the way people obtain health insurance in the United States. He plans to eliminate the tax subsidy for employer-based health insurance, and instead offer tax rebates to individuals ($2,500) and families ($5,000) so that they can purchase insurance on their own. He believes that putting the decisions and choices in individuals' hands will make them better consumers and bring costs down. The problem is that this may cause a significant number of people (some estimate 20 million) to lose their employer-paid health coverage, and there are no detailed plans on how individuals with pre-existing conditions will get care.

Q: How would you summarize Senator Obama's statements on health care? What is your take on his plans?

A: Senator Obama wants to keep the current system in place while trying to get additional people coverage. He wants to expand the safety nets, like Medicaid and State Children's Health Insurance Program (SCHIP). He also wants to allow individuals to purchase plans through something like the Federal Employees Health Benefits Program (FEHBP). He also wants to make it impossible for people to be denied coverage for pre-existing conditions. The problem is that many of the plans in the FEHBP are expensive; moreover covering many more people through the existing system will be expensive.