By Ceci Connolly
Washington Post Staff Writer
Thursday, May 6, 2004; Page A08

President Bush's plans for expanding health care would provide coverage to fewer than 2.5 million uninsured Americans at a cost of $90 billion, a far more modest approach than Democrat John F. Kerry's $653 billion package that would insure 27 million people, according to an analysis released yesterday.

The 10-year cost projections by Emory University health economist Kenneth E. Thorpe illustrate the widely divergent views of the two presidential candidates on an issue that continues to be high on the list of voter concerns.

"The two sets of numbers demonstrate the magnitude of dollars required to cover a substantial number of the uninsured," said Diane Rowland, executive vice president of the Henry J. Kaiser Family Foundation.

Nearly 44 million Americans -- or 16 percent of the population -- do not have health insurance. Some pay for medical care out of their own pockets, but many more receive emergency care only at hospitals, expenses that are passed on in the form of higher fees to insured individuals, employers and the government.

Kerry and Bush share some common ideas. Both support refundable tax credits for individuals who purchase their own health insurance. The two also propose opening up larger purchasing pools to individuals and small businesses to help take advantage of group discounts.

Under Thorpe's analysis, in 2008 Bush would spend about $3,800 for each new person covered, while Kerry would spend less than $3,200 per person.

Part of the reason Bush would put such a small dent in the number of uninsured -- at a comparable or slightly higher costt -- is that the people most likely to take advantage of his proposals already have some insurance, Thorpe said.

Kerry's plans are more ambitious and targeted more directly at middle-income workers, Thorpe said. The Massachusetts senator would accomplish that in large measure by expanding a handful of government health programs such as Medicaid and the Children's Health Insurance Program, called CHIP.

Under Kerry's plan, a couple earning less than $12,500 a year would be eligible for one of the two programs at very little cost. States would receive reimbursement from the federal government for enrolling more people in the programs.

Kerry also has devised a program to help private insurers handle the most expensive medical cases. He would have the federal government pick up 75 percent of the cost of catastrophic cases once a patient's care reached $50,000. In return, he would require those companies to offer affordable health care to all their workers. Campaign aides say Kerry would pay for his initiatives by rolling back the Bush tax cuts for wealthy Americans.

Thorpe credited Kerry with $298 billion in savings through disease-management programs and technology improvements. Bush advisers disputed the savings, calling such projections speculative. If Bush develops a more detailed plan for shifting to electronic medical records, the cost of his plans would probably be reduced, Thorpe said.

Megan Hauck, deputy policy director for the Bush campaign, did not dispute Thorpe's figures but said the president's strategy on health care expands beyond Kerry's focus on government and the uninsured. "The underlying problem is rising health care costs," she said. Bush believes changing malpractice laws is key to controlling costs, she added.

Hauck said Bush also deserves credit for adding money to community health centers that care for the poor and giving states waivers to expand Medicaid programs, though neither of those initiatives appears to have reduced the number of uninsured.

The health care debate, Rowland said, is really a "stalking horse for the broader discussion of national priorities and the use of federal dollars."

Using a computer model, Thorpe has analyzed the cost impact and coverage benefits of the various health care proposals offered during the campaign. He is a former health adviser to the Clinton administration but receives no money from any campaign for his policy analyses.