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Opponents Support Expanding Medicaid Coverage


This afternoon, two longtime adversaries in health care will come together. They will unveil a new proposal for overhauling the nation's health care system, including a broad expansion of the Medicaid program for the poor. NPR's Julie Rovner reports.

JULIE ROVNER: Families USA is one of the leading liberal advocacies groups pushing for expanded health insurance coverage for the past two decades. The Pharmaceutical Research and Manufacturers of America, better known as PhRMA, represents the nation's leading drug makers. The two groups, says Families USA executive director Ron Pollack, rarely see eye to eye.

Mr. RON POLLACK (Executive Director, Families USA): We have been on the opposite sides with PhRMA on almost every major piece of legislation.

ROVNER: But in this topsy, turvy health care year, the two groups find themselves with common goals. Families USA wants to get more people health insurance. It's most concerned about those with the lowest incomes, like those on the Medicaid program. But Medicaid eligibility varies widely from state to state. Only poor children, the elderly, and the disabled are guaranteed coverage. As a result, says Pollack, if you're a childless adult…

Mr. POLLACK: In 43 states, you literally can be penniless and you're ineligible for Medicaid, so that for these populations, the safety net is more hole than webbing.

ROVNER: PhRMA comes to the problem from a different, but no less urgent, angle. As drug prices go up and insurance coverage goes down, fewer people can afford their medications. Billy Tozan is PhRMA's president and CEO.

Mr. BILL TOZAN (President, CEO, PhRMA): We're up to almost 50 percent prescriptions unfilled in this country because people either don't have insurance or because the co-pays are so high that they're not encouraged to stay adherent to their medicines. And the result is people get sicker and sicker and then end up costing everybody a lot more.

ROVNER: And drug makers sell fewer drugs. So the plan the groups will present today will call for everyone who earns up to one and a third times the federal poverty level to be eligible for Medicaid. That's about $14,000 for an individual.

Subsidies would be provided to those with somewhat higher incomes, and everyone would have their out-of-pocket health expenses capped. Now calling for such major government involvement in health care is ironic, not just coming from PhRMA, but from its leader. As the former Republican Chairmen of the House committee that oversees Medicaid, Billy Tozan was an outspoken opponent of expanding government health programs. But he says things have changed.

Mr. TOZAN: One is that it literally has become both an economic necessity for us to address the rising cost of health care in this country, and then secondly, the numbers of the uninsured and those who lack access in this country have been growing exponentially.

ROVNER: PhRMA isn't the only former opponent of health overhaul now supporting it. Insurance and business groups are also at the table. But Pollack says having Tozan's active involvement, could help get a lot of reluctant Republicans in Congress off the fence.

Julie Rovner, NPR News, Washington.

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MONTAGNE: You're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.

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