HEALTH INSURANCE NUMBERS LOOK GOOD WISCONSIN HAS NATION'S THIRD-LOWEST RATE OF UNINSURED RESIDENTS.(LOCAL/WISCONSIN) - The Wisconsin State Journal (Madison, WI)

Byline: Sarah Wyatt Associated Press

The percentage of Wisconsin residents who have no insurance has dropped significantly in the last two years, to the third-lowest rate in the country, a Census Bureau report says.

The percentage of state residents who went without any kind of health insurance was almost half the national rate in 2000 -- about 7.4 percent, down from 10 percent in 1999 and 10.5 percent in 1998, the report said.

The national rate in 2000 was 14 percent, down from 14.3 percent in1999.

The Census Bureau report was based on the March 2001 Current Population Survey, in which the agency asked people in 50,000 households nationwide whether they were covered by some form of private or government-provided health insurance in 2000.

Statistics on uninsured people released by the state Department of Health and Family Services painted an even more optimistic picture.

Wisconsin's 2000 Family Health Survey, conducted between May and December of last year, found that 4 percent of Wisconsin residents had no insurance in the previous 12 months, and 7 percent had health insurance for only part of the year.

At any one time, about 6 percent of state residents had no insurance, officials said. Those most likely to be uninsured were adults age 18 to 44, low-income residents, people who did not graduate from high school, part-time employees, Hispanics and blacks, the state report said.

Eleanor Cautley, an analyst for the state survey, said Wisconsin asked different questions and used a larger and more diverse sample than the Census Bureau, which could account for the differences in the statistics. State workers also conducted their entire survey by telephone, meaning they missed households that don't have telephones.

Of those who had health insurance, 76 percent had private insurance, 4 percent had medical assistance, 2 percent were enrolled in Medicare and 12 percent had a combination of different insurance providers, the state report said.

While the statistics reflected a positive trend, some wondered whether the numbers would hold in light of the nation's shaky economic future after the Sept. 11 terrorist attacks.

Jon Peacock, director of the Wisconsin Budget Project, a family advocacy group, said the positive news may dissipate this year if many people are laid off or if employers cut back their insurance coverage.

Some of the people who are most likely to be uninsured, according to Peacock, include:

* Low-income childless adults who don't qualify for Medicaid and can't afford their own health insurance.

* Farmers or employees of small businesses whose insurance is not covered by their employers and who can't afford private insurance.

* Low-income residents who don't know they qualify for state assistance.

* Employees whose job provides some coverage but who can't afford the insurance co-pay.

According to the Employee Benefit Research Institute, 77.7 percent of Wisconsin workers -- or roughly 2.3 million people -- receive health insurance through their employers.

'It's good news that employers in this state are well above average in insuring their workers,' he said. 'But it means that in a time of recession, there could be a big increase in the number of uninsured people and in the number of people who may be applying for state assistance.'

It's too early to measure the impact of the terrorist attacks on the state economy, said Chris Marschman, a spokesman for the Department of Workforce Development.

Philip Sanders, 36, said he is a roofer who has not had health insurance in the 10 years he has lived in Madison.

'I've just been taking my chances. I can't afford health insurance right now,' he said, adding that he was not aware of any state programs that might help him get insurance.

John Henry, 30, a steel driver, said he has had health insurance through employers in the past, but he is currently unemployed.

Wisconsin's BadgerCare program could have helped cut the number of residents without health insurance, although state officials have not analyzed the survey results, Cautley said.

HARRIS FAWELL TO PUSH HEALTH INSURANCE BILL - Sun Publications (IL)

U.S. Rep. Harris Fawell says a bill he will introduce in the next session of Congress could help reduce the number of Americans who have no health insurance.The bill to be sponsored by the 13th District Republican would allow professional associations to form regional or national health insurance risk pools, something they are currently prevented from doing because of legislation and having to meet the mandates of all 50 states.

Federal approval would allow the groups, such as the National Federation of Independent Businesses, to offer its members a health insurance policy that spreads the risk among all its members.

This is similar to what large companies and municipalities do with self-insurance plans.

Large employers which fit the qualifying criteria are federally exempted from having to meet individual state insurance requirements.

Fawell wants to extend that privilege to small employers with his bill.

Most job growth nationally is in small business enterprises, as it is locally in DuPage County.

Fawell said his bill will tackle the problem of uninsured Americans better than the Kassebaum-Kennedy bill, which allows employees who already have health insurance to carry that coverage to a new job.

The bill also limits the pre-existing medical condition exclusion.

Fawell said the revolution in health care insurance in the past 20 years has been a shift to employer-provided programs.

'Hence, those employees of small employers have to hope one spouse is working for a large employer,' the he said.

He used a report, titled Characteristics of the Uninsured, from the Employee Benefit Research Institute, a Washington D.C.-based group charged with contributing to public policy development pertaining to employee benefits, to buttress his bill.

Fawell embraced what he called the report's contradiction of four myths:

• 'Most uninsured people are unemployed' -- The report said 85 percent of the uninsured live in a family headed by a worker and the majority of these employed heads of households are full-time, year-round workers.

An estimated 41 million Americans currently have no health insurance.

Fawell said the 'single most important reason Americans lack health insurance is that they work, or they are in the family of a worker, for a small business that does not have access to affordable insurance.'

• 'Small employers not offering insurance just don't want to pay for it' -- The study confirmed small businesses' have higher per capita costs due to greater risk and higher average administrative costs, Fawell said.

• 'The Kassebaum-Kennedy bill will cover the uninsured' -- Fawell argued that the Kassebaum-Kennedy bill has no requirement that an employer offer health insurance to its employees.

Nor does it expand the 18-month period that some former employees have under COBRA, a plan that lets people leaving a position continue on their former company's health insurance so long as they pay the full premium.

The study, Fawell contends, points out the legislation will do little to decrease the size of the uninsured population.

'This provision,' Fawell quoted from the report, 'is expected to increase health insurance premiums and may contribute to the declining rate of employment-based health insurance.'

• 'The only way to get coverage to the uninsured (who work in small business) is through the government' -- Fawell asserted small businesses want to solve their own problem, without the government unduly stepping in.

Fawell said that if small business associations would be allowed to form nationwide health insurance risk pools, they could provide affordable health insurance coverage to a majority of the population currently lacking coverage.

Fawell acknowledged his bill faces opposition from the insurance industry since, if it is approved, it would allow those people currently paying for individual coverage to become policyholders of an association's health insurance plan.

From his own experience, Fawell knows the tribulation of having a small business.

As a lawyer, Fawell said he would purchase an expensive individual health insurance policy during the periods when his wife, Ruth, a teacher, was not working.

'That's why we have a high number of uninsured people,' Fawell said. 'People simply don't have the wherewithal to buy insurance from their employer.'

His bill would provide to smaller groups the economies of scale currently afforded large employers, he said.

'What we're offering is to let the little guys do what the big guys have the chance to do,' Fawell explained.

Children's health insurance coverage reaches record high. - AORN Journal

More children were covered by health insurance in 2003 than ever before, according to a June 30, 2004, news release from the National Center for Health Statistics. The overall percentage of Americans lacking health insurance remained unchanged, however, and lack of insurance coverage increased among working-age adults. Minority populations in particular lacked insurance coverage.

The percentage of children without current health insurance coverage decreased from 13.9% in 1997 to 10.1% in 2003. Among poor and near-poor children, tack of coverage decreased by approximately one-third from 1997. For near-poor children, public coverage increased from 24% to 47% between 1997 and 2003. These improvements reflect an increase in public coverage for poor and near-poor children, including that provided by the State Children's Health Insurance Program.

Many children without health insurance come from working families with incomes too high to qualify for Medicaid and too tow to afford private health insurance. More than 70% of poor children younger than 18 years of age rely on public coverage. The increase in public coverage also was observed for other age groups and corresponded with a decrease in private coverage.

Overall, 15.2% of the population--43.6 million people--was without current health insurance coverage in 2003, approximately the same level as in 1997. Recent estimates indicate a decline in coverage for working-age adults in 2003, however. Working-age adults were more likely than older adults or children to tack health insurance coverage, with 20.1% tacking coverage during 2003, an increase from 18.9% in 1997. More than half of unemployed adults were without health insurance in 2003.

Lack of health insurance continues to affect minorities disproportionately. In 2003, approximately 33% of Hispanic people tacked health insurance, a far greater percentage than the African American (17.4%) and Caucasian populations (11%).

These data are reported in the National Health Interview Survey, which was conducted by the National Center for Health Statistics. The survey is based on personal interviews with a sample of the nation's civilian, noninstitutionatized population.

NEW JOINT ECONOMIC COMMITTEE REPORT REVEALS WOMEN EXPERIENCING DOUBLE-WHAMMY OF LOSING HEALTH INSURANCE COVERAGE DUE TO THEIR OWN OR SPOUSE'S JOB LOSS - US Fed News Service, Including US State News

WASHINGTON, Aug. 6 -- The House-Senate Joint Economic Committee issued the following news release:

Today, Congresswoman Carolyn B. Maloney, Chair of the Joint Economic Committee (JEC), along with Rep. Elijah Cummings and Rep. Jim Moran released a JEC new report entitled, 'Comprehensive Health Insurance Reform: An Essential Prescription for Women.' The report reveals that during the recession, women are experiencing a double-whammy of lost health insurance as they lose their insurance due to either their own or their spouse's job loss. In addition, the JEC report chronicles the vulnerability created by women's dependence on their spouse's employer-sponsored health insurance, the unique risk of un-insurance for younger and older women, and the spike in newly uninsured children of unemployed single mothers. To access the new JEC report, visit: http://jec.senate.gov/index.cfm?FuseAction=Reports.Reports&ContentRecord_id=efb1d290-5056-8059-7656-1205b6b933c1&Region_id=&Issue_id=

JEC Chair Maloney said, 'Today's report underscores the unique risks women face in losing their health insurance coverage, and their unique difficulties obtaining affordable, quality health insurance policies. The system is clearly broken - over one million women have lost their health insurance because their spouse lost their job. The comprehensive health care reform proposals offered by the Obama Administration and currently taking shape in Congress include numerous provisions that are critical to providing quality, affordable health care for all Americans, both women and men. Many of these solutions are a key part of the prescription for easing the burden on America's women, for whom the status quo health care system is a failure.'

JEC Vice Chair Schumer said, 'This report should be a wake-up call to all legislators that we simply cannot afford to ignore the needs of a 64 million plus population. Women and men have different health needs, which in turn makes them some of the most active participants in our health care system. This fact illuminates the harsh reality that women are growingly susceptible, both economically and physically, to the effects of our broken system. I join with Chairwoman Maloney in continuing to work with our colleagues in Congress on proposals that benefit all Americans, giving mothers, sisters, daughters and grandmothers the care they need and deserve.'

Rep. Cummings said, 'We cannot continue with a health care system that discriminates against our mothers, daughters, sisters, and friends. We must act now to pass the comprehensive health care reform under consideration by the Congress to ensure that all Americans-including women-have access to quality, affordable health care that covers their individual needs.'

Rep. Moran said, 'Our current health system-the most expensive in the world-needs urgent surgery to insure women, especially those most grievously affected by the recession, receive equal care. For far too many women and their families, quality, affordable health care is out of reach. More than two out of every five low income women today lack health care insurance. With urgent warnings about a renewal of swine flu this fall and steep declines threatening even deeper cuts in state Medicaid funding, it is critical for us to act. Our goal-as Americans-should be to provide quality, affordable health care for all Americans.'

Key Findings From The JEC Report Include:

* Over one million women have lost their health insurance due to a spouse's job loss during the current economic downturn. Women have lost 1.6 million jobs since the recession began in December 2007, and many of those women saw their health insurance benefits disappear along with their paychecks. Second, women whose spouses lose their jobs are also vulnerable to losing their health benefits, because so many women receive coverage through a spouse's job-based plan. The Joint Economic Committee estimates that over 1.4 million women have lost health insurance benefits because of the contraction in the labor market since December 2007. 71 percent (1,001,913) lost their insurance due to a spouse's job loss. 29 percent (414,964) of those women lost their insurance due to their own job loss.

* As a consequence of single mothers' job loss, the Joint Economic Committee estimates that at least 121,000 children have lost health insurance coverage. The weak job market has been rough on single mothers; the number of unemployed female heads of household has increased 53 percent over the past twelve months. For many of these women, the loss of a job means not only a disappearing paycheck, but also the disappearance of employer-sponsored health insurance coverage for their families.

* Women between the ages of 55 and 64 are particularly vulnerable to losing their health insurance benefits because of their husbands' transition from employer-sponsored coverage to Medicare. One recent study concludes that a husband's transition from employer-sponsored coverage to Medicare at age 65 can be problematic for his younger wife. Many of these wives depended on their spouse's employer-based coverage and are not yet age-eligible for Medicare. As a result, 75 percent of these women reported delaying filling prescriptions or taking fewer medications than prescribed because of cost.

* Younger women are particularly vulnerable to lacking adequate health insurance coverage. Over one-quarter (28 percent) of all young women (ages 19-24) do not have health insurance coverage. The weak job market has hit young workers particularly hard, with the unemployment rate amongst young women at 15.7 percent in June 2009, the highest in a quarter century and substantially higher than the national unemployment rate of 9.5 percent. The dismal job market means that young women are less likely than ever to have access to job-based coverage, and many women who once received coverage through a parent's health insurance plan have seen this coverage evaporate with their parents' jobs.

* 41 percent of all low-income women lack health insurance coverage. Because of wide variability in state Medicaid eligibility rules, millions of American women fall through the safety net every day. The devastating impact of the recession on state budgets has forced some states to further tighten Medicaid eligibility rules at precisely the time when need is growing fastest.

* The health consequences of inadequate coverage are more severe for women than for men. Women are more likely than men to run into problems receiving adequate medical care. Over a quarter (27 percent) of women had health problems requiring medical attention but were not able to see a doctor, compared to 21 percent of men. Similarly, nearly a quarter (22 percent) of women reported that they were unable to fill a needed prescription, as compared to 15 percent of men.

* While the financial burden of inadequate health insurance coverage weighs heavily on all Americans, uninsured and under-insured women suffer more severe economic consequences than do men. Women are more likely than men to deplete their savings accounts in order to pay medical bills. One-third of under-insured women deplete their savings to pay medical bills, as compared to a quarter of under-insured men. The disparity is comparable amongst the uninsured (34 percent of uninsured women as compared to 29 percent of uninsured men).

The comprehensive health care reform proposals offered by the Obama Administration and currently taking shape under the leadership of Democrats in the House and Senate includes numerous provisions that are critical to providing quality, affordable health care for all Americans, both women and men. Many of these solutions are a key part of the prescription for easing the burden on America's women, for whom the status quo health care system is a failure.

GOV. PATERSON SIGNS LANDMARK HEALTH INSURANCE REFORM LEGISLATION - US Fed News Service, Including US State News

ALBANY, N.

Y., June 9 -- Gov. David Paterson, D-N.

Y., issued the following press release:

Governor David A. Paterson signed into law Governor's Program Bill No. 278, that reinstates the New York State Insurance Department's authority to review and approve health insurance premium increases before they take effect. Since 2000, New York had regulated health insurance premiums under a 'file and use' law that significantly limited the State's ability to disapprove health insurance premium increases and allowed the insurance industry to self-regulate.

'Deregulation of health insurance premiums is a failed experiment leading to unjustified premium increases and more people losing their health insurance coverage,' Governor Paterson said. 'Health care is a right, not a privilege, and requires sound, balanced regulation to make sure insurance premiums are fair and justified. I am pleased to sign into law my program bill, which will help make coverage more affordable and allow more small businesses and individuals to keep their coverage.'

The new law, which is part of Governor Paterson's successful health insurance reform agenda, requires health insurers and HMOs to make an application to the Insurance Department to implement premium increases. The Department would have the opportunity to review the rate applications, as well as the underlying calculations, to ensure that the rates are justified and not excessive, and may approve, modify or disapprove the rate application. The law would apply to all rate increases taking effect on or after October 1, 2010.

In addition, the legislation will immediately require health insurers and HMOs to spend more of every premium dollar they collect on medical claims. In particular, the legislation raises the 'medical loss ratio'-the percentage of premium spent to provide medical care-from 75 percent to 82 percent for small businesses and from 80 percent to 82 percent for individuals. This would allow the State to ensure that a greater percentage of premiums are returned to consumers in the form of benefits.

'Not only will stronger oversight of rate increases benefit New York's individuals and small businesses, but prior approval will also provide us with the tools necessary to make sure federal health care reform is implemented in a fair and efficient manner,' the Governor added.

Under the Federal Patient Protection and Affordable Care Act, health insurers will be required to report justifications for 'unreasonable' rates increases as well as the percentage of premiums spent on claims, quality of care, taxes and administrative costs.

New York State Insurance Department Superintendent James J. Wrynn said: 'This legislative victory, under Governor Paterson's unwavering leadership, is the culmination of years of battling for more affordable quality health care. Prior approval will work in tandem with President Obama's health care reform to make sure insurers' premium rates are transparent and their reporting is correct. Prior approval will also ensure that insurers comply with the requirements of the health insurance exchanges that will be developed under federal reform.'

The legislation also provides an opportunity for policyholders and the public to provide comments to the insurer and the Insurance Department on the rate applications. The Insurance Department is required to post relevant comments on its website to provide a forum for public input and discussion. Small businesses and individuals will also receive longer notice of rate increases - 60 days instead of 30 days - allowing them more time to consider alternative coverage options if they cannot afford a rate increase.

The bill signed into law is part of Governor Paterson's ambitious health insurance reform agenda. The Governor's initiatives in this area have thus far:

* Extended COBRA benefits for unemployed workers from 18 months to 36 months;

* Required insurers to allow unmarried young adults, through 29 years of age, to be covered under a parent's group health insurance policy; and

* Reformed the managed care system to help consumers receive the care they need and to reduce red tape which often leads to inappropriately delayed or denied claims.

Health insurance is a luxury many can't afford: Uncovered. - News Herald (Panama City, FL)

Byline: Faith Ford

Feb. 20--PANAMA CITY -- Karreen 'Dee' Adams has diabetes, high blood pressure, arthritis and no health insurance. The 57-year-old Panama City woman, semi-retired after 18 years working as a teacher's aide in New Jersey, said she cannot afford the luxury of medical coverage. Adams said she is living off her deceased husband's pension, and after moving out of a subsidized housing complex, Adams has to hold her purse strings tight.

She is one of a growing number of local residents living without health insurance.

In Florida, 19.2 percent of residents under 65 do not have coverage, according to the 2004 Florida Health Insurance Study conducted for the Florida Agency for Health Care Administration. In Bay County, the numbers are slightly lower, with 18.3 percent of those under 65 without insurance, the study shows.

The uninsured are not unique to Bay County or Florida, said Dan Morgan, chief financial officer for Bay Medical Center, the county's largest hospital.

'As the cost of health care goes up, you're seeing more and more employers either cutting back on providing health care or cutting back on the amount that they pay,' Morgan said.

Facing higher premiums, some workers are choosing between health insurance and necessities such as food and shelter.

Unemployed people like Adams, who do not qualify for Medicare of Medicaid, also make up a large portion of the uninsured. Almost half of Florida's unemployed population is not insured, the study shows.

Cardiologist Curtis Williams has witnessed what happens when patients, especially those with serious health problems, do not have medical insurance. Williams is the founder and medical director at the St. Andrew Community Medical Center, a free, faith-based Panama City clinic that serves patients who are at or below 150 percent of the federal poverty level and ineligible for Medicare or Medicaid.

'It is tragic. It is absolutely tragic,' Williams said. 'I've seen people who have diabetes and need insulin who have not checked their blood sugar level or taken any insulin in five years because they can't afford to go to the doctor.'

Ric Steen, 53, and Patricia Grizzle, 57, both have no health insurance and a long list of health problems. Adams, Steen and Grizzle -- all Panama City residents --are patients at the faith-based clinic.

A former mail handler, Steen said he went into security work when he could no longer handle the heavy lifting required by his former job. Eventually, Steen said, he reached a point where he felt he was a danger to himself and others because of his health problems.

Along with having no health coverage, he has no income. Before he went to the clinic, Steen said he was getting some care from a doctor who his daughter worked for.

Steen remembers the first time Williams treated him.

'He said, 'Son, you're a mess,'' Steen recalled, listing off his health problems including diabetes, high cholesterol, high blood pressure and chronic lung disease. He also has had a stroke.

'I shudder to think what kind of shape I'd be in now without their help,' Steen said.

Grizzle said she suffers from fibromyalgia, high blood pressure, chronic lung disease and other health problems related to an injury. She has not had health insurance since she and her husband divorced about 10 years ago.

'If it wasn't for the clinic, I would probably be dead right now,' she said.

Like Steen, she has no income. Before the clinic, Grizzle said she relied on the emergency department at Bay Medical Center.

Adams was making occasional trips to Gulf Coast Medical Center's emergency department before she was taken in at the free clinic. Not a fan of hospitals, she said she went only when she needed a prescription written or her children forced her because she was in such bad shape. She racked up more than $700 in charges.

'I'll owe them forever,' she said, adding that she tries to send $5 each month toward her bill.

Gulf Coast Medical Center CEO Todd Gallati said an increasing number of uninsured patients are landing in the private hospital's emergency department.

In 2005, 7,839 patients, or 18.8 percent of the hospital's emergency room traffic, were uninsured. By comparison, in 2004, 7,164 patients, or 17.6 percent of emergency department patients, did not have insurance.

Congress passed the Emergency Medical Treatment and Labor Act in 1986 requiring that hospitals treat all emergency department patients with or without payment.

Gallati suggested increasing the availability of preventative care might alleviate the burden on hospitals. Studies show patients with insurance are healthier, Gallati said, because they make regular doctor visits rather than waiting until medical issues reach crisis level.

To better serve the uninsured and keep chronic health problems in check, Gallati said more clinics like the Federally Qualified Health Center (FQHC) would be a good start.

Made possible through federal legislation passed in 1989, FQHCs provide primary care to all patients regardless of their ability to pay. Patients who can afford to pay are charged on a sliding scale based on income.

'If we had one, say, in every community -- Lynn Haven, the Beach, Panama City -- the overall health of folks in Bay County would dramatically improve,' Gallati said.

The Community Health Center-Bay County has been awarded federal grant money to become an FQHC. Since opening in 2003, the clinic for the uninsured has had limited hours. With the FQHC designation, the clinic is expected to be open seven days a week.

In 2005, Gulf Coast Medical Center provided $4.7 million in uncompensated care.

Bay Medical Center, a nonprofit hospital that receives some breaks for treating the indigent, provided $18.1 million in uncompensated care in 2005. That's up from $16.6 million in 2004, but Morgan said the jump is in line with an increase in overall patient admissions.

Clinics like the Community Health Center-Bay County and the St. Andrew Community Medical Center are part of a solution, Morgan said.

'Logic would say, if you get to these people earlier and particularly those with chronic diseases and other things,' Morgan said 'hopefully you can prevent the severity or frequency that they become inpatients.'

Still, he said: 'I don't see it solving the problem.'

Since its opening in 2004, the St. Andrew Community Medical Center has been overwhelmed. Office manager Mandi Simmons said she had to do away with a waiting list last year after realizing some patients had been waiting as long as a year for an appointment. The medical clinic -- run by volunteers -- is open only one night a week.

Simmons said there are 663 patients in the computer system, although that figure includes patients for the medical clinic and a dental clinic run by the same church group.

Steen is quick to shower praises on the medical center and its volunteer staff. He counts himself lucky to have signed on early before word spread.

'It's a classic thumb in the dike. It's a lot of help,' Steen said. 'But there is a whole lot more need than they can provide for. I know they have turned away more than they've helped.'

Copyright (c) 2006, The News Herald, Panama City, Fla.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.),

Dukakis Pledges to Seek Health Insurance Law; Pitch Is Aimed at Middle-Class Voters - The Washington Post

Democratic presidential nominee Michael S. Dukakis, assailingGeorge Bush's 'record of neglect' on health care, promised today toseek national legislation that would guarantee private healthinsurance benefits for most American workers and their families.

Dukakis, who has long advocated such a mandatory health insuranceprogram, provided few new details of the promised initiative. Buthis renewed pledge of broader health insurance benefits-like hisearlier proposal for a new college student loan program-was aimeddirectly at the majority of middle-class Americans who Dukakismaintains are being 'squeezed' by the rising costs of health care,education and other necessities.

It was a day of contrasts on the campaign trail that Dukakistried to use to his advantage. While Bush visited a flag factory inNew Jersey, the Massachusetts governor began his day at a Houstonhospital, where he discussed the need for health insurance with abouta dozen people, including two cancer patients and three unemployedsteelworkers.

Speaking at Western Kentucky University here later today from astage filled with white-uniformed nurses, Dukakis recalled the'tragic stories' he heard in Houston and ridiculed Bush's flag-ladencampaigning.

'Mr. Bush, don't you think it's time you came out from behindthat flag and told us what you intend to do to provide basic healthcare for 37 million of our fellow citizens?' he said.

'The fact is that Mr. Bush has no plan, but he does have arecord-a record of indifference, a record of neglect, a record thateven the American flag can't hide . . . . When the time came tostand up for the health needs of America's families, George Bush wasnowhere to be found.'

The Bush campaign dismissed the Dukakis proposal as 'socializedmedicine pure and simple.' Spokesman Mark Goodin called the plan 'aprescription for financial disaster' and said the solution for thoseAmericans who do not have insurance is not government forcingbusinesses to provide it but incentives for business to do so andefforts by the government to make insurance more available andaffordable.

The Democratic nominee spoke to an enthusiastic crowd, recallingthat his late father was a doctor and promising: 'When Americans getsick, the first question they hear will be the question my fatherused to ask-not `how can you pay?' but `where does it hurt?' '

Aides to Dukakis said the health insurance plan would reach about22 million of the estimated 37 million uninsured Americans byrequiring that most employers provide health insurance coverage fortheir employees. They said it would be modeled on pendinglegislation sponsored by Sen. Edward M. Kennedy (D-Mass.) and Rep.Henry A. Waxman (D-Calif.), which Dukakis has endorsed in concept butnot detail. It also would draw on legislation enacted inMassachusetts this year that provides incentives to business toobtain insurance coverage for employees, they said.

Dukakis said some small businesses might be exempted from therequirement, but would be offered special incentives to provide theiremployees with health insurance.

Most of the details of the Dukakis plan remain to be worked out,including measures to provide insurance coverage for part-timeworkers, the self-employed and the unemployed. Dukakis said he wouldappoint a task force with orders to report to him by March 30 onoptions to deal with these categories of uninsured Americans.

The Kennedy-Waxman legislation is fiercely opposed by businessbecause of its cost. David Blumenthal, a Boston physician andhospital administrator who is a health adviser to the Dukakiscampaign, said the average cost of insurance under the bill isestimated at $1,300 a year per worker. Employers would pay 80percent of the cost, employees 20 percent.