U.S. Rep. Jo Ann Emerson doesn't know exactly what universal health care will look like, but she knows what it needs to accomplish.

"I don't want a government health care system. What I want is a system to insure all Americans through the private sector. People can't afford health care today, so we've got to make it affordable," said Emerson, a Cape Girardeau Republican.

From this very simple premise came Emerson's fascination with a universal health care proposal by Sen. Ron Wyden, D-Ore., an unlikely ally for the typically conservative-minded Emerson. In April, she read a New York Times Magazine article about the Wyden plan titled, "What's the One Thing Big Business and the Left Have in Common?" This appealed to Emerson, who hopes to find a way to make health care available to everyone without bogging it down in government bureaucracy.

Emerson is now working with U.S. Rep. Bryan Baird, D-Wash., to introduce a companion bill to Wyden's in the House.

"What we are trying to do is create a mechanism through the private sector to have insurance for all Americans and allow 47 million uninsured -- and we have a lot in our district -- access to health care," she said.

Emerson said the only non-negotiable elements of a plan are that it must be driven by the private sector, stress prevention and not be government run.

Wyden rolled out his plan, the Healthy Americans Act late last year.

It has been endorsed by business leaders like Steve Burd, the CEO of Safeway Inc., one of the nation's largest employers, as well as labor leaders.

The proposal is one of more than a half-dozen being offered in Washington as the solution to providing health care coverage to Americans without health insurance.

The lack of insurance has consequences for both people with insurance -- they pay more for premiums and care -- and people without insurance, who are getting sicker before seeking treatment, said Alwyn Cassil, director of public affairs for the Center for Studying Health System Change in Washington, D.C.

The center doesn't endorse specific proposals, Cassil said. Instead, it studies the current system and provides information for policymakers and the public.

"There is no question that health care coverage expansion has become a much hotter issue in the last six months," Cassil said.

"Part of it has to do with the change in the Congress. The other issue is that there is a presidential election, and if health care is not the top domestic issue, it is one of the top domestic issues. We are going to have a lot of proposals over 18 months to two years."

Wyden's plan eliminates almost all types of employer-provided insurance.

Those getting coverage from Medicare or the military would continue to do so under the plan, but everyone else's coverage would change.

The plan seeks to accomplish this shift quickly by requiring employers to convert current health care premiums into higher wages for employees.

The wages would then be used by employees to purchase their own health insurance.

After two years, employers would make regular "Shared Responsibility Payments" to a central fund to defray premium costs for the insured.

All HAA participants would pay premiums through annual income tax filings.

The program promises to fully subsidize the premium for those below 100 percent of the federal poverty level with the premium phasing-in for people living between 100 percent and 400 percent of the poverty level.

Insurance would continue to be private, but it would be closely regulated by state governments.

The regulation would ensure that people of all ages, races and medical histories have an appropriate and affordable plan while preventing "cherry picking" of the healthiest patients by insurers.

New state agencies would be created to coordinate payments and provide consumers with unbiased information about competing plans.

All citizens would be required to carry health insurance at all times -- a regulation currently being attempted in states like Massachusetts and California.

The law would be enforced through federal income tax payments and driver's license registration.

The result would be guaranteed health care for all Americans equal to that enjoyed by members of Congress.

Emerson said a dialogue on the issue must be begun now, before the 2008 elections launch the next round of partisan bickering.

"We really want to have a debate on problems of the uninsured. And the bipartisan discussion ultimately taking shape will not be possible one year from now," Emerson said.

If the estimates are to be believed, the plan could save everyone money, including employers.

According to the Lewin Group, a non-partisan consulting firm which examined the proposal, implementing the plan tomorrow would mean health care spending would be about $1.48 trillion less over the next 10 years than over the previous 10.

Employers would save about $310 per employee under the plan, and family health spending would drop in every age group except 45 to 54 years old, according to the consultants.

The net result, say those in the business world, is needed as much by businesses as by people who are uninsured.

"Every time we do a survey, health care costs are the No. 1 concern of businesses, period. The business community is open to looking at ways to reduce costs to them. ... it's their No. 1 concern, hands down, walking away," said Cape Girardeau Area Chamber of Commerce president John Mehner.

Rudi Keller of the Southeast Missourian staff contributed to this report.

tgreaney@semissourian.com

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