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Originally published October 24, 2008 at 12:00 AM | Page modified October 24, 2008 at 9:35 AM

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Candidates' health plans: What they mean for you

When it comes to health care, the presidential ballots you cast this year could have enormous consequences. Sen. Barack Obama and Sen. John McCain have offered far-reaching — and strikingly different — proposals that could reshape health care for the insured and uninsured alike. Here is a comparison of three real-world scenarios.

Seattle Times health reporter

Will your health benefits at work become taxable income?

Will all parents be required to buy medical insurance for their kids?

Will insurers be barred from turning away diabetics, cancer survivors or pregnant women?

When it comes to health care, the presidential ballot you cast this year could come back to affect you directly.

Sens. Barack Obama and John McCain have offered far-reaching — and strikingly different — reforms that could reshape health care for the uninsured and the insured alike.

McCain's proposal is arguably more revolutionary.

He wants to shift the country away from employer-provided health plans — the source of medical coverage for two-thirds of American workers — and place the responsibility on individuals instead.

One of McCain's key goals is to eliminate what he considers an unfair tax break for people who get insurance through their work. He also wants to encourage Americans to buy portable coverage that stays with them, not their jobs.

He would discourage reliance on employers by counting any health benefits they provide as taxable wages — a change that would cost a typical family earning $80,000 about $1,350 a year in extra federal income taxes.

To offset the higher taxes, McCain would give every American who's not old enough for Medicare a refundable tax credit — $2,500 to individuals and $5,000 to families.

That would be a windfall for people who have no insurance. But it wouldn't buy generous coverage for almost anyone past their youthful prime.

And if the tax credits prompt some employers to drop insurance benefits, as some experts believe will happen, many workers would find it impossible to replace their lost coverage with the amount of the tax credits alone.

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Obama would leave the employer-centered system largely intact. He would expand it by requiring large employers to either provide "meaningful" coverage or pay to opt out.

For everyone else — including the self-employed, the unemployed and small employers — Obama would create a huge public insurance pool to give them more buying clout. He would also offer premium subsidies to small businesses and to low-income people to buy coverage either through the pool or from commercial insurers.

He would require all children to have coverage and would make more kids eligible for an existing federal insurance program.

Finally, Obama would make it illegal for insurers to deny coverage to anyone with a pre-existing medical problem. McCain's plan would not.

Some experts argue that Obama should make insurance compulsory for everyone, not just children. Others question whether the country can afford the tab for his agenda.

So how would Obama's and McCain's competing platforms affect you, really?

Answer: In more ways than you might realize.

Copyright © 2008 The Seattle Times Company

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