WASHINGTON, May 1, 2004 (Hispanic PR Wire) — The health care crisis is returning to American politics, gradually, but inexorably, with a force that will most likely grow as rising costs and deepening cuts squeeze more and more voters.

Representative Richard A. Gephardt of Missouri, a candidate for the Democratic presidential nomination, outlined his plan to cover the 41 million uninsured Americans last week. Senator John Kerry of Massachusetts, another candidate, will announce his health care proposal in three to four weeks, and former Gov. Howard Dean of Vermont has made the issue the centerpiece of his presidential campaign, declaring in New York today that "all Americans deserve access to health care."

Pollsters say the issue ranks high with Democratic primary voters, which means that every presidential candidate must address it. It also means that the ultimate Democratic nominee will be eager to "encourage a broader debate over health care" with President Bush, Bill McInturff, a Republican pollster, said.

When people are asked to rate their personal concerns, more than a third now say they are worried about the rising cost of their health care — many more than say they are worried about losing their jobs, losing money in the stock market or becoming the victim of a terrorist attack, according to a poll released this week by the Kaiser Family Foundation, a health research group.

"Health care costs are, and have been for some time, the No. 1 pocketbook issue in the country," said Geoffrey Garin, a Democratic pollster who is expected to advise Senator Bob Graham, the Florida Democrat who is another contender for the presidential nomination.

In contrast to 1991-1992, Mr. Garin said, when the health care issue was fueled by people's fears of losing jobs and health insurance, the issue today is "driven by the experience people have of paying a lot more and getting a lot less coverage for it."

The classic symbols of these rising costs are prescription drugs, particularly for the elderly; Medicare, the health insurance program for older and disabled Americans, does not cover outpatient prescription drugs. Congress, in a few months, is expected to make another effort to create a new drug benefit in Medicare, but the budget pressures and political divisions will be hard to overcome.

Meanwhile, rising health costs, coupled with declining revenues, are forcing states to consider major cutbacks in Medicaid — the program that already covers millions of people who would otherwise be uninsured. State officials have not, so far, received the help they are pleading for from Washington. The Bush administration opposes short-term assistance, holding out for a more comprehensive overhaul, which critics assert is an effort to limit federal responsibility for the program.

There is an incongruity here, as Bob Blendon, a Harvard University expert on public opinion and health, put it: Candidates are proposing bold visions to expand coverage in the future, "and we don't have enough money to pay for the present."

Some states are considering cuts deep enough to extend to children, the one group that politicians of all stripes agreed ought to be covered in the 1990's. "The idea of reversing that progress is astonishing," said Dr. Irwin Redlener, president of the Children's Health Fund, a program based in New York intended to provide coverage to children.

Medicaid has its own special political problems. As Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said, "it's thought of as a poor people's program." But, Ms. Rowland noted, Medicaid covers millions of low-income people in working families, and is increasingly used to fill in the gaps in Medicare — most notably, for prescription drugs and long-term care, often for elderly Americans who are solidly middle class until they live long enough, and get sick enough, to encounter major drug and nursing home bills.

The Medicaid cuts now being debated in state legislatures have yet to reach a critical mass in national politics. But some advocates and experts say to give them time.

"It will impact providers, it will impact the uninsured, it will impact people on the street," said Robert Restuccia, executive director of Health Care for All, a consumer advocacy group in Massachusetts. "Harris Wofford will come again."

Maybe. Right now, there are several contenders for the visionary role filled by Mr. Wofford, the Pennsylvania Democrat who won a Senate race in an upset and pushed health care to the forefront of American politics in 1991. Building the support to pay for that vision is another matter, as the defenders of Medicaid will attest.