This is the second in a series examining how the candidates’ health care proposals will affect ordinary people and how the press could cover that angle. The entire series is archived here.

James Bell III and James Bell IV

Father and son walked into the Dr. Vesudevan Wellness Center, a Delta Area Health Education Center jointly funded by the state of Arkansas and the federal government. The elder James, age sixty-two, looked healthy; his son, age forty-three, did not. James Bell IV was a diabetic and had been for eleven years. He had trouble breathing, and it was almost hard for him to talk. He said he hadn’t seen an eye doctor in years; his feet were numb and often swollen, making it hard to stand or walk,or hold a job. He had thought about applying for a job at Wal-Mart, but a worker there told him the company might not hire him because he was so sick. His HBA1C level, a marker of how well the disease is controlled, registered a nine—too high, and he knew it, but he had no insurance or money to buy the insulin and the test strips needed to monitor and control his blood sugars.

The Bells had been to a health clinic in another town, but it had no insulin to give out and wasn’t much help otherwise. “They’ll give you a meter (to test your blood) but not the strips,” said James the younger. Strips cost eighty dollars for a supply of 100. A doctor’s visit costs thirty dollars, but to someone without money, it might as well be thirty million.

His father, who works two jobs as the county’s head jailer and as a grill cook on the night shift at McDonalds, was trying to help, but his own income is only about $30,000 a year before taxes. At least he has health coverage—a 70 percent, 30 percent arrangement. The insurer pays 70 percent of a bill; he pays 30 percent, along with copayments for doctors’ visits and premiums totaling $480 a month. (Add to that another $30 for blood pressure medication.) His wife of forty-four years has no coverage, as he can’t afford to add her to the policy.

The health center helped the younger Bell apply for assistance from a drug company that makes medicines available to the very poor; he qualified for both insulin and test strips. Abbott Laboratories was willing to give him free strips as long as he applied for Medicaid and was rejected. He was. In Arkansas, single men without children generally don’t qualify for Medicaid. Getting to a doctor regularly, though, is problematic. “I don’t have any money to take him,” says his father. “I’m just broke.” What spare cash he once had, he used to send his youngest daughter to college. Still, he was planning to use eighty dollars from the $570 paycheck he would get the next day to buy test strips for his son to tide him over until Abbott’s supply arrived.

How they would fare under McCain.

Neither father nor son would fare well under McCain’s proposals. Bell the elder would have to pay taxes on the value of his health insurance benefits. Economists argue that removing the tax exclusion for employer-provided benefits is a move toward equity, since the exclusion now favors highly paid people who get rich benefits. Equity or not, Bell would have to find the money to pay the extra taxes on an income that hardly covers the essentials. In exchange, he would get a $2500 tax credit to buy his own coverage, as an incentive to leave the county’s health plan.

The flat tax credit would favor younger people, enabling them to buy more coverage; policies in the individual market cost less if you are young. Using the credit, Bell might be able to spend less on premiums for an Arkansas Blue Cross Blue Shield policy with a $1000 deductible and 20 percent coinsurance—if the carrier would insure him at all and if it didn’t tack on a 50 percent surcharge for having high blood pressure and being overweight (as measured by the insurer). Under McCain’s scheme, insurers would not have to cover people who are already sick.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.