Health plan to offer lifetime of care Draft has citizens, employers paying

September 11, 1993|By Edwin Chen and Robert A. Rosenblatt | Edwin Chen and Robert A. Rosenblatt,Los Angeles Times

WASHINGTON -- In his ambitious national health care reform plan, President Clinton promises all Americans a lifetime of affordable medical coverage under a redesigned system that requires an insurance premium payment from virtually every citizen and employer.

According to a 239-page draft of the American Health Security Act, a copy of which was obtained yesterday by the Los Angeles Times, Mr. Clinton would revamp the current system by eliminating various discriminatory insurance market practices and organizing consumers into vast "alliances" set up and supervised by each state to shop for the best insurance plans on behalf of their members.

Mr. Clinton's agenda leaves the states plenty of flexibility to implement their own reform measures under a national framework. But it also retains for Washington a strong role as overseer, allowing the federal government to take over from any state that fails to meet strict federal standards -- and impose a payroll tax on every employer in that state.

For the first time in U.S. history,the federal government would set a basic standard for health insurance, insisting that all Americans have comprehensive coverage for doctor and hospital bills, mental health care and prescription drugs. No one could be denied coverage because of a particular occupation or pre-existing condition. Each person would receive a national health security card, much like an automated teller machine card, that could be used at a hospital or doctor's office.

The president's plan proposes a "sin tax," on cigarettes and perhaps on some alcoholic beverages, to help pay for the plan. Otherwise, the primary source of money to cover 37million now-uninsured Americans is company- and worker-paid premiums and projected savings, primarily from caps on the growth of the government's Medicaid and Medicare programs -- savings that some liberals in Congress and many economists say may not be realistic.

The Clinton plan goes a long way toward achieving universal coverage by requiring all employers and workers to contribute to health insurance premiums. Businesses would pay a levy ranging from 3.5 percent to 7.9 percent of payroll, and employees would pay as much as 1.9 percent of their pay in premiums. Contributions would be required from a large number of the uninsured, 85 percent of whom are employed, first lady Hillary Rodham Clinton noted in a speech yesterday.

Subsidies provided

Subsidies would be provided for low-wage earners and small businesses with fewer than 50 employees, and the government would pay for the indigent and the unemployed.

Illegal immigrant workers under Mr. Clinton's plan would not be guaranteed coverage, but they and their employers would be required by law to contribute health insurance premiums. Such a provision would entitle the illegal immigrants to join consumer alliances and choose a health plan. The insurance-purchasing alliances are prohibited from reporting such workers to the Immigration and Naturalization Service.

"If they work for an employer, they and their employer have to pay," said Kevin Anderson, a White House spokesman on health care issues.

"It's just like Social Security. There are plenty of undocumented workers paying Social Security taxes. But if they lose their jobs, health care coverage is not guaranteed them," Mr. Anderson said.

Uniform claim forms

A major change consumers would experience by Jan. 1, 1995 -- if Mr. Clinton has his way -- is uniform insurance claim forms: one for institutions, one for doctors and other noninstitutional providers, one for dental services and one for prescription drugs. Now, virtually each of the nation's 1,500 insurers uses a different form.

Mr. Clinton's plan would affect the way virtually every American receives and pays for health care.

The plan aims to achieve savings by encouraging the majority of Americans to move from traditional fee-for-service care to health care networks, which attempt to control costs through limits on payments to doctors and hospitals. Typically,they require approval from a "gatekeeper" doctor before a person can consult a specialist.

Subject to change

White House aides cautioned yesterday that elements in the plan are subject to change before Sept. 22, when he is scheduled to unveil his proposals formally in a speech to a joint session of Congress. Some elements of the draft already have been changed as a result of consultations with members of Congress and various interest groups, according to one White House source.

In any case, the president's final proposals are sure to be changed -- perhaps significantly -- as they work their way through Congress, a fact that Mrs. Clinton acknowledged yesterday.

"None of this comes without controversy; none of this will be easy," she said.

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