Clinton's health care reform gets a hard look and in detail Comprehensive benefits promised CLINTON'S HEALTH PLAN

September 15, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- Hopeful but wary, Americans are beginning to take a hard look at President Clinton's health care reform plan.

They see laudable goals: guaranteed insurance, comprehensive benefits emphasizing prevention and tough controls on health costs now rising faster than family income.

Yet polls show that Americans are as skeptical about the president's plan as they are about insurance contracts in general. They know the fine print means more than a salesman's promises. With copies of the plan circulating in advance of Mr. Clinton's scheduled health reform speech today, people are already asking, "Will my family and I really be better off?"

For the majority of Americans, the answer is a qualified "yes" -- if the administration's untested ideas work.

Here's a preview of what Mr. Clinton will say next week about how the plan helps you, with some caveats from critics who believe he can't deliver.

The plan -- certain to be revised during months of congressional debate -- promises:

* "Health security." Under his plan, all but illegal residents would be covered, including the more than 35 million Americans who currently lack insurance. No one would be dropped, regardless of employment status or health problems.

* Comprehensive benefits. An official of the national Blue Cross and Blue Shield Association terms the proposed package "relatively rich." It includes the full range of doctor and hospital care, plus coverage for mental health, substance abuse, prescription drugs, long-term care in a home and community setting, and a broad range of preventive services such as routine physicals and childhood vaccinations.

* Choice. The Clinton plan states that consumers must be offered at least one plan that gives them the freedom to choose doctors and hospitals, though it may cost them more.

* Quality. For the first time, Americans would be given extensive information about the quality and performance of their health plans, and the doctors and hospitals they visit. Health plans that flunk quality tests would be barred from offering coverage.

* One-stop shopping. "Health alliances," agencies created by each state, would shop for coverage for most people. They would pick offerings from competing insurance companies, HMOs and other plans.

Each year people would receive a packet of information from the alliance describing the various health insurance plans that meet government standards for quality and solvency and that offer the guaranteed benefits package. They would make a choice and inform the alliance, which would charge employers, employees and the government for the premiums.

One exception: The Medicare program for the elderly would continue to run pretty much as it does today, with participants choosing any willing doctor and hospital. Medicaid, the health program for the very poor, would be folded into the new system. Participants would receive coverage through the alliance.

* Reasonable costs. Generally, people who are paying a fortune today for lousy health coverage would pay less and get better from Mr. Clinton's plan. Those paying comparatively little for great coverage could see their premiums rise.

Administration officials estimate the benefits package would cost $1,800 a year for individual coverage and $4,200 for family coverage -- less than most plans today charge for similar benefits.

The financial linchpin of Mr. Clinton's plan is a requirement that all employers pay at least 80 percent of workers' premiums. For family coverage, that would be $3,360. Employees would pay up to 20 percent, or $840.

Employers could pay more of the premium, as many do now, and supplement the benefits package. But, 10 years after the reform legislation takes effect, employees would be taxed on the value of any employer-paid benefits that exceed the government-guaranteed benefit package.

Low-wage workers and small businesses with low-wage workers would be eligible for federal premium subsidies, the details of which the administration is still considering.

In addition to premiums, consumers would have other costs, as most do now: deductibles and co-payment charges that would vary according to the particular health plan they select.

The net effect, administration officials assert, is that two-thirds of Americans would pay no more than they do now. Who's in the other third? It includes people who currently pay nothing for health care.

Everyone must contribute under the Clinton plan and be covered, even if they don't want insurance.

Mr. Clinton believes that people should pay roughly the same premium regardless of health risk, in contrast to the present system. Leveling premiums, as he proposes, would likely mean higher premiums for young healthy people and lower premiums for the middle-aged and ill.

The only way for an employee to really tell whether he or she would pay more under the plan is to add what he and his employer pay annually for his health insurance, and compare it to the $1,800 and $4,200 estimates of the administration.

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