Clinton's Health Plan

September 15, 1993|By Michael Ollove


'End the nightmare for millions' of consumers

For an estimated 35 million Americans without health insurance, there is nothing ambiguous about the Clinton health proposals. In one fell swoop, the plan would free them from the worry and hardship that plague those without health coverage.

"The step that the president has taken would end the nightmare for millions of American consumers," says Gail Shearer, manager for policy analysis for Consumers Union, which for decades has advocated universal health insurance.

Perhaps no aspect of Mr. Clinton's reforms is more ambitious than his promise of comprehensive health insurance for every American citizen and legal resident.

Every year, tens of millions of Americans are without health insurance for at least some period of time. They work for small firms that provide no health benefits. They lose their jobs or are between jobs. They have a medical condition that either makes coverage too expensive or causes insurance companies to reject them. They have temporary disabilities that keep them from the work force.

Those without health insurance are either paying for health care out of their own pockets -- something no one can afford for long -- going to community clinics, or using hospital emergency rooms for primary care. Or they simply do without.

President Clinton's reforms would change all that. The uninsured would all automatically be insured. Most would gain coverage under a new requirement forcing all employers to provide health care coverage. Part-timers, who often are excluded from benefits, would have to be offered coverage on a pro-rata basis.

But even the unemployed who didn't qualify for Medicaid, the federal program for the poor, would be entitled to health insurance. Those who couldn't pay for it would receive a government subsidy. The cost of the subsidy is estimated at about $428 billion spread between 1996 and 2000.

Pre-existing medical conditions, such as acquired immune deficiency syndrome, diabetes and cancer, would no longer be a bar to affordable health insurance. Everyone would be entitled to coverage, and no one could be charged a surtax because of their diagnosis. The biggest promise the Clinton plan makes to currently insured Americans can't be calculated in dollars and cents. It's peace of mind, a guarantee of coverage regardless of condition or employment.

The plan also promises Americans that they will have more choices of health plans than many have now.

For people more interested in the bottom line, administration officials also promise improvements. They assert that the plan provides benefits at least equal to those held today by most insured Americans. They further contend that most Americans would pay no more under the plan -- and in many cases less -- than they would pay if the present insurance system remains and costs continue to skyrocket.

But would this plan provide you with better benefits than you have now? At a lower cost? To find out, compare the benefits you receive now with those under the Clinton plan. (See accompanying chart of benefits.) Compare what you and your employer pay for those benefits with the roughly estimated price of the Clinton plan: $1,800 a year for individual coverage and $4,200 for family coverage.

Although it's best to calculate the plan's effects individually, some generalizations can be made based on where Americans work and receive their health insurance.

Large businesses. Workers in the biggest companies tend to be the best insured. Employees at companies such as Bethlehem Steel Corp. may find they have better overall benefits than the Clinton plan offers, with smaller deductible and co-payment charges. One noticeable difference may be adult dental care and children's orthodonics, which are common benefits in big-company plans but absent in the package of benefits proposed by Mr. Clinton. Another difference is that many big-company plans offer prescription drug coverage without the 20 percent co-payment requirement set by the Clinton plan.

This doesn't mean these workers will be worse off under the Clinton plan. Even workers with so-called Cadillac plans don't have all the preventive services that the Clinton plan would pay for. For example, the Health Insurance Association of America reports that routine physical exams for adults are covered for only half of all workers with employer-sponsored insurance. Fewer than 70 percent of workers have insurance plans that cover childhood immunizations, well-baby care and well-child care. One in five workers lacks coverage for routine mammography screening; nearly three of 10 aren't covered for routine Pap smears.

But the Clinton plan, by contrast, would cover all of these services.

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