Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, April 15, 1993 TAG: 9304150184
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Long
`HEALTH CARD' PLAN OUTLINED A2 A1 HEALTH HEALTH
As Bill Clinton sees it, one day every American will carry a "health security card" that guarantees each person the same basic set of medical benefits.Ideally, it won't matter who people work for or whether they have jobs. It won't matter if they're elderly and sick or young and healthy. It won't matter if they're rich or poor.
Clinton knows what he wants.
The hard part is figuring out how to write such dramatic change into law, how to overcome political and institutional opposition, and how to pay for it.
Many key questions remain to be resolved before the plan is unveiled in May, but after months of toil the framework is taking shape. Here are the broad outlines of how the plan is likely to work, according to those involved in the planning:
Q: I have health insurance through my job now. How will that change?
A: Your employer would have to offer insurance for you and your family, but the coverage and charges might well differ from what you have now. You probably would be able to choose among several plans offered by your employer and through a local health purchasing alliance.
Q: What will the plans cover?
A: All insurers would have to cover a set of basic benefits to be spelled out by law. Aides say the benefits likely would be toward the top range of what typical health plans now offer, and probably would include some preventive medical services not now covered.
Q: What if I get seriously ill or have a chronic medical condition? Could insurers drop me, refuse to cover me or charge me extra?
A: Insurers would not be able to turn you away because of ill health or a pre-existing medical condition. In addition, the administration is considering a "community rating" system under which everyone in a given area would pay the same amount for coverage, regardless of their health status. There might be some difference in charges based on age.
Q: Who will pay for my coverage?
A: Employers would have to pick up the bulk of the tab, probably 80 percent, for the basic benefits coverage. You would pay whatever was left of the premium, probably plus deductibles and some co-payments.
Q: Will everyone have to have health insurance?
A: No, that would be unconstitutional. But every American who wants insurance would be able to get it either through their employers, purchasing their own coverage or obtaining government-subsidized policies.
Q: What about coverage for long-term care services at home or in nursing homes?
A: The basic benefits package is likely to contain some modest provisions for long-term care, probably stressing home and community-based services.
Q: What about coverage of mental health and substance abuse services?
A: The administration plans to include coverage of both in the basic benefits package, aiming to put coverage of mental illnesses on a par with that of physical ailments.
Q: Will elective abortions be covered?
A: Clinton said a day after his inauguration he wanted the package to provide "access to quality, affordable health care - including abortion services."
Q: Can I keep my own doctor?
A: Yes, but it may cost extra. Clinton is expected to encourage people to follow their primary doctor into a health plan that the physician links up with, so there would be no extra cost.
Most health plans would offer networks of certain doctors who treat patients for a flat annual fee, much like existing health maintenance organizations. But there also would be "fee-for-service" plans available that allow people to see specific doctors, who would be reimbursed separately for each service and visit.
Q: Why would that cost more?
A: Because doctors who get a fixed amount for each patient have an incentive to hold down costs, while "fee-for-service" plans encourage doctors to see patients more often, do more tests and perform more procedures so they can make more money.
Q: What about employers who can't afford to offer health insurance, such as small businesses?
A: All employers, including small businesses, would have to offer coverage. Small companies would be able to join big insurance purchasing pools with more power to bargain for lower costs. Also, small businesses would be eligible for extra financial help to cover their employees.
Q: What about low-income families and the unemployed?
A: People who couldn't afford health insurance would be eligible for government subsidies to help pay their premiums and other out-of-pocket costs.
Q: What about Medicare, the federal system that covers health care for the elderly?
A: People now on Medicare would continue to get the same benefits in the same way. Clinton hasn't decided whether to eventually integrate new Medicare recipients into the broader system.
Q: How would Clinton's plan control skyrocketing medical costs?
A: The competition created by big purchasing networks is supposed to drive down costs. Also, the administration is considering state-by-state limits on overall public and private spending for health care. Clinton also has pledged to reduce wasteful administrative spending, reams of insurance paperwork, and unnecessary medical procedures.
Q: How would the government get the money to cover the 37 million people who are uninsured?
One likely source is higher taxes on tobacco. There also has been talk of taxing health-care benefits. Another option is a national sales tax, or so-called value-added tax.
Q: What's the downside?
A: There is lots of nervousness about how the changes will affect various people and interest groups. Some critics question whether the plan will produce the savings it anticipates; small businesses worry that new insurance costs will drive them out of business; some individuals wonder if their costs will go up while their choices go down; and doctors and other medical interests oppose cost controls and worry that new government regulations will crimp their freedom in treating patients.
Q: If the plan gets approved by Congress, when would the new system be in place?
A: It will take years to make all the changes Clinton envisions, but he hopes to extend coverage to the uninsured during his first term.