
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, April 30, 1993                   TAG: 9304300043
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-10   EDITION: METRO 
SOURCE: Knight-Ridder/Tribune
DATELINE: WASHINGTON                                LENGTH: Medium

PHASE-IN LIKELY FOR HEALTH PLAN

President Clinton's health reform program could easily take the rest of the decade to implement, with high-cost benefits such as universal coverage spread over many years.

Phasing in benefits would allow the administration to propose sweeping reform without a huge cost up front.

The president's package is expected to be a single, comprehensive bill. But after Congress passes it, individual elements would be phased in on different schedules.

Congressional tax analysts estimate health reform could require $40 billion to $100 billion a year in new taxes.

The administration has signaled unwillingness to impose big new taxes, such as a national sales tax. That means Clinton may take a pragmatic approach, with inexpensive reforms and cost controls coming first, and more costly benefits to be phased in slowly.

On the short-term agenda would be:

Insurance-purchasing co-ops, which the administration now calls "alliances," to let individuals and small and medium-sized businesses pool their purchasing power and get the lower insurance rates that big companies obtain.

Tax equity: letting self-employed people and small businesses deduct all of their health insurance premiums, as corporations do.

Clinton's long-run agenda would include the more expensive parts of his plan. One Democrat half-jokingly said it would not be finished until Vice President Al Gore's first term as president.

Among the long-term elements:

Universal coverage.

No final decision has been made, but an official said it could take four to seven years until all Americans have health insurance.

Requiring all employers to provide coverage. Clinton has promised tax credits for small businesses that provide coverage to their workers.

Community rating. Returning to a system where everybody in the same community pays the same for health insurance means rates will go up for younger, healthier people. Sudden premium increases would be unpopular, so the change is likely to be gradual.

Long-term care. Aside from the cost of providing long-term care, Clinton's emphasis on supporting home and community-based care means a fledgling industry will have to expand. For example, case managers have to be trained to coordinate services for homebound people. One official said it might take until 2010 to achieve full long-term care benefits.

by CNB