Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, September 23, 1993 TAG: 9309230164
SECTION: NATIONAL/INTERNATIONAL PAGE: A-13 EDITION: METRO
SOURCE: The Washington Post
DATELINE: WASHINGTON LENGTH: Long
\ When will all this begin to affect me?
Not any time soon. President Clinton will send Congress a detailed legislative proposal next month, which the lawmakers then will debate. There are competing plans offered by Republicans and conservative Democrats as well as by lawmakers who prefer a Canadian-style government-financed plan. These competing interests must all be resolved, so that next year is the earliest that anything could be expected to happen.
Keep in mind, though, that many large employers already are adopting policies that resemble parts of the Clinton proposal, so your own health insurance may change without any congressional action.
\ Let's assume that the Clinton plan becomes law. Basically, how would it work?
In some ways, the program would resemble the federal employees health care system, with health plans within the separate regions competing for patients, and with workers choosing a plan once each year during an enrollment period.
Regional "health alliances" would be formed to purchase health care services from health maintenance organizations (HMOs) and other companies that in turn contract with doctors, hospitals and other providers. Americans, other than those on Medicare and a few other groups, such as military personnel, would be eligible to choose a health care plan offered by their alliance. The health care plan must provide a standard set of benefits.
The alliances would offer several types of plans, typically including one or more HMO-like plans, traditional fee-for-service plans and some hybrids of the two. You would be able to choose one, based on your preference.
Employers would make payments to the regional alliance on behalf of their workers equal to at least 80 percent of the average cost of a premium. Workers would pay up to 20 percent.
Americans would receive a health security card, which would serve as proof of eligibility for coverage.
\ Now, when I need health care, I go to my doctor, he treats me and I submit the bill to my insurance company. Under the Clinton plan, what would I do?
That would depend on what kind of plan you choose from your regional or corporate alliance. With an HMO-type plan, you might simply pay a "co-pay" of $10 for the office visit and nothing more. With a fee-for-service plan, you probably would have to pay a deductible and a portion of the doctor's bill beyond that. As for forms, there would be far fewer, and much of the information would be handled electronically.
\ I work for a large company that has workers here and in other parts of the country. How is my health insurance going to change?
It depends on how large your company is. The plan distinguishes between very large companies and others. Very large companies - those employing 5,000 or more workers - would have the option of purchasing health care for their workers on their own in what would be called "corporate alliances." Workers at other companies would join regional alliances. Some big companies might choose not to form a corporate alliance but instead allow its workers to obtain care through the regional alliance. But in either case, the choices are expected to be similar.
\ Suppose I am transferred to another office in a different part of the country? What happens then?
If you are in a corporate alliance, you would continue to get care through the plans offered by it. If you are in a regional alliance, you would join a plan offered by the regional alliance in the new area. There would be no restrictions on your ability to join, nor would there be a waiting period. Also, you would pay the same premium that everyone else in that plan pays; the plan could not make you pay more if you are already sick.
\ My company now provides excellent benefits and pays most of the premium. Would I pay more under the Clinton plan? Would my benefits be reduced?
That depends to a large extent on your employer.
Benefits experts say that generally if you work for a large employer, you probably would get to keep the benefits you have now, with the company paying some or all of the extra cost. Ten years after the program becomes law, though, you would have to pay income tax on the portion of those benefits that exceeded what is in the standard package.
Employers would be allowed, though not required, to pay more than 80 percent of the premium, so that if your employer is paying more than 80 percent now, it can continue doing so. Some employers may decide to cut back to 80 percent, though.
One important point: Currently the law allows employees to pay a portion of health insurance premiums and medical costs with pretax dollars through a flexible benefits plan. That would be repealed, and all out-of-pocket expenses would be paid by workers with after-tax dollars, making them more expensive for people whose employers have offered this pretax option.
\ I work for a small company that does not now provide health care coverage. What happens to me?
You would be eligible to get coverage under the regional alliance, and the plan would require your employer to contribute 80 percent of the cost of the average standard benefits package. The good news is that you would have health insurance. The bad news is that you would now be paying a portion of the premium - an expense you didn't have before.
\ I work for a small company that doesn't provide health insurance, but I am covered under my spouse's policy at a bigger company. What happens to me? What about our kids, who are now on my spouse's plan?
In most cases your entire family would get its care through the regional alliance. Your employer and your spouse's employer would divide the cost based on a formula specified in the Clinton proposal.
However, if one of you worked for a company with more than 5,000 workers, your family could get its care through one of the corporate alliance's plans. In that case, your spouse's employer would make its payment to the corporate alliance.
\ I had surgery for cancer last year. I've been covered by my employer, but I'd like to take a job with a small computer company. Will I be able to get coverage?
Yes. You can't be denied coverage and you can't be charged more for coverage because you have a preexisting condition. In addition, there would be no lifetime limit on your benefits.
by CNB