Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, October 28, 1993 TAG: 9310280124
SECTION: NATIONAL/INTERNATIONAL PAGE: A-14 EDITION: METRO
SOURCE: Los Angeles Times
DATELINE: WASHINGTON LENGTH: Long
Q: What will coverage cost the average American?
A: According to the administration's revised estimates, based on 1994 prices, the total premiums for average-priced coverage would be $4,360 for a two-parent family with children, $3,893 for a single-parent family, $3,865 for a couple and $1,932 for a single person. But each family or single individual would be required to pay no more than 20 percent of the premium, and no one would be asked to pay more than 3.9 percent of his annual income.
The average premium payment would amount to $73 per month for a two-parent family with children, $65 a month for a single-parent family, $64 a month for a couple and $32 a month for a single person. In addition, there would be some deductibles and copayments at the time of treatment, depending on the type of coverage selected. No deductible would exceed $200 a year for an individual and $400 for a family.
Q: What would my employer pay toward my health care coverage?
A: All employers would be required to pay at least 80 percent of the average worker's premium. But employers could choose to pay as much as 100 percent. The administration estimates that the annual cost to the employer, based on 1994 prices, would be $2,479 for any family with children, $2,125 for a couple without children and $1,546 for a single person. No business would be required to pay more than 7.9 percent of payroll for health insurance. Low-wage businesses with 75 or fewer employees would receive substantial government-subsidized discounts, depending on the size of the company and the average wage.
Q: What won't be covered by the basic benefit package?
A: Uncovered by the basic package is anything deemed by a doctor to be medically unnecessary, private hospital rooms, adult eyeglasses and contact lenses, hearing aids and cosmetic surgery. Initially, it also would not cover preventive dental care for adults or orthodontics. But those benefits would be phased in by the year 2001. Mental health and substance abuse benefits, which are limited at first, also would be expanded by 2001. Nothing would prevent Americans from buying these services themselves or purchasing supplemental insurance to cover them.
Q: What impact would this proposal have on Medicare recipients?
A: Current Medicare benefits would be maintained for persons over the age of 65. Beginning in 1996, a new home- and community-based care program would allow older Americans with severe disabilities to receive subsidied care at home, rather than going to a nursing home. Medicare recipients also will receive a new prescription drug benefit with a $250 annual individual deductible. Premiums for Part B insurance, which covers physician and outpatient services, will increase about $11 a month to finance 25 percent of the cost of the new drug benefit.
Q: How will the program treat workers who retire before age 65?
A: Workers who retire between the ages of 55 and 64 would be eligible for discounts based on income. No matter what their income, they would be required to pay no more than 20 percent of the premium. Employers who wish to help pay any or all of the retired employee's share of the cost of health insurance coverage would be able to do so. During the first three years, employers who save money because of this new benefit for early retirees would be required to return one-half of their savings to the government.
Q: How would the program affect part-time workers, self-employed workers and two-wage earner families?
A: Part-time workers would pay 20 percent of the average premium in their area if they enroll in an average-priced plan; their employers would pay a prorated share based on the hours worked pased, and government subsidies would be available to those with low incomes. Self-employed workers, who now get a tax deduction for 25 percent of the cost of their health care, would be permitted to deduct 100 percent and would be eligible for discounts if their income is low. Two-wage earner families will pay their share of the premium only once, but both of their employers would be required to pay the same amount they would pay for any similar worker.
Q: What impact will the program have on Medicaid beneficiaries?
A: Like all other Americans under age 65, Medicaid recipients would choose their coverage from the list of plans available through the regional health alliance. They could choose any plan at or under the average premium without making any additional payment. Those whose income is below 150 percent of the official poverty level would receive subsidies for copayments and deductibles. Supplemental services such as transportation to a doctor and vision care would continue to be available to those who are eligible.
Q: Will the program create a big, new bureaucracy?
A: The administration has scaled back on the regulatory powers of the proposed new government agencies - the regional health care alliances and the National Health Board. Clinton has stipulated that alliances could not reject qualified health plans from participating in the system unless their premiums exceed the average by more than 20 percent, nor could they limit the number of fee-for-services plans offered in the area. Once envisioned as an independent operating agency, the National Health Board now is being viewed as little more than an executive branch advisory committee.
Q: When would this plan go into effect?
A: The administration assumes that the system would be in place in many states by 1996, but it would not be available everywhere until the end of 1997.
by CNB