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

DATE: WEDNESDAY, August 17, 1994                   TAG: 9409290002
SECTION: EDITORIAL                    PAGE: A11   EDITION: METRO 
SOURCE: JOHN J. SWEENEY
DATELINE:                                 LENGTH: Medium

HEALTH-CARE REFORM

NOW THAT the Clinton health-care plan has been officially declared too much, opponents of reform in the House and Senate are competing to see who can come up with less - less coverage, less participation by employers, less supposed government bureaucracy, less urgency. The tragedy is that with health-care reform, less guarantees more - more shifting of out-of-control costs, more uninsured, and more money out of the pockets of middle-income workers and their families.

Most of the alternatives being discussed include insurance reform guaranteeing everyone ``access'' to coverage, as well as premium subsidies for very-low-income families. Some require employers to pay 50 percent of premiums, others require employers to pay for insurance only if coverage targets aren't reached over a period of time.

For upper-income Americans who can afford to buy insurance, no matter what it costs, and for families below the poverty level who would receive 100 percent subsidies, questions of how much and when may be meaningless. But for working families, the voluntary, partial and incremental approaches being discussed will amount to a national purse-snatching.

When the Congressional Budget Office studied one of the more popular voluntary plans, it found that insurance reforms and subsidies backfire without full employer participation. At least 25 million families would remain uninsured, two-thirds of them headed by working people making between $15,000 and $50,000 a year. Why? Guaranteeing access doesn't make coverage more affordable. In fact, the effect may be just the opposite because low-risk Americans would forgo buying insurance until they became ill, skewing the coverage pool and forcing insurance companies to raise premiums overall to cover high-risk purchasers. Under the CBO study, a single parent earning $25,280 would end up having to pay $5,000 per year for full family coverage.

The CBO predicts further anomalies. Employers of lower-wage workers eligible for partial subsidies may well drop their insurance coverage, using the subsidies available as an excuse. Overall federal outlays for subsidies then would increase. Most of the subsidy proposals being considered also amount to a penalty on work - they decrease as wages rise above poverty level, but remain far below what would be necessary to buy insurance.

The experience of New York state with an experimental ``voluntary'' insurance system reveals more flaws in the concept. Insurers are required to take all comers under a community rating system - that is, pre-existing conditions exclusions are prohibited. Consequently, low users, mostly the young and healthy, have dropped their insurance coverage because they know they can get back in. Individual and small-group coverage actually fell by more than 25,000 last year. Because the people remaining in the pool are less healthy, premiums are up 30 to 40 percent, and middle-income New Yorkers therefore are being subjected to a hidden tax that is quite involuntary.

Can we delay implementation? A recent paper released by Sens. Tom Daschle, D-S.D., and Jay Rockefeller, D-W.Va., documents the high cost involved. If current trends continue unchecked, by the year 2000 Virginia will have 617,229 members of working families with no health insurance, 139,645 of them children. Virginia businesses currently offering health insurance will be paying $354 million more per year in premiums. An estimated 54,000 citizens of this state will be losing their health insurance each month. And Virginia will be paying $659 million more per year in health-care costs.

Can we afford less than universal coverage? Without everybody under the tent, controlling health-care costs will be impossible. People who don't have health insurance go to expensive emergency rooms when they get sick. Usually, they are critically ill when they are admitted and they become more expensive patients. When the hospitals can't collect, they raise charges on insured patients - middle-class workers and their families who already are paying 10 to 30 percent of their premiums to cover the cost of uncompensated care.

Under any health-care reform plan without universal coverage and full employer participation to pay for it, the poor will be subsidized, the rich will be able to pay and only this nation's huge middle class of working men and women will get whacked ... again.

John J. Sweeney is president of the million-member Service Employees International Union and also chairs the AFL-CIO's health-care committee.

by CNB