Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 25, 1995 TAG: 9506260117
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: EDWIN CHEN LOS ANGELES TIMES
DATELINE: WASHINGTON LENGTH: Medium
Instead, the opposite is happening.
States are sharply slowing or halting their reform efforts, with some even repealing the measures they had adopted.
Amid such reversals, the afflictions of the nation's $1 trillion-a-year health care system have only worsened - and once again are exerting pressure on Congress to act.
Despite the traumatic collapse last year of Clinton's top-to-bottom reform initiative, there are signs of movement on Capitol Hill. A few tenuous, narrow proposals are being advanced by Republican lawmakers, and Clinton weighed in last week with his own package of limited reforms.
A record 41 million Americans, predominantly women and children, are uninsured. Six consecutive annual declines in the percentage of Americans with employer-based coverage has fed the trend while medical costs continue to rise at more than double the rate of inflation.
``The two big problems that put this issue on the agenda in the first place - the uninsured and rising health care costs - are still here,'' said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy in California.
Moreover, if the economy slows dramatically, as many believe is beginning to happening, those problems could accelerate.
The scenario has dashed the hopes of politicians who thought six months ago that a combination of state initiatives and private-sector cost-containment measures would take the pressure off Washington to find cures.
Now there is a growing realization among the Republican majority that Congress must devise reforms that transcend the GOP plan to make steep cuts in the rate of growth in Medicare and Medicaid.
``There are a number of things wrong in the private sector that need to be fixed,'' conceded Sen. Robert Bennett, R-Utah, a former business executive who heads the Senate GOP task force on health care.
For all the rush to return power to the states, he said, it is Congress that must come up with federal solutions to health care problems.
A central reason for the demise of statehouse-inspired health care reforms is skepticism about government's ability to dictate sweeping reforms in what is one-seventh of the economy.
Richard Merritt, director of George Washington University's intergovernmental health policy project, said the GOP sweep in November's elections tilted many statehouses that way.
``Legislatures now in session are much more conservative, much more market-oriented and much more anti-government,'' he said.
A second reason is the growing reluctance on the part of fiscally conservative lawmakers to expand coverage at a time of growing budgetary pressures. ``What we're seeing is the implementation of the popular will,'' said Uwe E. Reinhardt, a Princeton University professor of political economy.
Also, evidence suggests some reforms have fallen short of expectations, notably the savings from channeling Medicaid patients into managed-care networks.
In Florida, Democratic Gov. Lawton Chiles' Health Security Act is said to be ``dead on arrival'' now that the GOP has taken control of the state Senate. Contributing to its demise are studies indicating that pushing Medicaid recipients into managed care will not produce the estimated $3.2 billion in savings needed over five years to subsidize coverage for low-income workers, according to State Health Notes, a newsletter edited by Merritt.
``We expected a 15 percent reduction in costs. We had a 6 percent increase,'' state Sen. John McKay, a Republican, told the publication. ``So the basis of the governor's plan is moot.''
The most notable setback occurred last month in Washington state, where veto-proof majorities in both houses of the Legislature repealed the Health Services Act, which had been approved in 1993 amid much hoopla and expectation of national reforms.
The plan resembled Clinton's, complete with a standard benefits package, government authority to set insurance prices, consumer purchasing cooperatives and a requirement for employers to pay at least 50 percent of the cost of workers' health coverage.
A major factor in the demise of health care reform in Washington state is the 1974 federal Employee Retirement Income Security Act, or ERISA, which looms as an all-but-insurmountable barrier to most state initiatives. The law bars states from regulating health plans set up by the growing number of self-insured companies.
Even though state initiatives assumed new importance last fall after the death of Clinton's agenda, Congress adjourned without granting any states an ERISA waiver.
A Wall Street Journal/NBC News poll found last week that Americans rank health care reform as the most important of six legislative priorities. The poll said 45 percent wanted health care reform, up from 29 percent just five months ago, while 38 percent cited a balanced federal budget.
by CNB