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Clinton Promises Sweeping Coverage in Health Care Plan : Medicine: Draft of measure requires insurance payments from most citizens, employers. People would use national health security card for services.


WASHINGTON — In his ambitious national health care reform plan, President Clinton promises all Americans a lifetime of affordable medical coverage under a redesigned system that requires an insurance premium payment from virtually every citizen and employer.

According to a 239-page draft of the proposed American Health Security Act, a copy of which was obtained Friday by The Times, Clinton would revamp the current health care system by eliminating various discriminatory insurance-market practices and organizing consumers into vast "alliances," set up and supervised by each state, to shop for the best insurance plans on behalf of their members.

Clinton's agenda leaves the states plenty of flexibility to implement their own reform measures under a national framework. But it also retains for Washington a strong role as overseer, allowing the federal government to take over for any state that fails to meet strict federal standards.

For the first time in U.S. history, the federal government will set a basic standard for health insurance, insisting that all Americans have comprehensive coverage for doctor and hospital bills, mental health care and prescription drugs. No one could be denied coverage because of a particular occupation or because of a pre-existing condition. Each person would receive a national health security card, much like an automated teller machine card, that could be used at a hospital or doctor's office.

The President's plan proposes a "sin tax," on cigarettes and perhaps some alcoholic beverages to help pay for the plan. Otherwise, the primary source of money for covering 37 million now-uninsured Americans is company- and worker-paid premiums and projected savings, primarily from caps on the growth of the government's Medicaid and Medicare programs--savings that some liberals in Congress and many economists say may not be realistic.

The Clinton plan goes a long way toward achieving universal coverage by requiring all employers and workers to contribute toward health insurance premiums. Businesses would pay a levy ranging from 3.5% to 7.9% of payroll, and employees would pay as much as 1.9% of their paychecks in premiums.

Contributions would be required from a large number of the uninsured, 85% of whom are employed, First Lady Hillary Rodham Clinton noted in a speech Friday.

Subsidies would be provided for low-wage earners and small businesses with fewer than 50 employees, and the government would pay for coverage of the indigent and the unemployed.

Under Clinton's plan, illegal immigrant workers would not be guaranteed coverage, but they and their employers would be required by law to contribute health insurance premiums. Such a provision would entitle the illegal immigrants to join the consumer alliances and choose from an array of health plans. The insurance-purchasing alliances are prohibited from reporting such workers to the Immigration and Naturalization Service.

"If they work for an employer, they and their employer have to pay," said Kevin Anderson, a White House spokesman on health care issues.

"It's just like Social Security. There are plenty of undocumented workers paying Social Security taxes. But if they lose their jobs, health care coverage is not guaranteed them," he said.

A major change consumers would experience by Jan. 1, 1995--if Clinton has his way--is the arrival of a uniform insurance claim form: one for institutions, another for doctors and other non-institutional providers, one for dental services and one for prescription drugs. Now, virtually every one of the nation's 1,500 insurers uses a different form.

"This system is an American solution to an American problem," Hillary Clinton said Friday as she made a spirited pitch for the plan in a morning speech to state legislative leaders meeting in Washington.

"This is a moment in history which we have to seize in order to take care of ourselves," she said.

In seeking to restructure one-seventh of the U.S. economy, Clinton's plan would affect the way virtually every American receives and pays for health care.

The plan aims to achieve savings by encouraging the vast majority of Americans to move from traditional fee-for-service care to health care networks, which attempt to control costs through strict limits on payments to doctors and hospitals. Typically, they require approval from a "gatekeeper" doctor before a person can consult a specialist.

Clinton's planners hope that tough measures can control the soaring growth in health care costs, which have been expanding at a rate of 10% a year, far faster than the nation's overall economic growth. The goal is to bring the inflation rate in health care down to a manageable 4%.

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