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Health Interest Groups Not Sure How to Respond to Clinton Plan : Medicine: Most can find things to support and oppose. They intend to bide their time till final details are released by the White House next week.


WASHINGTON — For key health policy-makers in the nation's capital, the insurance industry intends to run this message in newspapers over the weekend: "Surprise!" it proclaims, announcing that the insurance industry supports a dozen elements in President Clinton's plan and only opposes three.

For the average American living outside Washington, however, the message from the same industry on television ads is very different: "Things are going to change and not all for the better," an announcer intones after a husband and wife, poring over a stack of bills on their kitchen table, lament the changes in their coverage under health reform.

Therein is the paradox: Unlike virtually every other major bill that comes before Congress--where one interest group is happy, while another is unhappy--the health reform proposal that has been circulating in recent days appears to be making everyone of interest both happy and unhappy.

And, as the dual ads from the Health Insurance Assn. of America suggest, they are somewhat befuddled about how best to respond.

"There's never been a process like this one on a major piece of legislation," Charles N. Kahn III, executive vice president of the insurance group, said Monday. "No one really knows yet what the rules are. That's why we're doing ads that argue both what we're for and what we're against. We want to let the policy-makers know we're willing to work with them--but we still want to raise some doubts with the general public."

Numerous other organizations with a stake in the outcome of the reform effort have reacted similarly:

* The Pharmaceutical Manufacturers Assn., for example, which represents the drug industry, says it is pleased that prescription drugs will be covered but angry that the Administration intends to attempt to curb prices by forcing companies to pay rebates to the federal government based on the difference between the lowest and highest prices that are charged.

* The American Assn. of Retired Persons, which lobbies in behalf of older Americans, applauds the inclusion of long-term care and prescription drugs as benefits but is nervous about the plan to use savings from Medicare spending as a financing mechanism, afraid that doctors and hospitals, faced with more stringent restrictions on their payments from the government, will start turning away Medicare beneficiaries.

* The American Medical Assn., which represents many of the nation's physicians, says it likes numerous aspects of the proposal, including the basic benefits package, but dislikes the professional liability and antitrust reforms, saying they don't go far enough.

Most groups said Monday that they intend to bide their time until the final details are released next week and will save their biggest push for Congress, where the ultimate decisions will be made--and just in time for the elections, they noted.

"We met this past week at a three-day retreat, not just to talk about health but about all issues concerning us, and decided one way to have some influence is to get some of our people to start running for office," said Terry Hill, a spokesman for the National Federation of Independent Business, a trade group representing many of the nation's small businesses.

The group opposes Clinton's plan to require all employers to provide health insurance for their workers--but says it wants to find some non-mandatory way of bringing the uninsured into the system.

Getting proponents of small business to run for Congress, "will be a major focus for us in the long haul," Hill added. "Too many people in Congress do not know how to meet a payroll or run a small business."

Rick Wade, a spokesman for the American Hospital Assn., said that his organization supports about 70% of the proposal "and we will support it strongly," but "we're ending up where everyone else is ending up--which is that there are some areas of disagreement."

Kahn, of the insurance industry, said he also is disturbed by the concept of regional purchasing alliances, which will negotiate with networks of doctors and hospitals on behalf of consumers, and the potential premium caps. He called these "life or death issues" for his industry. He said he fears the creation of another bureaucracy.

Still, he said, "if you look down at the ethical underpinnings of the plan, we basically agree with everything that's in there."

Times staff writer Edwin Chen contributed to this story.


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