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Clinton's Health Plan : Health Plan: A User's Guide : Reform Will Affect All Americans : PREMIUM COVERAGE : My biggest fear is I would lose my job'

September 26, 1993|LESLIE BERKMAN

Next month, James F. Gominsky will mark his 21st anniversary at First American Title Insurance Co. in Santa Ana, where he feels fortunate to have risen to assistant vice president with an annual salary of $90,000.

Gominsky, who will turn 40 this week, feels even luckier to have a generous medical insurance plan, underwritten by the company, that for the last 15 years has enabled him to fight off cancer with multiple surgeries, radiation and chemotherapy.

President Clinton's proposed minimum health care package would take from Gominsky the complete freedom he enjoys today to go to the specialists of his choice to treat his life-threatening condition.

In return, he would pay somewhat less--and, more important for a professional like Gominsky, he would be able to switch jobs without losing his health insurance. Under today's system of employer-based health insurance, cancer has sharply narrowed Gominsky's professional horizons. If he left First American, thus forfeiting the company's self-provided insurance plan, no one else would insure him because his medical costs--an estimated $26,000 last year--are guaranteed to exceed any premium he could reasonably be asked to pay.

"One of the reasons I didn't jump ship was because of the medical insurance," he said.

Gominsky's current health plan pays 80% of most of his family's medical and dental bills after a $200 per-person annual deductible for medical costs and $25 per person for dental expenses. First American withholds $105 from his paycheck each month for medical and dental coverage not only for him but also for his wife, Eleanor, and his 12-year-old son Jim Jr.

Gominsky is his family's principal user of health care services. He has had a cancerous foot amputated. He has had one tumor removed from his groin, another from his chest. Cancer has claimed his gallbladder, which was removed, and in August he had two tumors cut from his neck.

He has also sustained several injuries playing sports with his artificial foot. Last year, when he was playing basketball, he fell on a finger and tore a ligament that required surgery costing about $1,700.

Gominsky is grateful that his family's medical costs came to only about $4,500 last year. If he didn't have insurance, he figures he would have spent $26,000.

The hospital bill alone for the most recent neck surgery tallied $2,639, in addition to a charge of about $800 for a CAT scan and $130 for laboratory work. He is still waiting for the surgeon's bill. Doctors say that Gominsky must now be screened for cancer four times a year with the expensive high-tech CAT scan.

Under the President's plan, Gominsky's employer, because it has more than 5,000 workers on its payroll, could continue providing its workers with a choice of health insurance plans of its own selection. Most big employers want to continue their own plans, at least for the immediate future.

Under Clinton's plan, First American and other big firms would be required to offer their employees a choice of health plans: an HMO; a less formal network of independent doctors and hospitals, and a traditional fee-for-service plan in which patients may be treated by the doctor or hospital of their choice.

The Administration estimates that the average premium for family coverage through an HMO would be about $4,200 a year. The employee's share would be 20%, or $840; the employer would pick up the rest.

The fee-for-service option, while more expensive, would probably cost no more than the $1,260 he pays toward his insurance now. Gominsky's costs would depend on whether First American decided to pay only the minimum 80% of his premium or voluntarily contributed more.

Like Gominsky's current plan, the high option plan under the Clinton program would require him to pay 20% of all costs of outpatient visits to a doctor. But unlike his current plan, it would limit his out-of-pocket costs to $3,000 a year, compared with the $4,500 he paid last year.

While his current plan covers the full cost of hospital emergency room care, his new one could require a 20% coinsurance for hospital visits. He paid nothing recently when he got a hairline fracture in his hand while playing racquetball and needed $357 in emergency medical treatment and $132 in X-rays. Under Clinton's plan, the cost would be close to $100.

Gominsky said he would not mind paying somewhat more under the Clinton plan for a fee-for-service plan that would let him stick with the specialists who have treated him in the past, rather than choosing a less costly HMO option that might require him to change physicians. He feels comfortable with the ones who know him and his medical history.

But there are limits on how much he can afford to pay for choice, he added. "It would be very hard for me to leave the doctors I have and I would be willing to pay maybe as much as $1,000 a year to retain that relationship. But not much more," he said.

Gominsky said First American "is like a small family. They take care of us." But he said the recession and real estate slump have taken a toll on the company's business, forcing cycles of employee layoffs and rehirings.

If nothing else, the Clinton plan would bring him peace of mind.

"My biggest fear is somehow I would lose my job and be out in the cold," he said. "I believe with my skills I could easily find another employer somewhere, but I couldn't find more insurance."

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