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Clinton's Health Plan : Health Plan: A User's Guide : Reform Will Affect All Americans : FAMILY IN AN HMO : 'It makes going to the doctor as painless as possible. . . . '

September 26, 1993|JAMES M. GOMEZ

Kevin Hanly was on the road on business three months ago when he received a frantic phone call from his wife: One of their six boys had split his head open with a golf club during a church picnic.

Hanly rushed back to his Mission Viejo home. But before he arrived, not only had 7-year-old Kevin's head been properly patched up, but the bills had already been handled by PacifiCare Health Systems, the Cypress-based health maintenance organization to which Hanly and his family belong.

"It took care of everything," said Hanly, who makes about $60,000 a year as a supervisor with McGaw Inc. of Irvine, a manufacturer of medical equipment.

For the Hanlys, as for many families in Southern California, HMOs are security blankets that provide medical care for relatively low cost and with relatively little paperwork.

And under President Clinton's health plan, many more Californians could have HMOs in their future. Clinton's plan, by providing fixed amounts to cover the basic health care needs of all Americans, would encourage people to join HMOs.

For the Hanlys and others already in HMOs, Clinton's plan would have only a modest impact. They now pay PacifiCare Health Systems a flat annual fee of $1,320; under the Clinton program, a typical family plan would cost $840. But each Hanly family member's visit to a doctor's office, now priced at $5, could cost $10.

For the Hanlys, the service delivered by PacifiCare has been good but not ideal.

PacifiCare's drawback, Hanly said, is typical of HMOs: Sometimes medical care is not always administered as quickly as he would like. Once, Hanly said, his son was bounced between the HMO's clinic and its emergency room by administrators who were not sure where he should be treated.

More often than not, however, the Hanlys are satisfied with what they get. Someone in the family needs medical care at a rate of at least twice a month. And this is bumps-and-bruises season for the Hanly boys: 14-year-old Josiah is a freshman football player at Trabuco High School, and 12-year-old twins Jacob and Jared, 10-year-old Adam and 7-year-old twins Kevin and Kaleb are enrolled in after-school soccer leagues.

At $5 a visit, medical care is affordable. "They (the HMO doctors) will see a lot of her," Hanly said, referring to his wife, Teresa.

It wasn't always that way for the Hanly family. While serving his apprenticeship as a plastic injection molder in Ft. Collins, Colo., Hanly was enrolled in a so-called indemnity or fee-for-service plan that paid for 80% of his medical bills.

Yet even at that, he estimates he paid $2,000 for his first son's birth and a whopping $7,000 for his first set of twins. The tab for his fourth son was $3,000.

But Kevin and Kaleb were delivered by a doctor in his HMO. The cost for that delivery was $300.

"What the HMO does for me is that it makes going to the doctor as painless as possible in terms of my budget," Hanly said, whose job is to oversee the manufacture of McGaw's bio-degradable intravenous solution bags.

In addition to the $110-a-month fee that he pays PacifiCare, he estimates that he spends an average of $30 a month for drugs and visits to the HMO's clinic. Hospitalization at Mission Hospital Regional Medical Center in Mission Viejo is fully covered by the plan.

"If I had all the money in the world, I could buy a the best doctors in the world," Hanly said. "But the doctors I see are very good. The HMOs fill the needs of people like me."

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