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Clinton's Health Plan : Health Plan: A User's Guide : Californians Have Edge, but It's Still a Good News-Bad News Deal : Benefits: With about 6 million uninsured people, the state would gain considerably. However, some groups face higher costs for service.

September 26, 1993|DOUGLAS P. SHUIT | TIMES STAFF WRITER

Some Californians will clearly fare better than others under President Clinton's proposed health plan.

The plan is good news for many people not now covered by health insurance. But it is bad news for many of those covered now who might find they have to pay more.

Small employers who don't provide insurance to their employees figure to be hit hard, but many large employers will be helped.

The full extent of what the Clinton plan means for California won't be known for months. But enough of the plan has been released so far to give those familiar with the health system a good idea of what may be in store for the state.

California stands to benefit more than other states in at least one important respect: It has more uninsured than anywhere else--an estimated 6 million people--due in part to the state's sluggish economy that has put many people out of work.

"The sigh of relief here if the plan passes will be a little louder than anywhere else because we have more uninsured," said Drew Altman, president of the Henry J. Kaiser Foundation, which has done extensive polling and analysis of the health system.

Key groups of the uninsured in California include unemployed aerospace and defense industry workers and the thousands in the Hollywood movie industry who lack permanent jobs and the benefits that go with them.

Many unemployed aerospace and defense industry workers have been out of work so long that their transitional health benefits have run out. They would all be covered under the Clinton plan.

In the movie industry, workers could join large purchasing pools supported by contributions from employers. But many in the movie industry are uninsured because they jump from show to show, and job to job, sometimes with long, unemployed dry spells in between.

"Some of the studios provide health insurance, but the requirement can be that you have to work there six months. Since I never work anywhere that long, I never get insurance," said free-lance movie production coordinator David Craig, 29.

Expectations are high that the money following the newly insured would greatly improve the position of Southern California hospitals, who are considered to be in worse shape than their counterparts in other parts of the nation because of the uncompensated cost of serving the high number of uninsured patients. A recent study showed that in 1991, 57% of the hospitals in six Southern California counties lost money.

But while the uninsured and those who serve them are expected to gain, some Californians may have to pay more for insurance than they do now and may face disproportionately higher costs than other parts of the country.

One reason is that health costs here are higher than elsewhere, and the new insurance system is likely to reflect that. Southern California, for example, has the distinction of having more high-tech magnetic resonance imaging (MRI) equipment, which provides expensive diagnostic tests, than anywhere else in the country.

One group that could see higher fees are those currently in traditional fee-for-service indemnity plans that allow consumers to choose their own doctor and direct their own health care. The price of those plans could get steeper, in part because all of the economic incentives in the Clinton system are expected to be aimed at encouraging people into managed care plans.

The increases, when they come, could be in deductibles: the out-of-pocket expenses that consumers must make before their insurance kicks in.

Annual out-of-pocket deductibles of $1,500 for each individual and $3,000 per family are being mentioned now as caps.

But already insurance companies are warning that Clinton's plan to cap premiums--without comparable limits placed on the fees charged by doctors, hospitals and other health care providers--would create pressure to raise deductibles.

Those who may be in for the softest landing in the new system are persons already enrolled in some kind of managed care plan, like Kaiser. A third of Californians are enrolled in health maintenance organizations, compared to 16% nationwide.

While the rest of the nation is bracing for the new system and such wrenching decisions as whether to give up the family doctor in favor of the more impersonal health maintenance organizations, Californians have been there already. With 75% of the Californians who have health insurance already in some form of managed care, industry analysts say the system is particularly well suited for the state and its transient lifestyle.

"California is years ahead of the rest of the country," said Dr. Paul Ellwood, president of the Jackson Hole Group, a collective of health experts that played a big role in pushing the nation to managed care. "I don't see a change other than an acceleration of the changes already under way in California."

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