August 1993

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President's Message (Arlene Ellis) Planning & Zoning: Waterfront Plan Presented (Astrid Monson) Planning & Zoning: Convention Center (Astrid Monson) Hawaii State Constitution: A Reference Guide President's Plan is Effective Blueprint for Health Care Reform (Becky Cain) Highlight's of the Clinton Health Plan Activity of Education Committee - 1993 (Marion Saunders) Membership (Annie Kim)

Highlight's of the Clinton Health Plan New York Times September 11, 1993 All Americans and legal residents would be guaranteed a package of minimum benefits that would continue despite any illnesses or changes in employment. UNIVERSAL COVERAGE A range of services would be covered, including hospital care, emergency services, doctors and other health professionals, pregnancy-related services, hospice and home health care, ambulances, outpatient laboratory tests and prescription drugs. The Administration describes the coverage as equal to that offered by the nation's largest companies. A new long-term care program would be created for disabled people that would provide expanded home care services. Coverage of dental, eye and mental health care would be initially limited, but be expanded in 2000. Items considered not medically necessary, like cosmetic surgery, would not be covered. Free preventive care, including periodic medical exams, immunizations and screening procedures like mammograms, pap smears and reading of cholesterol levels would be provided in accordance with a schedule set by the Government. A Medicare benefit for prescription drugs would be created. Beneficiaries would pay 25 percent of the program through their Part B premium, a $250 deductible and 20 percent of the costs beyond that to an annual maximum of $1,000. A choice would be offered between enrollment in a traditional fee-for-service plan, a health maintenance organization or a plan that combines elements of each. Employers would be allowed to provide benefits that are more generous than the standard package, although after the year 2000 the extra benefits would be treated as taxable income for employees. Illegal immigrants would not be covered, although they would continue to be eligible for emergency and other services; institutions that serve many uncovered patients would continue to receive Federal reimbursement. HOW IT WOULD WORK: Most Americans would be enrolled in regional entities called health alliances, which would negotiate the price of coverage with health plans, offer a range of plans to members and collect premiums from employers and individuals. States would insure that alliances exist in areas where coverage would otherwise be insufficient. Companies with more than 5,000 employees would have the option of providing care to their workers by creating a corporate alliance and contracting directly with a health care provider. People now enrolled in Medicare would continue in that program, but could later join the regional alliances. States would have the option of integrating Medicare recipients into their alliances so long as their coverage is as good or better. Medicaid recipients would be enrolled in regional alliances and receive the standard package of benefits, as well as supplementary services. All Americans would be issued a national health identification card that would guarantee them access to needed services. WHO WOULD PAY: The average premium for the standard package would be $1,800 a year for individuals and $4,200 for families. Businesses would be required .to pay 80 percent of the average premium. Families and individuals would pay the difference between that amount and the full cost of the plan they select, meaning that those enrolled in cheaper plans would pay less, or more for plans more expensive than the average. Employers would have the option of paying more than 80 percent. The plan also suggests that a worker would be able to buy an average health policy for just $360 a year and a family policy for $840. The employer would pay four times that much. No business on a regional alliance would have to pay more than 7.9 percent of its payroll. Companies with fewer than 80 employees and those with many low-wage workers would be eligible for Government subsidies and for caps ranging from 3.5 percent to 7.9 percent of payroll, depending on their average wages. Families and individuals could pay their share of the premium directly or through withholding: alliances may require withholding to avoid bad debt. The self-employed and unemployed would be responsible for the entire amount of the premium, unless they were eligible for assistance based on income. Retired workers under 65 would be responsible for 20 percent of the premium. Employers would pay for part-time workers on a pro-rated basis. Out-of-pocket costs would depend on the kind of service chosen. Alliances would be required to offer high-cost, low-cost and combination plans. The terms appear to refer respectively to traditional fee-for-service coverage, HMO's and preferred provider networks. A high-cost plan would allow the use of any doctor but calls for deductibles of $200 an individual and $400 a family and 20 percent co-payment after that. In a low cost plan, the patient would see only doctors approved by the plan, but pay no deductible besides a $10-avisit fee for outpatient services. In the Combination plan, the patient would agree to pay 20 percent of the cost whenever using a doctor outside the plan. Out-of-pocket expenses are capped annually at $1,800 for each person and $3,000 for a family under all three plans. CONTROLLING COSTS A National Health Board would be created to oversee the system and set a national health budget with the goal of limiting the rate of increase of health care spending to that of the general rate of inflation by 1999. Health care expenses are now growing at more than twice the inflation rate. If the competitive process does not reduce growth to that level, the board would impose mandatory limits on the growth of annual premiums, forcing health plans to spend less. Upon introducing the plan, the President would urge all sectors of the health care industry to limit price and spending increases to a specific amount not yet disclosed. Prices and spending would be monitored by the Secretary of Health and Human Services. The National Health Board would make public declarations about the costs of new drugs and could investigate the costs of existing drugs it considers overpriced. It would have no authority to set drug prices. The rate of increase of Medicare and Medicaid would be reduced. WORKERS COMPENSATION The separate insurance systems that now exist to cover the costs of injuries suffered at work or in automobile accidents would be continued. But the care would be provided through the health alliances created under the plan through contracts between them and the insurers. TAKING EFFECT States could begin implementing the system by Jan. 1, 1995, and would be required to have it in place by Jan. 1, 1997.

August 1993

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