Current Shareware 1994 January/SHAR194.ISO/textfile/hplan93.zip/10PGR.TXT

Text File | 1993-09-22 | 26KB | 497 lines

                     THE HEALTH SECURITY ACT OF 1993
                      Health Care That's Always There

 Every American citizen will receive a Health Security Card that
 guarantees you a comprehensive package of benefits that can never
 be taken away.

 Guaranteeing comprehensive benefits that can never be taken away.
 Controlling health care costs for consumers, business and our nation.
 Improving the quality of American health care.  Increasing choices for
 consumers. Reducing paperwork and simplifying the system.  Making
 everyone responsible for health care.  These are the principles of the
 Health Security Act of 1993 and they are not negotiable.

 In America, rights and responsibilities go hand-in-hand.  We will ask
 everybody to pay something, even if your contribution is small.
 Everyone must assume responsibility.  No one should get a free ride.

 Most important, we're going to offer new opportunities and new
 incentives for people to stay healthy -- and to treat small problems
 before they become big ones.  Our goal should be to keep people
 healthy, not treat them after they become sick.

               What's Wrong With the Current System

 The things that are wrong with our health care system are threatening
 everything that's right with American health care.

 *    Over the next two years, one out of four of us will be without
      health coverage at some point.  Change jobs, lose your job, or
      move -- and your insurance company is currently allowed to drop
      you.

 *    Today's system is rigged against families and small businesses.
      Insurance companies pick and choose whom they cover.  Then they
      drop you when you get sick.  If you have a pre-existing condition,
      you usually can't get any insurance at all.

 *    Insurance companies charge small businesses as much as 35% more than
      the big guys.

 *    Only 3 of every 10 employers with fewer than 500 employees offer any
      choice of health plan.  Millions of Americans have almost no choice
      today.

 *    Twenty-five cents out of every dollar on a hospital bill goes to
      bureaucracy and paperwork -- not patient care.

 *    Fraud and abuse are exploding, costing us at least $80 billion a
      year.  That's a dime of every dollar we spend on health care.

 *    Our nation's health costs have nearly quadrupled since 1980.
      Without reform, by the year 2000, one of every five dollars
      we spend will go to health care.

                           The Health Security Plan

 Every American citizen and legal resident will receive a Health
 Security Card.  Once you get your card, you can never lose your
 health coverage -- no matter what. If you get sick, you're covered.
 If you change jobs, you're covered. If you lose your job, you're
 covered. If you move, you're covered. If you have the courage to
 start a small business, you're covered.

 Your Health Security card guarantees you a comprehensive package of
 benefits that can never be taken away.  The package is as comprehensive
 as the ones that many Fortune 500 companies offer their employees. And
 in critical ways -- like paying for preventive care and prescription
 drugs -- the package gives you more than big companies provide today.

 You will be able to choose your doctor. Everyone will have a choice of
 health plans.  You'll be able to follow your doctors and nurses into a
 traditional fee-for-service plan, join a network of doctors and
 hospitals, or join an HMO.  Your boss or insurance company won't decide
 how or where or from whom you get your care -- you will.

 Almost everybody will be able to sign up for a health plan at work,
 like you do today.  You'll get brochures that give you
 easy-to-understand information on several health plans -- which doctors
 and hospitals are included, an evaluation of the quality of care, a
 consumer satisfaction survey, and prices. If you're self-employed or
 unemployed, you can sign up at your area health alliance, which will
 be run by consumers and businesses and bargain for affordable health
 care for you.

 The federal government will set up a national health board -- a board
 of directors to set standards and make sure you get the comprehensive
 benefits and quality care you deserve. State governments will set up
 health alliances give consumers and small businesses the power to buy
 affordable care; and the businesses with 5,000 or more employees will
 be allowed to operate as "corporate alliances."

 Insurance companies will be required to use a single claim form to
 replace the thousands of different forms they have today. So when you
 get sick, you won't be buried in forms -- and neither will your
 nurse, your doctor or your hospital.

 *    Security of guaranteed, comprehensive benefits.
 *    Health care costs that are under control.
 *    Improved quality of care.
 *    Increased choices for consumers.
 *    Less paperwork and a simpler system.
 *    Responsibility from everyone.

                That's what the Health Security Act is all about.

 Principle #1:
 Security: Guaranteed, comprehensive benefits.

 Over the next two years, one of every four of us will lose health
 coverage for some time. The Clinton plan guarantees that you will
 never lose your insurance -- no matter what. All Americans will
 receive a Health Security card that guarantees you a benefits package
 that is as comprehensive as those offered by most Fortune 500
 companies...and then some. Here's how the plan guarantees security:

 *    Makes it illegal for insurance companies to deny you coverage
      because of "pre-existing conditions." The Health Security Act also
      makes it illegal for insurers to raise your premiums or drop you
      because you get sick. All health plans will be required to accept
      anyone who applies -- healthy or sick, young or old.

 *    Guarantees coverage if you lose your job. The proposal guarantees
      that you will keep your health coverage even if you lose your job,
      with the employer portion picked up by Federal revenues and
      savings. Under the current system, if you lose your job, you lose
      your health insurance.

 *    Guarantees coverage if you switch jobs, move or start a small
      business.  You will always be protected -- no matter what. Today,
      if you switch jobs, move or start a small business, you can find
      yourself without health insurance -- and risk bankruptcy.

 *    Emphasizes preventive care. The comprehensive benefits package
      goes beyond virtually all current insurance plans by covering a
      wide range of preventive services, including mammograms, Pap
      smears, and immunizations -- at no charge to you. It puts a new
      emphasis on helping you stay healthy, rather than waiting until
      you get sick. Prevention saves money and improves people's
      health.

 *    Includes prescription drugs.  Many insurance companies and
      Medicare have failed to cover prescription drugs. But drug costs
      are breaking family budgets, forcing many older Americans to
      choose between food and medicine.  Health insurance should cover
      prescription drugs. The Health Security plan does.

 All Americans will be guaranteed coverage of:
 *    Preventive Care ( i.e., screenings, physicals, immunizations,
      mammograms, prenatal care)
 *    Doctor Visits
 *    Prescription Drugs
 *    Hospital Services
 *    Emergency/Ambulance Services
 *    Laboratory and Diagnostic Services
 *    Mental Health and Substance Abuse Treatment
 *    Expanded Home Health Care
 *    Hospice Care/Outpatient Rehabilitation
 *    Vision and Hearing Care
 *    Children's Preventive Dental Care

 Principle #2:
 Savings: Controlling health care costs.

 Here's how the Health Security Act will control health care costs:

 *    Limits how much insurance companies can raise your premium.
      Insurance companies will no longer be able to raise your
      premiums as they please.  Today, insurance companies hike
      your premiums -- sometimes at several times the rate of
      inflation -- if you get sick, if someone in your family gets
      sick, and for any other reason.

 *    Introduces competition to the health care marketplace. The Health
      Security plan will release the chokehold that in today's system,
      insurance companies have on all of us -- consumers, nurses,
      doctors, and businesses. Reform will encourage competition --
      forcing costs down as health plans compete by offering
      high-quality care at an affordable price.

 *    Cracks down on fraud. The health security proposal makes
      health-care fraud a crime and imposes stiff penalties on those
      who cheat the system. It prohibits doctors from referring
      patients to outside facilities, like labs, which they own a
      piece of. It stops the kickbacks that some laboratories give
      doctors in an effort to get their business.

 *    Asks the drug companies to hold down prescription drug prices.
      The Health Security plan asks drug companies to take
      responsibility for keeping prices down, without setting prices.
      In today's system, overcharging runs rampant --certain
      prescription drugs cost Americans three times more than people
      pay in other industrialized countries.

 *    Reduces paperwork. All health plans will adopt a single, standard
      claims form by Jan. 1, 1995. Along with other measures to
      streamline the system and free nurses and doctors from excess
      bureaucracy, this will reduce paperwork, cut red tape, and save
      money.

 *    Squeezes the waste out of Medicare and Medicaid. By slowing the
      growth of these government programs, the proposal uses funds
      that have been wasted on excessive charges and funnels them into
      comprehensive benefits. Under reform, Medicare will be expanded
      to cover prescription drugs, and there will be a new long-term
      care program to help cover home- and community-based care.
      Today, Medicare and Medicaid spending keeps going up and up. But
      the elderly and poor aren't getting any extra benefits. Health
      security will change that.

 Principle #3:
 Quality: Making the world's best care better.

 *    Emphasizes preventive care. The Health Security plan puts a new
      emphasis on preventing illness before it becomes a medical
      crisis. Prevention will improve the quality of care by helping
      people stay healthy rather than treating them after they get
      sick.  The benefits package fully pays for a wide range of
      preventive services; the vast majority of today's insurance plans
      don't cover a penny.

 *    Gives consumers the power to judge the quality of care.
      Consumers will receive quality "report cards" that provide
      information on the performance of health care plans and patient
      satisfaction. These report cards will hold health plans
      accountable for meeting high standards. The National Quality
      Program will help states share information on health plan
      performance.

 *    Reforms malpractice.  The President's proposal will limit lawyers'
      fees in order to discourage frivolous medical malpractice
      lawsuits. It will also encourage patients and doctors to use
      alternative forms of dispute resolution before they end up in
      court.  This will help eliminate the "defensive medicine" that
      drives up costs and hurts quality -- doctors ordering extra tests
      because they fear lawyers looking over their shoulders.

 *    Encourages cooperation in rural and urban areas.  Rural residents
      will have access to the latest technology and emergency services
      through telecommunications links set up between local doctors and
      advanced networks of specialists and hospitals. In urban areas,
      the plan will increase investment in public hospitals and
      community health centers.

 *    Provides incentives for more family doctors to practice in rural
      and urban areas.  The health security plan will give financial
      breaks to doctors and nurses who work in underserved rural and
      urban areas. It will expand the National Health Service Corps.
      Two of three rural counties today do not have enough doctors and
      111 rural counties have no physician at all.

 *    Increases funding for prevention research. The National Institutes
      of Health (NIH) will expand research in areas like children's
      health, and health and wellness promotion.  Preventive care keeps
      people healthier and saves money at the same time.

 *    Promotes research on the effectiveness of treatments. Today, a lack
      of information about the most cost-effective methods of treatment
      often leads to expensive defensive medicine and wide variation in
      treatments and costs. The plan's investments in research into what
      treatments really work will help improve the quality of care.

 Principle #4:
 Choice: Preserving and increasing what you have today .

 *    Preserves your right to choose your doctor. The proposal ensures
      that you can follow your doctor and his or her team to any plan
      they might join.  Today, more and more employers are forcing
      their employees into plans that restrict your choice of doctor.
      After reform, your boss or insurance company won't choose your
      doctor or health plan -- you will.

 *    Increases your choice of health plan. You will be able to choose
      from among all the health plans offered in your area -- no matter
      where you work. Only one of every three companies with fewer than
      500 employees offer any choice of health plan. After reform,
      every employee will be able to choose a health plan.

 *    Puts consumers in the driver's seat. The Health Security Act
      brings competition to health care -- unleashing the market forces
      that will lower costs and improve quality. Giving small
      businesses and consumers the power to band together in alliances
      will level the playing field and give them the same bargaining
      strength as big businesses.

 *    Increases options for long-term care.  The President's proposal
      will make it possible for more Americans to continue to live in
      their homes and communities while receiving care. Today too many
      families are split apart when insurance or federal programs only
      pay for hospital coverage. The plan will help put an end to this
      situation and give families the options they deserve.

 Principle #5:
 Simplicity: Reducing paperwork and cutting red tape.

 *    Gives everyone a Health Security Card. The card -- with full
      protection for privacy and confidentiality -- will allow for
      electronic billing and the creation of health care information
      networks. This will reduce paperwork and simplify the system.

 *    Requires insurance companies to use a single claim form. The
      Health Security Act will reduce the insurance company red tape
      that forces doctors and patients to spend their time filling out
      forms and fighting bureaucrats. All health plans will adopt a
      single, standard claims form by Jan. 1, 1995. It will enable
      doctors and nurses to spend more time taking care of you -- and
      less time wrestling with paper.

 *    Eliminates fine print. Everyone will get a comprehensive
      benefits package -- and what you get will be spelled out in
      easy-to understand language. If you get sick, insurance
      companies won't be able to point to fine print and deny you the
      coverage you've paid for.

 *    Streamlines billing reimbursement for doctors, nurses and
      hospitals. The comprehensive benefits package, a standard rules
      and codes for payment, and elimination of excessive government
      regulations will reduce confusion. Doctors, nurses, and hospitals
      will have more time to care for patients; and all of us will
      benefit.

 *    Removes the burden on business of negotiating insurance. Groups
      of businesses and consumers -- regional health alliances -- will
      negotiate for high-quality care at affordable prices. This will
      simplify today's system, where hundreds of thousands of
      businesses negotiate with more than 1500 insurance companies. The
      burden of finding insurance will be lifted -- and so will
      administrative costs -- which can run as high as 40% of total
      health costs for small business.

 Principle #6:
 Responsibility: Making everyone responsible for health care.

 *    Cracks down on fraud. The health security proposal makes
      health-care fraud a crime and imposes stiff penalties on those
      who cheat the system. It prohibits doctors from referring
      patients to outside facilities, like labs, which they own a piece
      of.  It stops the kickbacks that some laboratories give doctors
      in an effort to get their business.

 *    Asks the drug companies to hold down prescription drug prices.
      The Health Security plan asks drug companies to take
      responsibility for keeping prices down, without setting prices.
      In today's system, overcharging runs rampant --certain
      prescription drugs cost Americans three times more than people
      pay in other industrialized countries.

 *    Emphasizes preventive care. The Health Security plan puts a new
      emphasis on preventing illness before it becomes a medical
      crisis. Prevention will improve the quality of care by helping
      people stay healthy rather than treating them after they get
      sick.  It offers you full coverage of a wide range of
      preventive services, but asks you to take responsibility for
      keeping yourself healthy.

 *    Reforms malpractice.  The President's proposal will limit
      lawyers' fees in order to discourage frivolous medical
      malpractice lawsuits. It will also encourage patients and doctors
      to use alternative forms of dispute resolution before they end up
      in court.  This will help eliminate the "defensive medicine" that
      drives up costs and hurts quality -- doctors ordering extra tests
      because they fear lawyers looking over their shoulders.

   *  Everyone contributes, and no one gets a free ride. In America,
      rights and responsibilities go hand-in-hand. Everyone will get a
      Health Security card that guarantees you a comprehensive package
      of benefits that can never be taken away. But we will ask
      everybody to pay something, even if your contribution is small.
      Small businesses and low-wage workers will get substantial
      discounts on the cost of insurance, but everyone must take
      responsibility.

                    HOW THE SYSTEM IS FINANCED

 The financing proposal was developed under the most rigorous and
 conservative forecasting standards.  For the first time,
 representatives from every federal agency involved in fiscal
 accounting and financial projections have been brought together to
 work out the numbers. Then teams of actuaries, health economists and
 other financial analysts from outside the government served as
 auditors and consultants, checking and rechecking.

 The system is financed from five major sources:

 1) Medicare savings -- The savings from reducing the growth of
 Medicare are based on specific, scorable policy proposals. Every penny
 of these savings will be channeled back into benefits -- prescription
 drugs and long-term care -- for the people which these programs serve.

 2)  Medicaid savings -- The rate of growth of Medicaid can be reduced
 primarily by folding the acute care portion of Medicaid into the
 overall health care system.  Since everyone will be insured, there
 will be savings in "uncompensated care" -- the money that goes to
 doctors and hospitals to compensate for caring for the uninsured.

 3) Savings from federal employee health care costs -- As all federal
 workers are integrated into the overall health care system, there
 will be less expense to taxpayers to provide for their health care.

 4) Reducing the benefits of tax-free compensation -- By reducing the
 rate of growth for health insurance, the President's proposal lowers
 the amount of compensation paid as tax-free health benefits, and
 frees up money for higher wages, wages for new workers, or
 profits -- all of which are taxable and thus bring in new federal
 revenues.

 5) Sin taxes -- There will be some new "sin taxes," the composition of
 which is not yet decided.

 In addition, there will be other savings. Reducing paperwork and
 administration, cracking down on health care fraud, and emphasizing
 prevention will save money in the long-run.

                         PAYMENT SCENARIOS

 As a rule, most individuals and families in which at least one person
 works will pay a maximum of 20% of the average health plan premium in
 their area. Those who choose a lower cost plan -- from among those
 offered in the area -- will pay a little less than the 20% average.
 Those who choose a more expensive plan will pay a little more, as
 they do today.Employers who currently pay 100% of health benefits may
 continue to do so.

 Two parent family with children: Two parent families with children --
 whether one or both parents work -- pay a maximum of 20% of the family
 premium offered by the average plan in their area.  If both parents
 work, they choose how to pay their family's share. They can have the
 share deducted monthly out of either paycheck or write a check to the
 local alliance.

 Couple: Working married couples -- whether one or both spouses work --
 pay a maximum of 20 percent of the average plan premium. They can have
 the share deducted monthly from either paycheck or write a check to the
 local alliance.

 Single-parent family: Working single parents with children pay a maximum
 of 20 % of the average plan premium for a single parent policy.

 Individual: Working single people pay a maximum of 20% of the average
 premium for an individual policy in their area.

 Part-time worker with no unearned income: Part-time workers pay a
 maximum of 20% of the average plan premium for their policy type
 in their area.

                             EXCEPTIONS


 Exceptions are provided for: (1) the self-employed and independent
 contractors; (2) part-time workers who have unearned income; (3)
 families with incomes below 150% of the poverty level; and (4)
 seasonal workers.

 Self-employed/independent contractors:  The self-employed and
 individual contractors can deduct from their taxes 100%  of their
 health care costs. As with any small business, they pay the employer
 share. They also pay an individual share. If a firm earns less than
 $24,000 a year, it is eligible for subsidies.

 Part-time workers with unearned income: Part-time workers with
 unearned income pay a maximum of 20% of the average plan premium
 for their policy type -- individual, couple, two parent, or single
 parent family.

 The number of hours someone works determines how much of the premium
 is paid by the employer and how much by the individual. For example,
 an employer would pay 40% of the premium for someone who works
 half-time. Payment of the remaining 40% of the premium depends on how
 much a person makes in unearned income, with subsidies provided on a
 sliding scale for those whose incomes are below 250% of the poverty
 level.

 Families with incomes below 150% of the poverty level: Families at
 this level are eligible for discounted premiums and pay a maximum of
 20% of the employee's share of the average plan premium. This applies
 to individuals making $10,455 annually; couples with incomes of
 $14,145; families of three earning $17,835; and families of four with
 incomes of $21,525.

 Seasonal workers: Seasonal workers pay a maximum of 20% of the average
 plan premium in the area where they reside. Those whose incomes are
 150% of the poverty level or below are eligible for discounted
 premiums. If they have unearned income and are not working, seasonal
 workers are treated the same as part-time workers.

 Unemployed and non-working:  Unemployed individuals and heads of
 household who make less than 150% of the poverty level are eligible
 for individual subsidies on a sliding scale. Those with unearned
 income pay all or part of what would normally be the employer's share
 of the premium.

 Those whose incomes are 250% of the poverty level or less --
 pensioners, for example -- are eligible for discounts on what would
 be the employer's share. They are not eligible for individual
 subsidies, and pay the normal individual share of the health premium.