Clinton reform: good medicine or bad?

AuthorTubbesing, Carl
PositionTen legislators provide opinions on health care reforms - Includes related articles

Although legislators disagree about the details of the federal plans for reforming health care, they all believe that some restructuring is necessary.

Editor's Note: State Legislatures asked 10 lawmakers familiar with health-care reform their opinions on the Clinton proposal. In a wide-ranging interview they discussed universal coverage, cost containment, the benefits package, quality assurance, cost shifting, Medicaid, administering the plan and health alliances. The 10 are: Delaware Senator John Still, Arizona Senate Minority Leader Cindy Resnick, Ohio Senator Grace Drake, West Virginia Speaker Robert Chambers, Pennsylvania Representative David Richardson, Missouri Representative Chris Kelly, Illinois Senator Judy Baar Topinka, Pennsylvania Senator Allyson Schwartz, Maine Representative Charlene Rydell and Rhode Island Representative Jeffrey Teitz.

What do state legislators think of President Clinton's health plan?

Interviews with 10 legislators familiar with health-care issues found substantial but not total support for the president's framework and wariness about its details. Most agree that the proposal places states at considerable risk, yet believe that some kind of reform of the nation's health system is essential.

Of the legislators interviewed, only Ohio Senator Grace Drake totally opposes the president's package. "I don't like it," she says. "I don't like any part of it."

The others, despite differences in their own political philosophies, showed marked agreement on what a final package should look like and, to a lesser extent, on elements that should be of particular concern for state officials. Delaware Senator John Still's reaction is typical. "My quarrels are not with the goals of the administration's proposal. Rather, I take issue with some of its details."

Universal Coverage

Universal coverage--making health care accessible to everyone--tops the list of what this group of legislators likes about the Clinton proposal. Pennsylvania Senator Allyson Schwartz calls the plan's guarantee of universal coverage "extraordinary." For Maine Representative Charlene Rydell, including everyone in the plan is one of its several positive aspects. Although the rationale for universal coverage often focuses on its impact on individuals--especially those currently lacking health insurance--West Virginia Speaker Robert "Chuck" Chambers offers a valuable insight about why universal coverage is important to states. It is an element of reform for which there are economic disincentives for states to accomplish on their own.

"The universal coverage component is very important to West Virginia. We have lots of senior citizens. Our economy has changed. We've lost manufacturing jobs--jobs that carried health benefits--to jobs that don't provide health insurance. If we wanted as a state to provide universal coverage, we could be at an economic disadvantage. We'd have a hard time competing. Making universal coverage a provision of the federal plan removes that economic disincentive."

Rydell and Schwartz laud the administration's emphasis on cost containment. Senator Schwartz asserts that cost containment and universal coverage are inseparable objectives. "One without the other," she says, "is not satisfactory." Illinois Senator Judy Baar Topinka, skeptical that the administration has focused enough on costs, agrees. "They have to address both ends of the problem--universal access and costs. Otherwise, it's like pouring water into a bucket with a hole in it."

Benefits Package

There is less agreement among these legislators about three other elements of the Clinton proposal--the benefits package, quality assurance and flexibility for the states. How comprehensive the benefits package should be was one of several early debates among the designers of the Clinton package. Limiting benefits risks a two-tiered system with inequities between people who can afford supplemental coverage and those who cannot. Making the benefit package too "rich" conflicts with another major goal of the plan--controlling costs. Legislators, too, are divided on this issue.

Representative Rydell likes the administration's benefits package, particularly its emphasis on preventive care such as immunizations, mammograms, prenatal care and cholesterol screening. Baar Topinka disagrees. "They've created a Cadillac plan," she asserts. "It's too grandiose. We have to get a more basic plan."

Quality

The Clinton package attempts to address the quality of health care in several ways. For example, the health alliances, a centerpiece of the proposal, would publish annual report cards describing how each plan performs.

Rydell is pleased with this component, while Ohio Senator Drake lists quality assurance as her biggest reservation about the plan. "I don't hear anything about quality," she states. "I hear about access and cost containment, but I don't hear anything about assuring quality. Under the Clinton proposal, the quality of health care will decline for people who already have good plans."

Cost Shifting

The greatest reservation about the plan among all of the legislators interviewed is its potential for shifting costs to the states. The administration proposes to fund the package from a variety of sources, some of which are traditional state revenue, such as excise taxes on tobacco and taxes on insurance premiums.

Representative Teitz notes that "the plan must be honestly funded so there won't be a transfer of costs to the states." Senator Baar Topinka argues that the administration...

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