Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Source Description
These records pertain to health care reform.
Scholar Source Context
Document identity
localId
286185975
label
Health Care Reform - 92 Proposal - Darman Presentation to POTUS 12/20/91
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
286185975
contentType
document
title
Health Care Reform - 92 Proposal - Darman Presentation to POTUS 12/20/91
description
These records pertain to health care reform.
citationUrl
identifierLocal
06970-004
collections
Records of the White House Office of Policy Development (George H. W. Bush Administration)
Johannes Kuttner Subject Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
286185975
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
a81d8673bd418243
ocrText
Originally Processed With FOIA(s):
FOIA Number:
1999-0118-F
1999-0118-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
George H.W. Bush Presidential Records
Collection/Office of Origin:
Policy Development, White House Office of
Series:
Kuttner, Johannes, Files
Subseries:
OA/ID Number:
06970
Folder ID Number:
06970-004
Folder Title:
Health Care Reform - 92 Proposal - Darman Presentation to POTUS 12/20/91
Stack:
Row:
Section:
Shelf:
Position:
G
O
0
0
O
BUDGET REVIEW: COMPREHENSIVE HEALTH REFORM
TABLE OF CONTENTS
(FOR DISCUSSION 12/20/91)
TAB
(1) Summary
(2) The Problem
(3) Conceptual Alternatives for "Comprehensive Reform"
(4) Principles Guiding Reform
(5) Solution Element (A) :
"Health Insurance Market Reform"
(6) Solution Element (B) :
Health Insurance Tax Credits/Deductions/Exclusions
(7) Solution Element (C) :
Medicaid Restructuring and State Flexibility
(8) Solution Element (D) :
Medicare Cost Containment (without hitting beneficiaries)
and Upper Income Tax Cap
(9) Solution Element (E) :
[Other -- noted, but not elaborated here]
(10) Steelman Commission Recommendations
[As framed, these are an alternative to comprehensive reform
-- but most can be subsumed within comprehensive reform.]
BASIC ELEMENTS OF POSSIBLE
COMPREHENSIVE HEALTH REFORM
FOR DISCUSSION -- 12/20/91
(1) This approach is intended to:
(a) address the cost and access problem (see especially Tab 2,
pp. 8, 10, 12) ;
(b) meet the substantive and political test necessary to have a
"comprehensive plan";
(c) do $0 in a way:
(i)
that is in accord with a "pro-competitive" approach to
reform -- building on American strengths -- rather
than a "pay-or-play" or "Canadian" approach (Tab 3);
(ii) that is consistent with the principles at Tab 4; and
(iii) that is consistent with the budget agreement's
pay-as-you-go requirements.
If adopted, this approach would allow the President to put
forward a plan that would, over time:
assure access to affordable basic health insurance coverage
for all poor and working poor Americans;
assure that health insurance would be renewable and
portable -- regardless of the condition of one's health;
restrain the growing cost of health care and move the
current system toward more cost-effectiveness;
preserve and build upon the best of the private,
innovative, high-quality American health system; and
avoid a turn toward a government-managed health system that
would (ultimately) ration access to health care.
(2) The new elements of this plan are in addition to other health
initiatives already advanced by the Administration -- all of
which would continue to be supported as well: e.g., emphasizing
prevention and personal responsibility; advancing malpractice
reform; increasing investment in research; targeting resources
on at-risk infants and mothers; improving quality assessment;
and reducing subsidies for the rich. (The new elements are
summarized at (3), (4), (5), and (6) below.)
(3) Solution Element (A) -- Health Insurance Market Reform (Tab 5) :
To make health insurance more affordable and accessible for the
working poor -- especially those who work for smaller firms --
and to encourage more cost-effective insurance plans, state
insurance systems would be modified (or overridden) to:
pool risk;
guarantee issue, renewability, and portability;
override anti-managed care and mandated benefit laws;
extend group coverage for college graduates for 6 months
after graduation; and
facilitate the development of Health Insurance Networks to
increase bargaining power for small employers and to reduce
administrative costs.
(4) Solution Element (B) -- Health Insurance Tax Credits (Tab 6) :
To make health insurance more affordable for the uninsured poor
(those without public or private coverage) and the working poor,
a new transferrable health insurance tax credit (and a related
new health insurance deduction) would be provided. The health
insurance credit would be up to $1250 per poor individual and
$3125/family -- and the related new deduction would be available
to a family with up to 60K income.
(5) Solution Element (C) -- Medicaid restructuring (Tab 7) : To
control rising Medicaid costs and allow States greater
opportunity for cost-effective innovation, a major restructuring
of the Medicaid program would be proposed. It would switch away
from the current, open-ended, fee-for-service system toward
"managed care" [new label needed!] and other more cost-effective
health-insurance-and-delivery systems.
(6) Solution Element (D): To fill the financing gap, while also
advancing sound policy measures, the plan would:
reduce the Medicare SMI premium subsidy for those older
Americans with over 100K/year income (a modified
reproposal) ;
cap the exclusion of health premium costs for all those
individuals with over 100K/year income (with the excludable
premium cap at $1920/individual and $4800/family) -- Tab 8;
and
adopt other Medicare cost control measures -- without
adversely affecting beneficiaries. (These are summarized
at Tab 8.) NOTE: This part is sure to be unpopular with
health providers, and may lend itself to (unfair) political
criticism. It is, however, defensible policy -- and
essential to fill the financing gap (assuming, as seems
necessary and prudent, that the tax cap is not to be
lowered).