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.
Scholar Source Context
Document identity
localId
26082276
label
Kassebaum, Nancy [103rd Congress]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
26082276
sourceUrl
contentType
document
title
Kassebaum, Nancy [103rd Congress]
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Pam Cicetti's Subject Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
26082276
levelOfDescription
fileUnit
otherTitles
42-t-2124771-20140159S-010-030-2015
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
0674f4a6f6a3cf12
ocrText
Kassebaum, Nancy
PHOTOCOPY
PRESERVATION
THE WHITE HOUSE
July 1, 1993
Honorable Nancy Landon Kassebaum
United States Senate
Washington, D.C. 20515
Dear Senator Kassebaum:
Thank you for your letter in support of the
invitation extended by the Wichita Association of
Legal Administrators. Unfortunately, my schedule
does not permit me to accept every request that I
would like to honor. If I am able to participate in
this worthwhile event, I will contact Ms. Pamela
Downs directly.
Again, thank you for writing.
Sincerely,
Hillary Hillary Rodham Clinton
NANCY LANDON KASSEBAUM
KANSAS
United States Senate
WASHINGTON, D.C.
June 14, 1993
Dear Mrs. Clinton:
Knowing of the many demands on your time, I
hesitate to add yet another. Nevertheless
Pamela Downs has asked you to speak at the Spring
1994 Wichita Association of Legal Administrators
Managing Partners Appreciation Meeting. I am, at
this early date, adding my endorsement to her invita-
tion and hope you will be able to accept.
With all best wishes,
Warmest regards,
Nancy Vancy Landon Kassebaum
United States Senator
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
FLEESON, GOOING, COULSON & KITCH
LAWYERS
CARL A. BELL
DIXIE F. MADDEN
SIXTEENTH FLOOR 125 NORTH MARKET
DALE M. STUCKY
GERRIT H. WORMHOUDT
THOMAS J. LASATER
DONALD R. NEWKIRK
POST OFFICE BOX 997
WILLARD B. THOMPSON
DAVID G. SEELY
JAMES R. BOYD
RICHARD I. STEPHENSON
MARY E MAY
WICHITA, KANSAS 6720H0997
OF COUNSEL
THOMAS D. KITCH
STEPHEN M. STARK
(316) 267-7361
J. ERIC ENGSTROM
LYNDON W. VIX
STEPHEN M. JOSEPH
MARY RUTH BYERLEY
TELECOPIER
STEPHEN E ROBISON
ALAN R. WELCH
(316) 267-1754
MARK F. ANDERSON
JOHN T. STEERE
HOWARD T. FLEESON
RON CAMPBELL
WILLIAM L TOWNSLEY
(1895-1957)
TIMOTHY P. O'SULLIVAN
SCOTT D. JENSEN
HOMER V. GOOING
GREGORY J. STUCKY
JORDAN E CLAY
(1894-1986)
CHARLES E. MILLSAP
JOHN R. GERDES
WAYNE COULSON
EDWARD J. HEALY
RICHARD B. CHAMBERS
(1910-1985)
WILLIAM P. TRETBAR
JOHN E REES II
PAUL R. KITCH
SUSAN P. SELVIDGE
(1911-1987)
May 26, 1993
The Honorable Nancy Landon Kassebaum
United States Senate
304 Russell Senate Office Building
Washington, D.C. 20510
Re: Invitation to Hillary Rodham Clinton
Dear Senator Kassebaum:
I am writing to inform you that I have invited Mrs. Hillary
Rodham Clinton to speak at the Spring 1994 Wichita Association of
Legal Administrators Managing Partners Appreciation meeting. I
would appreciate your support in securing Mrs. Rodham Clinton, as
well as your attendence at this event.
Thank you, in advance, for your support.
Very truly yours,
Pamela R.Down S
Pamela N. Downs
Legal Administrator and
WALA President
PND/jds
S. 325 and H.R. 834, "BasiCare Health Access and Cost Control"
Introduced by Sen. Nancy Kassebaum (KS)
& Rep. Dan Glickman (KS)
February 4, 1993
Overview: This bill would require all insurers to offer a single uniform benefits
package (BasiCare), mandate all individuals to purchase this package, and provide
income-based vouchers for low-income persons.
Coverage: The bill would provide universal coverage through the individual mandate.
BasiCare would supplant Medicaid and after five years, a legislative proposal would be
developed to assimilate the Medicare, FEHB, and CHAMPUS programs into Basicare.
The bill would require community rating and establish premium bands across blocks of
business.
Benefits: While the bill sets a foundation for the Basicare package, an independent
Basicare commission would determine the specific benefits to be included in the
minimum coverage package. The package would have uniform national premiums,
deductibles, and copayments.
Quality: The commission would contract with States or private organizations to
collect and disseminate information to consumers on quality and cost effectiveness of
services in the States. Other elements of the plan include malpractice reforms,
expansion of low-income community health centers, and measures to increase the
number of health professionals in underserved areas.
Cost Containment: Cost control would be achieved through binding annual limits on
the rate of increase in Basicare premiums, capping tax exclusions for health benefits
at the cost of the Basicare plan, enacting tort reform, and implementing electronic
billing and payment systems.
Financing: Sources of revenue for this bill would include a diversion of up to 1
percent of the Social Security payroll tax, taxes on health benefits above the tax cap,
and the Federal and State funds that would have been used for Medicaid. (States have
a maintenance-of-effort requirement.) No cost estimates are available at this time.
Status: As of 7/20/93, this bill had 1 cosponsor in the House and 2 in the Senate.
Cosponsors are Rep. McCurdy (OK) and Sens. Danforth (MO) and Burns (MT). Groups
were not solicited to endorse this bill.
Clinton
S 325 Kassebaum
1. Goals/Coverage
Universal access achieved through expanded
Provides an individual mandate for basic
employer-based insurance and state
coverage and income-based vouchers for
administered regional health alliances.
low-income persons. Small group health
insurance market reforms to ensure
availability and affordability would be
phased-i immediately. Commission would
submit recommendations for national
standardization of the "BasiCare" package
to Congress for approval.
Medicare remains in place and expanded.
Medicare is incorporated;
Medicaid incorporation phased-in;
Medicaid is replaced with a more
FEHB incorporated;
extensive program;
VA incorporated for vets;
FEHB similar;
CHAMPUS/DOD study;
VA is incorporated;
IHS remains in place and expanded.
CHAMPUS is incorporated;
IHS is incorporated.
2. Benefits
Three (3) options available: fee-for-service,
Fee-for-service; managed care options to
network & HMO.
be developed by the Commission.
Guaranteed benefits package include:
At a minimum the "BasiCare" package would
hospital and physician services;
include:
preventive care services;
basic hospitalization/outpatient
mental health (w/ limits phased-in; vision
services;
and hearing for kids;
preventive services (if proven cost-
preventive dental for kids (phased-in for
effective)
adults);
Rx drugs w/ separate cost-sharing;
Small employer required to offer
limited long-term home care services through
benefits as offered under existing
separate program (with phase-in expansion).
Medicare Parts A & B.
Fee for service cost sharing incl. $250
The Commission is directed to employ
deductible & 20% copay, out-of-pocket limit
copayments rather than deductibles in
$1,500 indiv./$3,000 family; No cost sharing
providing for cost-sharing in the
for preventive services. Lower cost-sharing
BasiCare plan. Out-of-pocket protection
in managed care plans.
not defined. Coverage against
extraordinary long-term care costs.
No provision.
Small employers (less than 51 emplo:
)
cost sharing: deductibles $500
indiv./$1,000 family; no deductibles for
children up to age 23 or pregnant I
1.
No cost sharing for preventive services.
Out-of-pocket limit $2,000
individual/$3,000 family.
3. State Role
Federal program administered by States.
Federal program administered by the
States given flexibility to meet Federal
States.
requirements. State options include
establishment of a single payer system, an
alternative delivery system W/ multiple
plans, or an all payer system w/ multiple
plans.
Within Federal guidelines States must:
establish alliances;
no provision;
assure enrollment & access to care for
similar but only for low-income persons
its residents;
receiving vouchers;
regulate plans, incl. financial
State role not defined.
standards, risk adjustment
system, & quality standards;
provide for data/information
Commission could contract W/ State to
systems;
collect/disseminate information to
consumers on quality and cost-
effectiveness of services.
>enforce budgets after a transition.
no provision.
Clinton
S 325 Kassebaum
4. Cost Containment
The national health board will set a national
The BasiCare Commission would set basic
per capita budget target for health care
premium rates for all BasiCare plans with
based on current health care spending.
limited allowances for geographic and
demographic variations.
The Board will set annual allowable premium
Commission would establish a maximum
increases equal to CPI + POPULATION.
allowable rate of increase in premiums.
No provision.
Employers/employees would only be
permitted to take tax
deductions/exclusions for "BasiCare"
plans.
The allowable increase will be adjusted for
No provision.
each alliance to reflect any changes in the
demographics of the alliance during the
previous year.
State budgets allocated according to
No provision.
geographic adjustment factors. Federal funds
to States for low-income subsidies.
Payments to providers are negotiated by
No provision.
plans, except that provider payment limits
are one tool available to States/Feds to
enforce budget.
During years 1-3 the federal government
No provision.
assumes responsibility for enforcement of
alliance budgets, thereafter the states will
enforce the budgets.
5. Employer Financing
Employer must contribute 80% of the cost of
No provision.
employees coverage (contribution not to
exceed 7.6% of employee wages).
Small low-wage firms employer contribution
No provision.
capped at 3.2% (depending on size and average
wage level).
No provision.
Employer tax deduction for health
insurance expenses limited to cost of
"BasiCare" plan.
No provision.
Deduction for self-employed increased
from 25% of health costs to 100%.
6. Other Financing
Employees pay up to 20% of avg. premium in
Redirecting 1% of the existing Social
regional health alliance
Security payroll tax on wages and self-
employment income;
Redirects existing Medicaid (State and
Federal) funds, otherwise unobligated
amounts in the Medicare Hospital and
Medical Insurance Trust Funds;
Federal funds otherwise appropriated for
the VA health program, CHAMPUS, the
Indian Health Service, the FEHB, and the
funds necessary to provide assistance to
authorized low-income persons.
Cigarette tax.
Clinton
S 325 Kassebaum
7. Malpractice Reform
[To be determined.]
Limits non-economic damages to $250,000;
Allows for periodic payments (awards >
$100,000);
Requires collateral source offset;
Caps punitive damages at amount awarded
for economic and noneconomic damages;
Limits attorneys fees based on hourly
rate or as percentage of total damages
awarded (excl. punitives);
Reduces statute of limitations to 2 years
from date injury should have been found,
but not later than 4 years after
occurrence;
Authorizes grants to States to develop
ADR systems.
S. 1057 "The MediCORE National Health Act"
Introduced by Sen. James M. Jeffords
May 27, 1993
Overview: The bill would provide universal access to a set of "CORE" benefits to all
citizens and legal residents. It would create a federal board to design the CORE
benefits. States would have the responsibility of designing and administering the
program. They would also assume some financial responsibility for the program.
Coverage: The bill would provide universal access to all citizens and residents.
Coverage would be portable to other states and overseas. Medicare services would
be folded into the CORE and expanded to cover long-term custodial or personal
assistance care. Medicaid, FEHBP and certain CHAMPUS services would also be
folded into the CORE. DOD and Veterans Affairs programs would remain in tact.
Benefits: The program would provide a national comprehensive package to be
determined by a Federal board. The benefits would include: medically necessary
services, prescription drugs, mental health services, long-term care, primary and
preventive care services. The Board would have to design the CORE services within
the financing constraints predetermined by the current national health care
expenditures and institute funding controls to limit budgeting deficits.
Quality: States would be required to have proper quality assurances mechanisms to
receive accreditation to operate from the Board.
Cost Containment: Cost containment mechanisms include: limiting the scope and
content of CORE services to that which can be financed by the MediCORE Trust Fund;
State and regional level budgeting and fee schedules; outcomes reviews and
malpractice reform.
Financing: Roughly 70 percent of the costs of the program would be federally
financed. A MediCORE Trust Fund would be established and funded principally by a 6
percent payroll tax, where 4 percent is the employer's responsibility and 2 percent
that of the employee. Other Federal funds would included a new health premium of 6
percent that would be applied to each taxpayer's adjusted gross income as well as
funds which would otherwise have been appropriated to carry out specific Federal
health programs (Medicare, Medicaid, FEHBP, etc.). States would responsible for the
remaining 30 percent of the program funding. Cost estimates are not available at this
time.
Status: As of 07/15/93, there were no cosponsors for S. 1057.
Clinton
$ 1057 Jeffords
1. Goals/Coverage
Universal access achieved through expanded
Universal access provided by a federal
employer-based insurance and state
system of state-run and state-designed
administered regional health alliances.
health care programs.
Medicare remains in place and expanded.
Medicare folded into program and
expanded.
Medicaid incorporation phased-in;
Medicaid incorporated;
FEHB incorporated;
FEHB incorporated;
VA incorporated for vets;
Certain CHAMPUS services incorporated;
CHAMPUS /DOD study;
DOD and VA remain intact and studied;
IHS remains in place and expanded.
IHS remains in place.
2. Benefits
Three (3) options available: fee-for-service,
States must include at least one delivery
network & HMO.
plan offering significant freedom of
choice of providers.
Guaranteed benefits package include:
A basic, comprehensive benefit package
hospital and physician services;
determined by a Federal board would
preventive care services;
include: medically necessary services,
mental health (w/ limits phased-in; vision
prescription drugs, mental health
and hearing for kids;
services, long-term care, primary and
preventive dental for kids (phased-in for
preventive care services.
adults);
Rx drugs w/ separate cost-sharing;
limited long-term home care services through
separate program (with phase-i expansion).
Fee for service cost sharing incl. $250
No provision
deductible & 20% copay, $3000 out-of-pocket
limit; No cost sharing for preventive
services. Lower cost-sharing in managed care
plans.
3. State Role
Federal program administered by States.
Federal program designed and administered
States given flexibility to meet Federal
by the States. States given flexibility
requirements. State options include
to meet Federal requirements. States
establishment of a single payer system, an
given wide latitude in designing program
alternative delivery system w/ multiple
and they could establish single payer
plans, or an all payer system w/ multiple
systems.
plans.
Within Federal guidelines States must:
Within Federal guidelines States must:
establish alliances;
does not have to establish
alliances;
assure enrollment & access to care for
Similar
its residents;
regulate plans, incl. financial
Similar
standards, risk adjustment
system, & quality standards;
provide for data/information
Similar;
systems;
>enforce budgets after a transition.
States enforce budget.
Clinton
S 1057 Jeffords
4. Cost Containment
The national health board will set a national
The Federal board shall prepare an annual
per capita budget target for health care
budget containing estimates of total
based on current health care spending.
national expenditures and the total
amount it expects to be available from
the Trust Fund.
The Board will set annual allowable premium
The Board shall compute the national
increases equal to CPI POPULATION.
average per capita costs for each
category of CORE services and develop
adjustment factors for risk groups.
The allowable increase will be adjusted for
No provision
each alliance to reflect any changes in the
demographics of the alliance during the
previous year.
State budgets allocated according to
State budgets adjusted according to
geographic adjustment factors. Federal funds
differing state circumstances.
to States for low-income subsidies.
Payments to providers are negotiated by
No provision
plans, except that provider payment limits
are one tool available to States/Feds to
enforce budget.
During years 1-3 the federal government
The Board must design the CORE services
assumes responsibility for enforcement of
within the financing constraints
alliance budgets, thereafter the states will
predetermined by current national health
enforce the budgets.
care expenditures and institute funding
controls to limit budgeting deficits.
5. Employer Financing
Employer must contribute 80% of the cost of
Federal financing would be derived in
employees coverage (contribution not to
part by employers contributing a tax
exceed 7.6% of employee wages).
equal to 4 percent of wages paid during
each calendar year. Employers would not
be permitted to deduct amounts paid for
program coverage.
Small low-wage firms employer contribution
No provision
capped at 3.2% (depending on size and average
wage level).
6. Other Financing
Employees pay up to 20% of avg. premium in
Remaining Federal financing would be
regional health alliance
raised as follows: Employees must
wages).
contribute a tax equal to 2 percent of
wages received up to $100,000.
Self-employed individuals must contribute
a tax equal to 6 percent on the first
$100,000 of income, and at 4 percent on
amounts in excess of $100,000.
No provision
No provision
Cigarette tax.
No provision
No provision
Individuals would also pay a new tax on
adjusted gross income with a maximum of 6
percent.
No provision.
The Federal government would provide
approximately 70 percent of the
financing, with states responsible for
the remaining 30 percent.
H.R. 1200 and S. 491 "American Health Security Act"
Introduced by Rep. Jim McDermott (WA)
& Sen. Paul Wellstone (MN)
March 3, 1993
Program: The bill would establish a universal access health program that would be
paid for by the federal government as the single payor and administered by the states.
States would be allowed to establish their own health care delivery system and
patients would be able to chose their own providers. The bill would preserve the
current fee-for-service system and give the states the option to enroll their residents,
through capitated managed care, in comprehensive health service organizations.
Coverage: The bill would provide universal coverage, ensure portability of benefits
between states. Medicare, Medicaid, FEHBP, and CHAMPUS programs would be
replaced by the health security program and the VA and IHS programs would remain
intact.
Benefits: The program would provide a national comprehensive benefit package.
Quality: Quality assessments would be directed through a Quality Council, state
review programs, and a required State electronic database. The program would
emphasize primary care by increasing the number of primary care physicians and
primary care mid-level practitioners.
Cost Containment: Cost control mechanisms include health care expenditure budgets,
national fee schedules, and streamlined administration. Overall health care spending
increases would be limited to no more than the annual percentage increase in the
gross domestic product.
Financing: A Trust Fund would be established and financed with funds from payroll
and income taxes and funds which would otherwise have been appropriated to carry
out specific Federal health programs (Medicare, Medicaid, FEHBP, etc.). Cost
estimates are not available at this time.
Status: As of 7/20/93, this bill had 85 cosponsors in the House and 3 in the Senate.
Key cosponsors include Reps. Stark (CA), Moakley (MA), Studds (MA), Mfume (MD),
Collins (IL), Rangel (NY), Stokes (OH), Lewis (GA), Reynolds (IL) and Sens.
Metzenbaum (OH) and Simon (IL). Key endorsing groups include Citizen Action,
National Association of Social Workers, and Physicians for a National Health Program
(PNHP), Gray Panthers, United Church of Christ, Teamsters, and the National Farmers
Union.
Clinton
HR 1200 McDermott
1. Goals/Coverage
Universal access achieved through expanded
Universal access would be achieved
employer-based insurance and state
through a State-based/administered
administered regional health alliances.
national health insurance program.
Medicare remains in place and expanded.
Medicare replaced;
Medicaid incorporation phased-in;
Medicaid replaced;
FEHB incorporated;
FEHB replaced;
VA incorporated for vets;
VA remains;
CHAMPUS/DOD study;
CHAMPUS replaced;
IHS remains in place and expanded.
IHS remains.
2. Benefits
Three (3) options available: fee-for-service,
Multiple plan types not guaranteed.
network & HMO.
Guaranteed benefits package include:
Comprehensive benefit pkg. similar plus
hospital and physician services;
includes
preventive care services;
mental health (w/ limits phased-in;
full coverage for mental health.
vision and hearing for kids;
preventive dental for kids (phased-in for
adults);
Rx drugs w/ separate cost-sharing;
full coverage for prescription drugs
limited long-term home care services through
long-term care (age 65 and older pay
separate program (with phase-in expansion).
monthly premium);
Fee for service cost sharing incl. $250
No cost-sharing for acute care services.
deductible & 20% copay, out-of-pocket limit
#1500 indiv./$3,000 family; No cost sharing
for preventive services. Lower cost-sharing
in managed care plans.
3. State Role
Federal program administered by States.
Similar but States given greater
States given flexibility to meet Federal
flexibility in meeting Federal
requirements. State option includes the
requirements.
establishment of a single payer system, an
alternative delivery system w/ multiple plans
or all payer system w/ multiple plans.
Within Federal guidelines States must:
establish alliances;
no provision
assure enrollment & access to care for
similar provision
its residents;
regulate plans, incl. financial
similar except private health insurance
standards, risk adjustment
plans for basic benefits no longer exist.
system, & quality standards;
States would provide these functions
directly;
provide for data/information
similar provision;
systems;
>enforce budgets after a transition.
similar provision.
establish health planning programs;
establish fraud and abuse programs.
Clinton
HR 1200 McDermott
4. Cost Containment
The national health budget is established.
A national health security budget
established annually.
Statute will set annual allowable premium
Increases in the budget would be based on
increases equal to CPI
+
POPULATION
prior year health expenditures plus
growth in GDP.
No provision.
The national budget would be divided into
quality assessment, professional
education, administrative, and operating
components.
The allowable increase will be adjusted for
Similar provision, adjusted for
each alliance to reflect any changes in the
differences among States in costs and
demographics of the alliance during the
health status of populations.
previous year.
No provision.
States could spend no more than 3% of
budget on administrative costs.
State budgets allocated according to
States would receive federal funds b
I
geographic adjustment factors. Federal funds
on the national avg. per capita cost of
to States for low-income subsidies.
all covered services, factoring in a
state adjustment factor and a risk
adjustment factor.
Payments to providers are negotiated by
Payments to institutions would be made
plans, except that provider payment limits
based on annual prospective global
are one tool available to States/Feds to
budgets approved by the State. Global
enforce budget.
budgets would be developed through
State/institution negotiations.
During years 1-3 the federal government
State enforcement.
assumes responsibility for enforcement of
alliance budgets, thereafter the states will
enforce the budgets.
5. Employer Financing
Employer must contribute 80% of the cost of
The dollar limitation on the amount of
employees coverage (contribution not to
wages subject to the Medicare Hospital
exceed 7.6% of employee wages).
Insurance (HI) tax would be repealed. The
employer portion of HI tax would be
increased from 1.45% to 7.9%.
Small low-wage firms employer contribution
No provision
capped at 3.2% (depending on size and average
wage level).
No provision
The self-employed tax is increased from
2.9% to 8.35% of income.
No provision
State and local government employees
would be subject to 1.45% HI tax.
No provision
The top corporate tax rates would be
increased from 34 to 37%. Deductions for
business-related meals would be
abolished.
Clinton
HR 1200 McDermott
6. Other Financing
Employees pay up to 20% of avg. premium in
Individual income tax rates increased to
regional health alliance
28%, 31% & 34%; adds new top rate of 38%
for families with incomes over $200,000;
A health security premium equal to 7.5%
of taxes paid would apply to the income
taxes paid by each taxpayer.
A 10% surtax would be applied to income
taxes paid by persons with taxable inc
over $1 million.
The deductibility of moving expenses
would be limited to $5,000.
The deduction for club membership 1
Cigarette tax.
would be eliminated.
The portion of Social Security benefits
subject to taxation is increased from 50
to 85%.
All individuals age 65 or older eligible
for health security benefits would pay a
monthly premium of $65 for long-term
health care (adjusted annually based on
cost-of-living).
H.R. 5936 "Managed Competition Act of 1992"
Introduced by Reps. Cooper (TN), Andrews (TX) and Stenholm (TX)
Overview: This bill would guarantee universal access to affordable health care
coverage, relying on a system of managed competition. Through tax incentives,
providers and insurance companies would be encouraged to form health partnerships
to deliver quality, cost-effective health care. Each State would be required to have at
least one Health Plan Purchasing Cooperative (HPPC) which would enter into
agreements with Accountable Health Plans to offer a uniform benefit package. A
uniform package of effective benefits would be offered to small employers and
individuals through HPPCs. Unlike other managed competition models, there is no
employer or individual mandate.
Coverage: Universal access to affordable health care coverage would be attained by
allowing small employers and individuals to purchase a health care policy through a
HPPC. The Medicaid program would be repealed. All individuals below 200% of
poverty would be enrolled in a HPPC. Premiums, copayments and deductibles would
be paid for under the new federal program for all individuals below 100% of poverty.
A Federal subsidy would be provided to individuals between 100% and 200% of
poverty to help pay their premiums and copayments.
Benefits: The National Health Board would develop a uniform set of effective
treatment benefits, including preventive services which must be approved by
Congress. The Board could exclude treatments that have not been proven effective.
An enhanced benefit package including prescription drugs, eyeglasses and hearing
aids would be available for low-income individuals. Copayments and deductibles
would be required.
Quality: The National Board would be required to establish minimum quality standards.
Providers would be required to report medical outcomes and consumers would be
provided information on the quality of care provided in a plan.
Cost Containment: Cost restraint is built into the system through cost conscious
consumer choice, competition between health plans, reduced administrative overhead,
limitations imposed on the tax treatment of employer provided health benefits, and
specification of effective treatment benefits.
Financing: The bill would eliminate the limit on income which is subject to the
Medicare HI tax, cap deductibility of health plan expenses at the price of the lowest
health plan, impose a 34% excise tax on employers or individuals who purchase an
enhanced benefit package and redirect Federal Medicaid spending.
Status: HR 5936 was introduced in the 102nd Congress and had 19 cosponsors. It
has not been reintroduced in this Congress. Blue Cross/Blue Shield, the American
Hospital Association and American Healthcare Systems were strong supporters of Mr.
Cooper's bill.
Clinton
HR 5936 Cooper
1. Goals/Coverage
Universal access achieved through expanded
Access improved through State Health
employer-based insurance and state
Purchasing Cooperatives, but universal
administered regional health alliances.
access not guaranteed.
Medicare remains in place and expanded.
Similar
Medicaid incorporation phased-in;
Similar
FEHB incorporated;
No provision
VA incorporated for vets;
No Provision
CHAMPUS /DOD study;
No Provision
IHS remains in place and expanded.
No Provision
2. Benefits
Three (3) options available: fee-for-service,
Similar
network & HMO.
Guaranteed benefits package include:
Benefit package to be determined by
hospital and physician services;
Natl.Health Bd. to include at min.
preventive care services;
hospital, physician and prevention
mental health (w/ limits phased-in; vision
services
and hearing for kids;
preventive dental for kids (phased-in for
adults);
Rx drugs w/ separate cost-sharing;
limited long-term home care services through
separate program (with phase-i expansion).
Fee for service cost sharing incl. $250
Cost sharing required of all individuals.
deductible & 20% copay, $3000 out-of-pocket
Natl. Bd. determines copays and
limit; No cost sharing for preventive
deductibles. No cost sharing for
services. Lower cost-sharing in managed care
individuals under 100% of poverty; 100%-
plans.
200% of poverty cost sharing subsidized.
3. State Role
Federal program administered by States.
Federal program administered by States.
States given flexibility to meet Federal
States have no authority to set rates or
requirements. State option includes
adopt a single payer system.
establishment of a single payer system, an
alternative delivery system w/ multiple plans
or an all payer system w/ multiple plans.
Within Federal guidelines States must:
establish alliances;
same
assure enrollment & access to care for
same
its residents;
regulate plans, incl. financial
similar requirement for Natl.Bd.
standards, risk adjustment
system, & quality standards;
provide for data/information
same
systems;
enforce budgets after a transition.
No provision
Clinton
HR 5936 Cooper
4. Cost Containment
The national health board will set 8 national
No provision
per capita budget target for health care
based on current health care spending.
The Board will set annual allowable premium
No provision
increases equal to GDP -1%.
The allowable increase will be adjusted for
No provision
each alliance to reflect any changes in the
demographics of the alliance during the
previous year.
State budgets allocated according to
No provision
geographic adjustment factors. Federal funds
to States for low-income subsidies.
Payments to providers are negotiated by
Payments to providers are negotiated by
plans, except that provider payment limits
plans.
are one tool available to States/Feds to
enforce budget.
During years 1-3 the federal government
No provision
assumes responsibility for enforcement of
alliance budgets, thereafter the states will
enforce the budgets.
Tax deductibility for basic benefit plan.
Limits tax deductibility for employers
and individuals to 100% of lowest cost
plan.
5. Employer Financing
Employer must contribute 80% of the cost of
No provision
employees coverage (contribution not to
exceed 7.6% of employee wages).
Small low-wage firms employer contribution
No provision
capped at 3.2% (depending on size and average
wage level).
6. Other Financing
Employees pay up to 20% of avg. premium in
Individuals pay full premium with subsidy
regional health alliance
for low-income.
No provision
No provision
No provision
Cigarette tax.
No provision
No Provision
Eliminates limit on income subject to
Medicare HI tax; caps employer, employee
deductibility to 100% of lowest health
plan; imposes 34% excise tax for
excessive benefit pkg; redirects Medicaid
spending
H.R. 101 "Action Now Health Care Reform Act of 1993"
Introduced by Rep. Bob Michel (IL)
January 5, 1993
Overview: The product of the Minority Leader's Task Force on Health Care, this bill
would establish incremental reforms in the current health care system with the main
objective of cost containment. These various incremental reforms reflect where a
broad spectrum of Members were in the last Congress when comprehensive health
care reform was not thought possible.
Coverage: The bill would expand the availability and affordability of health insurance
to small employers. The plan would ensure portability, restrict the use of preexisting
condition limitations, and place limits on premium increases. For self-employed
persons who purchase their own insurance, the existing deduction for these expenses
would be increased from 25 to 100 percent. The bill would also increase funds for
the community health centers program.
Benefits: Insurers would have to offer small employers at least two plans, one
providing only essential medical and preventive benefits and the other a more
generous package.
Quality: To improve rural health care, the bill would authorize a series of grants to
train emergency medical personnel, develop air transport systems, and improve
telecommunication links between rural and urban hospitals. It would also extend the
special treatment rules for Medicare dependent, small rural hospitals.
Cost Containment: In an attempt to include consumers in health care cost
containment, the bill would authorize individual medical savings accounts similar to
IRAs. Employers could make tax-deductible contributions to employee accounts and
workers could use the money to purchase insurance and pay other medical costs.
Also, the bill proposes malpractice reforms including mandated use of
alternative dispute resolution, caps on non-economic damages, elimination of joint and
several liability, and limits on attorneys' fees.
Likewise, the bill would seek to reduce administrative costs by streamlining the
insurance billing system and utilizing electronic data cards for Medicare beneficiaries.
Financing: No specific financing is provided for in this bill. Cost estimates are not
available at this time.
Status: As of 7/20/93, this bill had 69 Republican cosponsors. Key cosponsors
include: Reps. Archer (TX), Bilirakis (FL), Bliley (VA), Gingrich (GA), Grandy (IA),
Hastert (IL), Johnson (CT), Kasich (OH), McMillan (NC), and Moorhead (CA).
Clinton
HR 101 Michel
1. Goals/Coverage
Universal access achieved through expanded
Establishes incremental reforms in the
employer-based insurance and state
current health care system with the main
administered regional health alliances.
objective of cost containment.
Medicare remains in place and expanded.
Federal programs remain in place;
Medicaid incorporation phased-in;
Community health centers expanded.
FEHB incorporated;
VA incorporated for vets;
CHAMPUS/DOD study;
IHS remains in place and expanded.
2. Benefits
Three (3) options available: fee-for-service,
No provision
network & HMO.
Guaranteed benefits package include:
Insurers would have to offer small
hospital and physician services;
employers 2 alternative MedAccess benefit
preventive care services;
plans: a "basic" plan with essential
mental health (w/ limits phased-in; vision
medical and preventive benefits, and a
and hearing for kids;
"standard" plan more comparable to
preventive dental for kids (phased-in for
coverage now generally available. The
adults);
HHS Secretary would request that the
Rx drugs w/ separate cost-sharing;
National Association of Insurance
limited long-term home care services through
commissioners to specify the benefit
separate program (with phase-in expansion).
standards.
Fee for service cost sharing incl. $250
No provision
deductible & 20% copay, out-of-pocket limit
$1,500 /$3000 family; No cost sharing
for preventive services. Lower cost-sharing
in managed care plans.
3. State Role
Federal program administered by States.
States have increased regulatory
States given flexibility to meet Federal
authority due to insurance market reforms
requirements. State option includes
and increased responsibilities due to
establishment of a single payer system, an
alternative dispute resolution systems
alternative delivery system W/ multiple plans
(see malpractice reform section)
or an all payer system w/ multiple plans.
Within Federal guidelines States must:
No provision
establish alliances;
assure enrollment & access to care for
its residents;
regulate plans, incl. financial
standards, risk adjustment
system, & quality standards;
provide for data/information
systems;
>enforce budgets after a transition.
Clinton
HR 101 Michel
4. Cost Containment
The national health board will set a national
No provision
per capita budget target for health care
based on current health care spending.
The Board will set annual allowable premium
No provision
increases equal to
CPI
POPULATION.
The allowable increase will be adjusted for
No provision
each alliance to reflect any changes in the
demographics of the alliance during the
previous year.
State budgets allocated according to
No provision
geographic adjustment factors. Federal funds
to States for low-income subsidies.
Payments to providers are negotiated by
No provision
plans, except that provider payment limits
are one tool available to States/Feds to
enforce budget.
During years 1-3 the federal government
No provision
assumes responsibility for enforcement of
alliance budgets, thereafter the states will
enforce the budgets.
Alternative delivery systems are available in
States are allowed to provide coverage to
each alliance for all citizens, not just
Medicaid recipients through alternative
Medicaid.
delivery systems such as HMOs or PPOs.
Certain physician referrals to facilities in
Similar provision
which the physician holds an ownership or
investment interest are prohibited.
Administrative costs reforms are implemented.
Administrative cost reforms include
requiring States to develop comparative
value information programs and requiring
the adoption of uniform standards for
electronic collection and transmission of
health insurance information.
No provision
Employees/Employers have option to
contribute to a tax fee medical savings
account. Funds to be used for medical or
long term care services/insurance.
5. Employer Financing
Employer must contribute 80% of the cost of
No provision
employees coverage (contribution not to
exceed 7.6% of employee wages).
Small low-wage firms employer contribution
No provision
capped at 3.2% (depending on size and average
wage level).
6. Other Financing
Employees pay up to 20% of avg. premium in
No provision
regional health alliance
No provision
Cigarette tax.
Clinton
HR 101 Michel
7. Malpractice Reform
[To be determined]
Requirement that all medical liability
disputes would be handled through an
alternative dispute resolution process
(ADR) before plaintiffs could go to
court. A state's ADR would have to apply
to all medical malpractice claims in the
state, would require the written opinions
be issued that contain findings of fact,
and would have to be approved by state or
local governments.
Non-economic damages would be limited to
$250,000.
Attorneys' fees could not exceed 25% of
the first $150,000 of an award or
settlement and 15% of any additional
amount.
The liability of each defendant in a
medical malpractice action would be
several and not joint.
Punitive damages would be capped at 2
times the total damage award and these
payments must go to the States to defray
malpractice-related expenses.
SUMMARY OF SEN. CHAFEE'S HEALTH CARE REFORM
PLAN (UNDER DEVELOPMENT)
OVERVIEW - SEN. CHAFEE IS DEVELOPING A HEALTH CARE REFORM
BILL WITH A TASK FORCE OF OTHER MODERATE REPUBLICANS AND
SEN. DOLE. THE CHAFEE BILL WOULD BE SIMILAR IN SOME RESPECTS
TO REP. COOPER'S APPROACH TO MANAGED COMPETITION. THE
CHAFEE BILL WILL PROPOSE INSURANCE MARKET REFORMS, A HIPC
STRUCTURE AND OTHER COMPETITIVE INCENTIVES TO ENHANCE
PURCHASING CLOUT FOR INDIVIDUALS AND SMALL EMPLOYERS.
CHAFEE WILL PROPOSE AN INDIVIDUAL MANDATE IN AN EFFORT TO
BRING ALL AMERICANS INTO THE REFORMED HEALTH CARE SYSTEM.
THERE WILL BE SIGNIFICANT STATE FLEXIBILITY TO SET UP HIPCs AS
THEY SEE FIT.
COVERAGE - THE PLAN WILL REQUIRE ALL INDIVIDUALS TO ENROLL IN
BASIC HEALTH INSURANCE COVERAGE. EMPLOYERS WOULD BE
PERMITTED TO CONTRIBUTE TOWARD THIS COVERAGE, BUT WOULD
NOT BE REQUIRED TO DO SO. A WAIVER BOARD MAY BE ESTABLISHED
TO PERMIT STATE EXPERIMENTATION WITH MEDICAID AND MEDICARE
INTEGRATION. SUBSIDIES TO LOW INCOME PERSONS WILL BE
AVAILABLE AS COST CONTAINMENT SAVINGS ARE REALIZED.
BENEFITS - THE PLAN WILL PROVIDE FOR A GUARANTEED LEVEL OF
HEALTH COVERAGE WHICH ALL PLANS MUST OFFER. COVERAGE OF
PREVENTIVE HEALTH SERVICES AND PRIMARY CARE WILL BE
EMPHASIZED.
QUALITY - INDIVIDUALS WOULD BE PROVIDED INFORMATION ON
QUALITY OF CARE TO INFORM THEIR CHOICE OF PLANS, THEREBY
PROVIDING INCENTIVES FOR HEALTH PLANS TO MAINTAIN QUALITY.
SUMMARY OF SEN. CHAFEE'S HEALTH CARE REFORM
PLAN (UNDER DEVELOPMENT) (CONTINUED)
COST CONTAINMENT - SMALL EMPLOYERS (UNDER 125 WORKERS)
WISHING TO PURCHASE COVERAGE WOULD DO SO THROUGH
PURCHASING COOPERATIVES. INDIVIDUALS NOT OTHERWISE COVERED
WOULD ALSO PURCHASE INSURANCE THROUGH THESE COOPERATIVES.
MARKET PRESSURES COMBINED WITH MALPRACTICE REFORMS AND
ADMINISTRATIVE SIMPLIFICATIONS ARE THE PRIMARY COST
]
CONTAINMENT TOOLS AT THIS TIME.
FINANCING - MEDICARE AND MEDICAID SAVINGS PLUS SOME FORM OF
TAX CAP.
STATUS - CHAFEE IS WORKING WITH 23 OTHER REPUBLICAN SENATORS
ON A TASK FORCE TO DRAFT THIS PLAN WHICH WILL BE INTRODUCED
AROUND THE TIME THAT THE PRESIDENT INTRODUCES HIS PLAN.
HEALTH AIRA POLPREENTO
SUMMARY OF THE NICKLES/McCAIN BILL
(UNDER DEVELOPMENT)
OVERVIEW - CONSERVATIVE REPUBLICANS WILL INTRODUCE A BILL
BASED ON THE HERITAGE FOUNDATION PROPOSALS. THEY ARE
DEBATING WHETHER IT SHOULD BE VOLUNTARY OR INCLUDE AN
INDIVIDUAL MANDATE. IT WOULD END EMPLOYER-BASED COVERAGE
AND CONVERT CURRENT BENEFITS INTO WAGES FOR EMPLOYEES
WHICH THEY COULD USE TO PURCHASE HEALTH INSURANCE.
COVERAGE AND BENEFITS - IF A MANDATE IS CHOSEN, IT WILL BE FOR
A "CATASTROPHIC" LEVEL POLICY.
QUALITY - THERE WILL BE NO FORMAL NEW QUALITY SYSTEM.
COST CONTAINMENT - INDIVIDUAL RESPONSIBILITY FOR PAYMENT OF
HEALTH COSTS AND THE LARGE OUT-OF-POCKET CONSEQUENCES FOR
A CATASTROPHIC PLAN WILL CONTROL COSTS ALONG WITH
MALPRACTICE REFORM AND ADMINISTRATIVE SIMPLIFICATION.
FINANCING - WILL ELIMINATE ALL TAX DEDUCTIBILITY FOR EMPLOYER
PAID HEALTH CARE AND PROBABLY CAP THE BASE OF GROWTH OF
MEDICARE AND MEDICAID.
STATUS - WILL PROBABLY BE INTRODUCED SHORTLY AFTER THE
PRESIDENT'S BILL BY A COALITION OF HOUSE AND SENATE
CONSERVATIVE REPUBLICANS.
H.R. 2610, "MediPlan Health Care Act of 1993"
Introduced by Rep. Pete Stark (CA)
July 1, 1993
Overview: Of the various bills introduced by Mr. Stark, this one is most
representative of his health care reform agenda. Mr. Stark believes that the Medicare
program has been a success and logically should be extended to everyone. Therefore,
H.R. 2610 would create a publicly financed federally administered Medicare-for-all
program. States would be granted substantial flexibility; they could elect to receive
their MediPlan share in the form of a block grant to use in their own health reform
system so long as Federal standards of access, cost containment and quality were
satisfied.
Coverage: The bill provides for universal health care coverage through a newly
created MediPlan program. All residents would be enrolled in MediPlan. Medicaid,
FEHB and CHAMPUS remain only for services not covered by MediPlan.
Benefits: The benefit package would be that which is currently offered under
Medicare plus a new prescription drug benefit (with cost-sharing), preventive services
and pregnancy-related services (incl. pre- and post-natal care, well-baby and well-child
services).
Quality: Quality programs currently utilized under Medicare would remain in place.
The bill includes administrative simplification provisions for electronic claims
processing of all claims, uniform billing, eligibility determination, and the reporting and
coordination of benefits.
Cost Containment: Cost control mechanisms include a national health budget system,
a single rate of payment for all providers (after phase-in), and streamlined
administration.
Financing: A MediPlan Trust fund would be established and financed from a 10% tax
on health care providers based on the amount of benefits provided during the prior
year, payroll taxes, and MediPlan premiums. A State maintenance-of-effort is also
required with regard to Medicaid. No cost estimates are available at this time.
Status: As of 7/20/93, there were no cosponsors for HR 2610. The bill has been
referred jointly to the House Ways and Means and Energy and Commerce Committees.
No committee action has been taken on the bill. The single payer groups have
bypassed supporting Stark in favor of McDermott.
Clinton
HR 2610 Stark
1. Goals/Coverage
Universal access achieved through expanded
Universal access achieved through
employer-based insurance and state
publicly financed Federally administered
administered regional health alliances.
Medicare-for-all program.
Medicare remains in place and expanded.
Incorporated.
Medicaid incorporation phased-in;
Medicaid remains, but only for services
not covered in MediPlan.
FEHB incorporated;
FEHB remains but, only for services not
covered in MediPlan.
VA incorporated for vets;
No provision.
CHAMPUS/DOD study;
CHAMPUS remains but, only for services
not covered in MediPlan.
IHS remains in place and expanded.
Not specified.
2. Benefits
Three (3) options available: fee-for-service,
No provision.
network & HMO.
Guaranteed benefits package include:
Existing Medicare benefits w/addition of
Medicaid acute care services.
hospital and physician services;
Medicare spell of illness limits. No stay
limits or cost-sharing for kids.
preventive care services;
Similar.
mental health (w/ limits phased-in); vision
More extensive.
and hearing for kids;
Similar.
preventive dental for kids (phased-in for
No provision.
adults);
Rx drugs w/ separate cost-sharing;
Similar but cost-sharing $800 deduct./20%
copay.
limited long-term home care services through
No provision.
separate program (with phase-in expansion).
Fee for service cost sharing incl. $250
Cost-sharing: single deductible of $350
deductible & 20% copay, out-of-pocket limit
indiv./$500 family; $2,500/$3,000 out-of-
01,500 indiv./$3000 family; No cost sharing
pocket limits. No cost-sharing for child
for preventive services. Lower cost-sharing
preventive services or pregnancy-related
in managed care plans.
services. Low-income persons have
sliding-scale deductibles.
3. State Role
Federal program administered by States.
Federal program administered Federally.
States given flexibility to meet Federal
States would certify/regulate
requirements.
supplemental health plans.
State options include establishment of a
State option broader; State may elect to
single payer system, an alternative delivery
develop its own program subject to
system w/ multiple plans, or an all payer
meeting federal requirements for
system W/ multiple plans.
universal access, cost-sharing, cost
containment, etc.
Within Federal guidelines States must:
establish alliances;
assure enrollment & access to care for
its residents;
regulate plans, incl. financial
standards, risk adjustment
system, & quality standards;
provide for data/information
systems;
>enforce budgets after a transition.
Clinton
HR 2610 Stark
4. Cost Containment
Similar; Board apportions to States.
A MediPlan budget would be set
statutorily; and equal to the amount
spent for MediPlan benefits now provided
under Medicare, Medicaid and private
health insurance plans.
Statute will set annual allowable premium
Growth in MediPlan would be set at
increases equal to CPI
+
POPULATION.
(approx.) current trend minus 1% and
phase down to the increase in the GDP
over 5 years.
The allowable increase will be adjusted for
No provision.
each alliance to reflect any changes in the
demographics of the alliance during the
previous year.
State budgets allocated according to
N/A
geographic adjustment factors. Federal funds
to States for low-income subsidies.
Payments to providers are negotiated by
HHS would set MediPlan rates of payment
plans, except that provider payment limits
for providers at levels estimated to
:
are one tool available to States/Feds to
the MediPlan budget limit. Payments to
enforce budget.
providers would be made based on existing
Medicare reimbursement methodologies.
No provision.
Expenditures relating to qualified group
and staff model HMOs would not be
included under the budget to encourage
and support these plans.
During years 1-3 the federal government
Federal enforcement.
assumes responsibility for enforcement of
alliance budgets, thereafter the states will
enforce the budgets.
5. Employer Financing
Employer must contribute 80% of the cost of
Employer must contribute 80% of cost of
employees coverage (contribution not to
MediPlan benefits through payroll tax
exceed 7.6% of employee wages).
(approx. .60/hr). Employer contribution
is credited against employees' MediPlan
premium paid through income tax (reduces
adult liability to approx. $300).
Benefits beyond guaranteed level may be
Employers currently providing benefits in
offered for 3 years or duration of contract &
excess of MediPlan benefits required to
receive tax favored status.
continue for current employees and
dependents.
Small low-wage firms employer contribution
No provision.
capped at 3.2% (depending on size and average
wage level).
6. Other Financing
Employees pay up to 20% of avg. premium in
All individuals (except low-income) pay
regional health alliance
MediPlan premium ($1,500/indiv.;
$3,000/working couples) through income
tax system. Children and Medicare
beneficiaries exempt from tax.
States maintenance of effort required
portion of Medicaid.
A 10% tax on providers of health care
benefits under MediPlan.
Cigarette tax.