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State, local leaders forge agreement on health care reform.

State, local and business leaders last week reached agreement on a joint public-private statement on health care reform that focused on a managed competitive approach and an expanded federal role for primary and preventive care. The group also agreed that local governments must be full partners in any such arrangement.

NLC First Vice President Sharpe James, mayor of Newark, and Second Vice President Carolyn Long Banks, councilwoman-at-large of Atlanta, led NLC efforts at the NGA-sponsored national meeting in Washington last week. The meetings purpose was to reach consensus on providing access to health care for all Americans and for containing the costs as they affect all levels of government.

The agreement calls for a managed competitive approach to health care with attention to ensure that the approach' will work both in rural small towns and inner cities. The agreement calls on the federal government to establish a national health care board that includes state and local representation.

The National Governors' Association, National Conference of State Legislatures, National Association of Counties, U.S. Conference of Mayors, American Business Conference, Committee for Economic Development, National Federation of Independent Businesses, Business Roundtable, and the International City/County Management Association all participated.

After reaching agreement on a joint public-private statement on health care

reform, the leaders began efforts to reach agreement on a strategic plan to eliminate the federal deficit by the beginning of the next century and provide for an increased federal role in providing the investment in human and physical infrastructure necessary for economic growth. The leadership group is scheduled to reconvene on January 19th to complete action on the plan.

Colorado Governor Roy Romer, the Chairman of the National Governors' Association, who chaired the heatlh care summit, said the meeting was intended to help break the gridlock that has held up action on fundamental changes in the nation's health care system. Noting that the growth in health care costs has adversely impacted every level of government, eroded the global competitiveness of U.S. businesses, but left far too many Americans without access to affordable health care; Romer described the highlights of the agreement, saying it would ensure that cities and states would be at the table with the Clinton administration and the new Congress in fashioning a response to the nation's health care crisis.

The key points of the agreement include:

* a managed, competitive approach;

* portability of benefits;

* limitations on discrimination again st beneficiaries;

* a single claims form;

* an expanded federal role for primary and preventive care;

* tax deductibility for selfemployed and employees to a level comparable to a level provided by the most effective HMO plans;

* a basic benefit package; and

* an agreement to a partnership with local governments.

Bank's, who succeeded in getting the group to adopt language guaranteeing a full partnership for local governments and universal access, thanked Romer for his leadership, saying:

"We are pleased this agreement mirrors many of the policies and concerns reflected by our membership in New Orleans earlier this month at our Congress of Cities. Dealing with health care costs and access is critical to cities of all sizes. We know where the buck stops, so we will continue to work together to make those tough choices and sacrifices necessary to insure affordable investment in all our citizens.

Total health care costs have risen in the nation from $250 billion in 1980 to over $800 billion this year. Health care costs, especially Medicare and Medicaid, have become the fastest growing parts of the federal deficit and state budgets, and, for many cities and towns, among the fastest growing costs of local budgets. Yet, despite health care spending at levels far higher than any other nation, more than 30 million Americans in cities and towns have no health care insurance."

The participants agreed that every American must have health coverage. They agreed upon a goal of reducing the rate of overall growth in health care spending to 9 percent in 1994, 7 percent in 1995, and 5 percent after that. Such a goal, if reached, would reduce the federal deficit alone by $888 billion between this year and the end of the decade.

Eliminating the Federal Deficit

After completing consensus on controlling health care costs, Romer began the discussion of options for reducing the federal deficit. The leaders adopted a goal of eliminating the deficit in at least equal installments by the end of the decade and said that goal should be accomplished by excluding the surpluses in dedicated trust funds, such as Social Security and the Highway Trust fund.

On the key issue of strategic investment, Mayor. James prevailsed in the debate over whether the group should support only deficit elimination, or restructuring the federal budget to reduce the deficit and provide for a greater federal role in human and community investment:

The American people sent a clear message to the nation just one month ago when they elected Bill Clinton--not Ross Perot--that we need to do beth. The federal government must take the lead in helping to put people back to work. If people don't have jobs, then all the cutting in the world will never balance the budget; it would only increase the misery index in our cities.

"It would be unrealistic to ignore the human and physical stimulus needed to put the nation back on its feet again, to make our country competitive, and to revive economic growth and opportunity."

As its final budget goal, the group adopted the motion to include strategic investment as part of their working agenda for the January 19th session on proposing structural changes to the federal budget. The meeting is scheduled to take place immediately after a special luncheon of the nations governors with President-elect Clinton:

The Key Points of the Agreement

* a managed, competitive approach;

* portability of benefits;

* limitations on discrimination against beneficiaries;

* a single claims form;

* an expanded federal role for primary and preventive care;

* tax deductibility for self-employed and employees to a level comparable to a level provided by the most effective HMO plans;

* a basic benefit package; and

* an agreement to a partnership with local governments.
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Title Annotation:includes related information on various points of the agreement
Author:Shafroth, Frank
Publication:Nation's Cities Weekly
Date:Dec 21, 1992
Words:1016
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