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'Let the health care debate begin in earnest.'

With the release of the Administration's health care proposal, the national debate on health care reform can begin in earnest. Since the beginning of the 102nd Congress, at least 40 bills have been introduced in the Senate and more legislative proposals are expected to be introduced before Congress adjourns this fall.

The pending proposals fall into three general categories: Market-based--This approach, illustrated by President Bush's recently introduced initiative, would use a mix of tax credits and vouchers to make the purchasing of insurance coverage affordable, encourage the use of managed care as a way to reduce health care costs, create a pooling system to assist small businesses provide health insurance and streamline Medicaid. (see February 17 NCW).

"Pay or Play"--The "pay or play" proposal is exemplified by S.S. 1227, introduced by Senate Majority Leader George Mitchell (D-DE). It would require employers, including municipalities, to provide health insurance to employees or pay a tax to the federal government to provide that coverage under a public plan. NLC has historically opposed this type of federally mandated employee benefit.

Under a pay or play plan, municipalities would be required to determine the percentage of payroll they currently spend on health insurance for their employees and compare it to the tax levied against them by th federal government to provide such coverage. Current bills use a 7 or 9 percent tax.

"Single-payer"--This approach would establish one government-sponsored health care system and is illustrated by H.R. 1300 sponsored by Rep. Marty Russo (D-IL). Variations of this concept include a "Medicare for All" plan, a modified Canadian-style plan.

What is at stake for municipalities

In cities and towns across the country, municipal leaders are increasingly confronted with the consequences of a health care system that has failed to meet the health care needs of millions of people--most of whom work and many of whom have children.

The reasons for this failure are numerous and are compounded by the rapidly rising costs of medical services and health insurance, the increasing number of uninsured and underinsured individuals, an aging population, the deepening AIDS epidemic and the startling increase in the number of violent injuries and deaths of individuals caught in the intensifying drug trade.

As the federal debate progresses, municipal officials will be faced with agonizing choices. There will be many trade-offs and sacrifices, none of them satisfactory to everyone. This series of articles will address many of the issues municipalities will be forced to examine and evaluate and if they wish to assure themselves a voice in the provisions which will form the final comprehensive health care bill.

Prognosis for 1992

Although both House and Senate leaders are pushing to pass a comprehensive reform package before the 1992 Presidential election, we do not expect a final bill to be voted on by both Houses of Congress until 1993.

About the Series

During the course of the health care reform series, each category (i.e., market-based, "pay or play" or "single payer") will be illustrated through currently pending legislation, followed by a series of questions about the issues of importance to municipal officials.

Many of the authors are in general agreement on several broad policy issues including universal access to basic services. What is missing, however, is a payment mechanism.

Municipal officials have a tremendous stake in the evolution of the health care reform legislation. The current state of our nation's economy has placed an enormous burden on governments at every level. As employers, we face many of the same financial stresses as other employers, (e.g. steeply rising health care premium costs, canceled policies, and exclusions from coverage. Moreover, unlike private sector employers, municipal employers fund employee benefits with tax payer dollars.

Over the past two years, NLC has been engaged in the process of reformulating national municipal policy on health care reform. The task was at times overwhelming and contentious. Nevertheless, with the assistance and intense interest of municipal officials from across the country, NLC last December adopted a set of principles and criteria from which to build a more detailed policy. Those principles and criteria will provide the foundation for further development of municipal policy this year.

Principles and Criteria adopted by

NLC in December 1991 include:

The defining of adequate services should respect the continuum of health care and include preventive, primary, remedial, rehabilitative, mental health and long-term care. Coordination among education, acute and chronic care treatment, and psychological and social services is essential.

Administrative expenses and procedures should be minimized. The multiplicity of payers should be drastically reduced with the ultimate goal of establishing a single, publicly administered, unified program of coverage and payment. A unified level of care must be provided in the fifty states and territories.

Standards of care and cost containment mechanisms must be designed to ensure access to quality health care. Quality assurance activities, including data gathering and monitoring, must be utilized to ensure and maintain quality health care, protection of consumers, and allocation of resources.

The National League of Cities believes that transportation polices need to be reviewed to ensure that the poor and remote have access to health services and facilities.

The National League of Cities believes federal programming should actively promote the education and distribution of medical, nursing and allied health professionals to meet critical health manpower shortages and address the geographic maldistribution of such personnel. Particular attention should be devoted to the health care needs of rural communities and central cities.

Restructuring the health care system must begin with major strategies and mechanisms to control costs and reduce the rate of growth in health care expenditures and coverage costs.

Where required, individuals should contribute to the costs of their coverage, according to their ability to pay and in the interest of equity. Individuals should use services appropriate and responsibly. Implicit is the notion that our citizens must be educated to the responsible health consumers.
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Author:Mahaffey, Maryann
Publication:Nation's Cities Weekly
Date:Mar 2, 1992
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