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Cities need flexibility in health care reform; small towns have special needs, concerns.

The Clinton Administration's health care reform plan and speculation and rumors about it have been the topics of newspaper headlines, radio and television talk shows and dinner table conversation

The fact is cities and towns across the country are struggling to provide health care for citizens against the barriers of escalating costs, a lack of newly trained general practitioners, and limited small town access to new technologies.

Already the estimated cost of the Clinton Plan is expected to be at least twice the original estimates of $30 billion to $90 billion annually. Now, experts point to somewhere in the neighborhood of $145 billion to $175 billion. Realistically, as evidenced by the recent filibuster and eventual doom of the new administration's stimulus package, a high cost health care plan that relies on taxes will meet some heavy resistance.

NLC members agree with a need for health care reform, and experts believe a long-term phased in effort is the best way to approach a new health care movement. Large and small cities have unique health care challenges, with large cities having increased demands on hospitals and health services by the under and uninsured. Coupled with a rise in violence and related injuries, hospitals are buckling under to high costs. This is causing a pass along effect where those residents with health insurance end up with higher premiums to make up the differences.

City governments, traditionally known to offer good benefits to employees, are struggling against higher premiums and a need to provide more comprehensive health care options to employees. The rising cost of health coverage and for health related services to citizens further strain city budgets.

The city of Rochester, N.Y. was higlighted as a national model during the presidential campaign because of its low-cost health benefits plan for city employees. Many city employees who were hired prior to 1989 pay no dollar amount toward their health premiums.

Others pay less than 25 percent of the national premium average.

The low-cost benefit program is the result of a 50-year relationship linking the city government, local industry and the local Blue Cross-blue Shield. A study of the plan may prove helpful to other cities, but its unique makeup and relationship with the insurance provider has created an atmosphere that encourages innovative, low cost health care reform.

President Clinton has stressed his intention to provide basic health care for every American. The new administration says it wants to create long-term care services, develop programs for in-home care for the elderly and improve nursing services. Another goal is to expand medicare and medicaid services to decrease prescription costs for the elderly and the poor.

The key, said Beaumont, Tex. Councilmember Lulu Smith, is "we need to define what we mean when we say basic health care." Councilmember Smith is a family practitioner in Beaumont and sees first-hand the effects of health care's decline from a medical and local elected official perspective. Councilmember Smith said a growing number of small towns find that most of their patients are on medicare and medicaid. Because medicare and medicaid do not provide fun reimbursement of the costs of health services, small towns and cities often face a revenue deficit. Unlike cities with single insured patients, small cities are not able to pass the difference on to other patients.

"What is basic health care and what can we all afford. When we decide that then we can figure out how to pay for it," said Councilmember Smith.

The new administration's plan, it is hoped, will push for innovative approaches such as developing and constructing health centers in rural areas nationwide. Hopefully, much consideration will be taken to tackle the issue of a lack of general practitioners in smaller cities.

"The real problem with opening and improving access to health care is the shortage of primary care physicians. There has to be a policy change in how we train physicians," said Councilmember Smith.

To improve health care access the National Governors Association (NGA) study "Innovative Partnership for Affordable Health Care" suggests consideration of several factors including location, provider availability and financial resources.
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Author:Baker, Denise
Publication:Nation's Cities Weekly
Date:May 3, 1993
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