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Human Development discusses health care reform.

NLC's Human Development Steering Committee met in Alexandria, Va. to finalize policy recommendations on three broad policy priority issues last week. These recommendation will be presented to the NLC leadership at the Congress of Cities in New Orleans in November.

The steering committee, chaired by Maryann Mahaffey, council president from Detroit, divided into three subgroups which reflect the 1992 priority policy issues of health care reform, violence and education.

This marks the third year Human Development (HD) has studied a component of health care reform, this year focusing on health care reform finance. The health subgroup, lead by Dr. Wayne Creelman, councilmember from Cape Elizabeth, Maine, deliberate on the revenue and non-revenue options for financing health care reform identified by the Committee in June. At that time, these reforms were divided into those that would or would not advance NLC policy toward the "ultimate goal of establishing a single, publicly administered, unified program, of coverage and payment" and rated as positive or negative. The group then did an initial review of potential revenue sources based on progressivity, municipal impact and other effects.

At HD's request, NLC's FAIR Steering Committee met jointly in two sessions. At the first, two speakers addressed many of the issues arising out of attempts to develop a program to finance health care reform. The second session provided members with an opportunity to discuss these and other revenues sources.

At the conclusion of this meeting, a set of Principles for Financing a Reformed Health Care System were adopted by HD with the support of FAIR. These principles include the following:

* A progressive financing mechanism;

* A dedicated funding source (trust);

* Finance mechanism should use existing structures;

* Costs should be spread across society;

* All beneficiaries should shoulder at least some financial responsibility for the cost of the benefit;

* Cost containment must be part of any financing plan.

It was agreed that because of the complex and controversial nature of the revenue source issue deliberations would continue between the two committees would continue into 1993.

Health Care Reform

Over the course of the meeting, the committee heard from several individuals who have been intricately involved in the health issue. The first speaker, Mark Nadel, Assistant Director for National and Public Health Issues at the U.S. General Accounting Office (GAO,) provided an overview of numerous revenue source options including a payroll tax on employers (including municipalities); a tax on unearned income; and a value added tax.

Nadel also focused a portion of his remarks on "hidden costs" that is the cost of advertizing, administration and the costs added to the premiums of those with health insurance that subsidize those without. In addition, Nadel noted that the reaction of the public to various finance mechanisms can be influenced by its perception of the fee. For example, Nadel asked steering committee members how they perceived the FICA tax.

Was it considered a tax or a premium? Even in the case of compulsory or mandated fees, a premium is viewed more positively than a tax.

Joy Wilson, Senior Committee Director at the National Conference of State Legislatures (NCSL), addressed the challenges faced by individual states as they struggled to keep up the health care service needs of its residents at the same time the federal government heaps more and more mandates to expand coverage. Wilson, who staffed the Pepper Commission, discussed issues with respect to the phase-in of changes in the nation's health care system as outlined by the Commission.


A second subgroup focused on violence, and crafted policy recommendations that better reflect the priority status of drugs, crime and violence by NLC members and the growing incidence of violence. In June, the subgroup defined violence and identified four categories of victims of crime and violence.

During an afternoon session, HD heard from the City Manager;s of Richmond and Norfolk, Virginia about the collaboration between these cities that lead to a joint legislative strategy to fight violence. Both Robert Bobb, City Manager of Richmond and James Oliver, Jr., City Manager of Norfolk will present their anti- violence strategy in a workshop in New Orleans in November.

The policy recommendations of the Education subgroup, chaired by Katie Nack, Vice Mayor of Pasadena, Calif., emphasize the role of local government in education and offers policy recommendations in support of the linkage between the educational system and delivery of social services.

Other agenda items

Other issues on the steering committee's agenda included family and medical leave, the Americans With Disabilities Act (ADA) and federal mandates. A review of NMP on federally mandated family and medical leave was requested by Beth Davis, President of Women in Municipal Government. Although FAIR has jurisdiction over the issue, HD was asked to review NLC's position in opposition to the mandate because it has responsibility for closely related policy issues. (e.g., job training, health care and children and family issues such as as child care).

HD also responded to requested from both the Small Cities Council and the Community and Economic Development Committee (CED) to review current ADA policy for the purpose of adding language to reflect a greater sensitivity to the potential cost implications to local governments.
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Title Annotation:National League of Cities Steering Committee on Human Development
Author:Quist, Janet
Publication:Nation's Cities Weekly
Date:Sep 28, 1992
Previous Article:Balanced budget amendment studied at FAIR meeting.
Next Article:Hood, Bradley lobby for urban aid.

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