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Uninsured problem continues to puzzle Congress.

Uninsured Problem Continues to Puzzle Congress

Divergent views on how to provide access to health care to the 37 million uninsured Americans continue to confront Congress. At least that was the situation depicted by key legislators who addressed members of the Self-Insurance Institute of America at a recent legislative conference in Washington, DC.

"If you want to reform the current [health care delivery] system, then you start stepping on people's Guccis," said Sen. David Durenberger (R-MN) as he summarized the tough choices that Congress faces. Sen. Durenberger, as well as Rep. Henry A. Waxman (D-CA), another speaker at the two-day conference, is a member of the U.S. Bipartisan Commission on Comprehensive Health Care, which was scheduled to release its recommendations on March 1.

According to Sen. Durenberger, "The only way we're going to cure the access problem is by writing a financial guarantee to every American." He said this could be done by allocating additional funds through the federal budget, providing national health insurance as in Canada, mandating that employers provide coverage as in Massachusetts or creating a single-payer system.

All of these approaches, however, present significant hurdles. For example, if the federal government were to cover the 37 million uninsured and the 5.8 million people requiring long-term care through Medicaid, the cost would be a prohibitive $75 billion. "Why put $75 billion into a system that's broke... and nobody is happy with?" asked Sen. Durenberger.

Although Canada boasts a system with which everyone appears to be content, it has one serious flaw. "If there weren't a United States of America," explained the senator, "there wouldn't be a hell of a lot of health care. Somebody's got to make the investment in the technology."

What we need to do, implied Sen. Durenberger, is change people's attitudes and bring back "good old-fashioned insurance." Insurance, he explained, is supposed to provide protection against catastrophe, a fact that medical insurance ignores. In addition, the current system reimburses people for the consequences of their own irresponsible actions, such as smoking cigarettes.

Rep. Waxman, on the other hand, sees a clear answer to the problem in a bill that he and Sen. Edward Kennedy (D-MA) are sponsoring. The Basic Health Benefits for All Americans Act would require employers to provide a minimum level of health benefits to all their employees. The act would also expand Medicaid coverage to those not employed or covered under Medicare.

"The bottom line is that the idea of requiring employers to provide health benefits is no longer an obscure congressional proposal," said Rep. Waxman. "The State of Massachusetts, while off to a rocky start, has implemented a universal access program that requires employer participation. The State of Hawaii is many years into its successful experiment with mandating employee health benefits. And their efforts have not escaped the notice of other states."

Rep. Waxman's proposal, however, was attacked by the self-insurers. They contended that many of the expenses covered under Rep. Waxman's bill, such as prenatal care, immunizations and nursing home and institutional care, exceed the coverage provided by their health insurance plans.

Unhappy with the Kennedy-Waxman bill, Rep. Fred Grandy (R-IA) discussed a bill, the Health Empowerment and Partnership Act (HEAL), he was about to introduce. HEAL would give self-employers a 100 percent tax deduction for health premiums for themselves and their employees (about 25 percent of the uninsureds, according to Rep. Grandy), as well as require access to group health plans for employees, other uninsureds and COBRA eligibles. The act would also provide tax incentives to encourage the creation of multiemployer plans and ERISA pre-emption of state health benefit mandates.

"The HEAL bill is designed to provide incentives to make health care more affordable and accessible without heavy-handed government controls," said Rep. Grandy.

Offering the Bush administration's outlook, William Roper, deputy assistant to the president for domestic policy, said the uninsured situation must get worse before all sides are willing to compromise on legislation.
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Title Annotation:access to healthcare
Author:Schussel, Mark L.
Publication:Risk Management
Date:Mar 1, 1990
Words:657
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