Every American citizen will receive a Health Security Card that
guarantees you a comprehensive package of benefits that can
never be taken away.
Guaranteeing comprehensive benefits that can never be taken
away. Controlling health care costs for consumers, business and
our nation. Improving the quality of American health care.
Increasing choices for consumers. Reducing paperwork and
simplifying the system. Making everyone responsible for health
care. These are the principles of the Health Security Act of
1993 and they are not negotiable.
In America, rights and responsibilities go hand-in-hand. We will
ask everybody to pay something, even if your contribution is
small. Everyone must assume responsibility. No one should get a
free ride.
Most important, we're going to offer new opportunities and new
incentives for people to stay healthy -- and to treat small
problems before they become big ones. Our goal should be to keep
people healthy, not treat them after they become sick.
What's Wrong With the Current System
The things that are wrong with our health care system are
threatening everything that's right with American health care.
Over the next two years, one out of four of us will be without
health coverage at some point. Change jobs, lose your job, or
move -- and your insurance company is currently allowed to drop
you.
Today's system is rigged against families and small businesses.
Insurance companies pick and choose whom they cover. Then they
drop you when you get sick. If you have a pre-existing
condition, you usually can't get any insurance at all.
Insurance companies charge small businesses as much as 35% more
than the big guys.
Only 3 of every 10 employers with fewer than 500 employees
offer any choice of health plan. Millions of Americans have
almost no choice today.
Twenty-five cents out of every dollar on a hospital bill goes
to bureaucracy and paperwork -- not patient care.
Fraud and abuse are exploding, costing us at least $80 billion
a year. That's a dime of every dollar we spend on health care.
Our nation's health costs have nearly quadrupled since 1980.
Without reform, by the year 2000, one of every five dollars we
spend will go to health care.
The Health Security Plan
Every American citizen and legal resident will receive a Health
Security Card. Once you get your card, you can never lose your
health coverage -- no matter what. If you get sick, you're
covered. If you change jobs, you're covered. If you lose your
job, you're covered. If you move, you're covered. If you have
the courage to start a small business, you're covered.
Your Health Security card guarantees you a comprehensive package
of benefits that can never be taken away. The package is as
comprehensive as the ones that many Fortune 500 companies offer
their employees. And in critical ways -- like paying for
preventive care and prescription drugs -- the package gives you
more than big companies provide today.
You will be able to choose your doctor. Everyone will have a
choice of health plans. You'll be able to follow your doctors
and nurses into a traditional fee-for-service plan, join a
network of doctors and hospitals, or join an HMO. Your boss or
insurance company won't decide how or where or from whom you get
your care -- you will.
Almost everybody will be able to sign up for a health plan at
work, like you do today. You'll get brochures that give you
easy-to-understand information on several health plans -- which
doctors and hospitals are included, an evaluation of the quality
of care, a consumer satisfaction survey, and prices. If you're
self-employed or unemployed, you can sign up at your area health
alliance, which will be run by consumers and businesses and
bargain for affordable health care for you.
The federal government will set up a national health board -- a
board of directors to set standards and make sure you get the
comprehensive benefits and quality care you deserve. State
governments will set up health alliances give consumers and
small businesses the power to buy affordable care; and the
businesses with 5,000 or more employees will be allowed to
operate as "corporate alliances."
Insurance companies will be required to use a single claim form
to replace the thousands of different forms they have today. So
when you get sick, you won't be buried in forms -- and neither
will your nurse, your doctor or your hospital.
Security of guaranteed, comprehensive benefits.
Health care costs that are under control.
Improved quality of care.
Increased choices for consumers.
Less paperwork and a simpler system.
Responsibility from everyone.
That's what the Health Security Act is all about.
Principle #1:
Security: Guaranteed, comprehensive benefits.
Over the next two years, one of every four of us will lose
health coverage for some time. The Clinton plan guarantees that
you will never lose your insurance -- no matter what. All
Americans will receive a Health Security card that guarantees
you a benefits package that is as comprehensive as those offered
by most Fortune 500 companies...and then some. Here's how the
plan guarantees security:
Makes it illegal for insurance companies to deny you coverage
because of "pre-existing conditions." The Health Security Act
also makes it illegal for insurers to raise your premiums or
drop you because you get sick. All health plans will be required
to accept anyone who applies -- healthy or sick, young or old.
Guarantees coverage if you lose your job. The proposal
guarantees that you will keep your health coverage even if you
lose your job, with the employer portion picked up by Federal
revenues and savings. Under the current system, if you lose your
job, you lose your health insurance.
Guarantees coverage if you switch jobs, move or start a small
business. You will always be protected -- no matter what.
Today, if you switch jobs, move or start a small business, you
can find yourself without health insurance -- and risk
bankruptcy.
Emphasizes preventive care. The comprehensive benefits package
goes beyond virtually all current insurance plans by covering a
wide range of preventive services, including mammograms, Pap
smears, and immunizations -- at no charge to you. It puts a new
emphasis on helping you stay healthy, rather than waiting until
you get sick. Prevention saves money and improves people's
health.
Includes prescription drugs. Many insurance companies and
Medicare have failed to cover prescription drugs. But drug costs
are breaking family budgets, forcing many older Americans to
choose between food and medicine. Health insurance should cover
prescription drugs. The Health Security plan does.
All Americans will be guaranteed coverage of :
Preventive Care ( i.e., screenings, physicals, immunizations,
mammograms, prenatal care)
Doctor Visits
Prescription Drugs
Hospital Services
Emergency/Ambulance Services
Laboratory and Diagnostic Services
Mental Health and Substance Abuse Treatment
Expanded Home Health Care
Hospice Care/Outpatient Rehabilitation
Vision and Hearing Care
Children's Preventive Dental Care
Principle #2:
Savings: Controlling health care costs.
Here's how the Health Security Act will control health care
costs:
Limits how much insurance companies can raise your premium.
Insurance companies will no longer be able to raise your
premiums as they please. Today, insurance companies hike your
premiums -- sometimes at several times the rate of inflation -if
you get sick, if someone in your family gets sick, and for any
other reason.
Introduces competition to the health care marketplace. The
Health Security plan will release the chokehold that in today's
system, insurance companies have on all of us -- consumers,
nurses, doctors, and businesses. Reform will encourage
competition -- forcing costs down as health plans compete by
offering high-quality care at an affordable price.
Cracks down on fraud. The health security proposal makes
health-care fraud a crime and imposes stiff penalties on those
who cheat the system. It prohibits doctors from referring
patients to outside facilities, like labs, which they own a
piece of. It stops the kickbacks that some laboratories give
doctors in an effort to get their business.
Asks the drug companies to hold down prescription drug prices.
The Health Security plan asks drug companies to take
responsibility for keeping prices down, without setting prices.
In today's system, overcharging runs rampant --certain
prescription drugs cost Americans three times more than people
pay in other industrialized countries.
Reduces paperwork. All health plans will adopt a single,
standard claims form by Jan. 1, 1995. Along with other measures
to streamline the system and free nurses and doctors from excess
bureaucracy, this will reduce paperwork, cut red tape, and save
money.
Squeezes the waste out of Medicare and Medicaid. By slowing the
growth of these government programs, the proposal uses funds
that have been wasted on excessive charges and funnels them into
comprehensive benefits. Under reform, Medicare will be expanded
to cover prescription drugs, and there will be a new long-term
care program to help cover home- and community-based care.
Today, Medicare and Medicaid spending keeps going up and up. But
the elderly and poor aren't getting any extra benefits. Health
security will change that.
Principle #3:
Quality: Making the world's best care better.
Emphasizes preventive care. The Health Security plan puts a new
emphasis on preventing illness before it becomes a medical
crisis. Prevention will improve the quality of care by helping
people stay healthy rather than treating them after they get
sick. The benefits package fully pays for a wide range of
preventive services; the vast majority of today's insurance
plans don't cover a penny.
Gives consumers the power to judge the quality of care.
Consumers will receive quality "report cards" that provide
information on the performance of health care plans and patient
satisfaction. These report cards will hold health plans
accountable for meeting high standards. The National Quality
Program will help states share information on health plan
performance.
Reforms malpractice. The President's proposal will limit
lawyers' fees in order to discourage frivolous medical
malpractice lawsuits. It will also encourage patients and
doctors to use alternative forms of dispute resolution before
they end up in court. This will help eliminate the "defensive
medicine" that drives up costs and hurts quality -- doctors
ordering extra tests because they fear lawyers looking over
their shoulders.
Encourages cooperation in rural and urban areas. Rural
residents will have access to the latest technology and
emergency services through telecommunications links set up
between local doctors and advanced networks of specialists and
hospitals. In urban areas, the plan will increase investment in
public hospitals and community health centers.
Provides incentives for more family doctors to practice in
rural and urban areas. The health security plan will give
financial breaks to doctors and nurses who work in underserved
rural and urban areas. It will expand the National Health
Service Corps. Two of three rural counties today do not have
enough doctors and 111 rural counties have no physician at all.
Increases funding for prevention research. The National
Institutes of Health (NIH) will expand research in areas like
children's health, and health and wellness promotion. Preventive
care keeps people healthier and saves money at the same time.
Promotes research on the effectiveness of treatments. Today, a
lack of information about the most cost-effective methods of
treatment often leads to expensive defensive medicine and wide
variation in treatments and costs. The plan's investments in
research into what treatments really work will help improve the
quality of care.
Principle #4:
Choice: Preserving and increasing what you have today .
Preserves your right to choose your doctor. The proposal
ensures that you can follow your doctor and his or her team to
any plan they might join. Today, more and more employers are
forcing their employees into plans that restrict your choice of
doctor. After reform, your boss or insurance company won't
choose your doctor or health plan -- you will.
Increases your choice of health plan. You will be able to
choose from among all the health plans offered in your area -no
matter where you work. Only one of every three companies with
fewer than 500 employees offer any choice of health plan. After
reform, every employee will be able to choose a health plan.
Puts consumers in the driver's seat. The Health Security Act
brings competition to health care -- unleashing the market
forces that will lower costs and improve quality. Giving small
businesses and consumers the power to band together in alliances
will level the playing field and give them the same bargaining
strength as big businesses.
Increases options for long-term care. The President's proposal
will make it possible for more Americans to continue to live in
their homes and communities while receiving care. Today too many
families are split apart when insurance or federal programs only
pay for hospital coverage. The plan will help put an end to this
situation and give families the options they deserve.
Principle #5:
Simplicity: Reducing paperwork and cutting red tape.
Gives everyone a Health Security Card. The card -- with full
protection for privacy and confidentiality -- will allow for
electronic billing and the creation of health care information
networks. This will reduce paperwork and simplify the system.
Requires insurance companies to use a single claim form. The
Health Security Act will reduce the insurance company red tape
that forces doctors and patients to spend their time filling out
forms and fighting bureaucrats. All health plans will adopt a
single, standard claims form by Jan. 1, 1995. It will enable
doctors and nurses to spend more time taking care of you -- and
less time wrestling with paper.
Eliminates fine print. Everyone will get a comprehensive
benefits package -- and what you get will be spelled out in
easy-to understand language. If you get sick, insurance
companies won't be able to point to fine print and deny you the
coverage you've paid for.
Streamlines billing reimbursement for doctors, nurses and
hospitals. The comprehensive benefits package, a standard rules
and codes for payment, and elimination of excessive government
regulations will reduce confusion. Doctors, nurses, and
hospitals will have more time to care for patients; and all of
us will benefit.
Removes the burden on business of negotiating insurance. Groups
of businesses and consumers -- regional health alliances -- will
negotiate for high-quality care at affordable prices. This will
simplify today's system, where hundreds of thousands of
businesses negotiate with more than 1500 insurance companies.
The burden of finding insurance will be lifted -- and so will
administrative costs -- which can run as high as 40% of total
health costs for small business.
Principle #6:
Responsibility: Making everyone responsible for health care.
Cracks down on fraud. The health security proposal makes
health-care fraud a crime and imposes stiff penalties on those
who cheat the system. It prohibits doctors from referring
patients to outside facilities, like labs, which they own a
piece of. It stops the kickbacks that some laboratories give
doctors in an effort to get their business.
Asks the drug companies to hold down prescription drug prices.
The Health Security plan asks drug companies to take
responsibility for keeping prices down, without setting prices.
In today's system, overcharging runs rampant --certain
prescription drugs cost Americans three times more than people
pay in other industrialized countries.
Emphasizes preventive care. The Health Security plan puts a new
emphasis on preventing illness before it becomes a medical
crisis. Prevention will improve the quality of care by helping
people stay healthy rather than treating them after they get
sick. It offers you full coverage of a wide range of preventive
services, but asks you to take responsibility for keeping
yourself healthy.
Reforms malpractice. The President's proposal will limit
lawyers' fees in order to discourage frivolous medical
malpractice lawsuits. It will also encourage patients and
doctors to use alternative forms of dispute resolution before
they end up in court. This will help eliminate the "defensive
medicine" that drives up costs and hurts quality -- doctors
ordering extra tests because they fear lawyers looking over
their shoulders.
Everyone contributes, and no one gets a free ride. In America,
rights and responsibilities go hand-in-hand. Everyone will get a
Health Security card that guarantees you a comprehensive package
of benefits that can never be taken away. But we will ask
everybody to pay something, even if your contribution is small.
Small businesses and low-wage workers will get substantial
discounts on the cost of insurance, but everyone must take
responsibility.
HOW THE SYSTEM IS FINANCED
The financing proposal was developed under the most rigorous and
conservative forecasting standards. For the first time,
representatives from every federal agency involved in fiscal
accounting and financial projections have been brought together
to work out the numbers. Then teams of actuaries, health
economists and other financial analysts from outside the
government served as auditors and consultants, checking and
rechecking.
The system is financed from five major sources:
1) Medicare savings -- The savings from reducing the growth of
Medicare are based on specific, scorable policy proposals. Every
penny of these savings will be channeled back into benefits
-prescription drugs and long-term care -- for the people which
these programs serve.
2) Medicaid savings -- The rate of growth of Medicaid can be
reduced primarily by folding the acute care portion of Medicaid
into the overall health care system. Since everyone will be
insured, there will be savings in "uncompensated care" -- the
money that goes to doctors and hospitals to compensate for
caring for the uninsured.
3) Savings from federal employee health care costs -- As all
federal workers are integrated into the overall health care
system, there will be less expense to taxpayers to provide for
their health care.
4) Reducing the benefits of tax-free compensation -- By reducing
the rate of growth for health insurance, the President's
proposal lowers the amount of compensation paid as tax-free
health benefits, and frees up money for higher wages, wages for
new workers, or profits -- all of which are taxable and thus
bring in new federal revenues.
5) Sin taxes -- There will be some new "sin taxes," the
composition of which is not yet decided.
In addition, there will be other savings. Reducing paperwork
and administration, cracking down on health care fraud, and
emphasizing prevention will save money in the long-run.
PAYMENT SCENARIOS
As a rule, most individuals and families in which at least one
person works will pay a maximum of 20% of the average health
plan premium in their area. Those who choose a lower cost plan--
from among those offered in the area -- will pay a little less
than the 20% average. Those who choose a more expensive plan
will pay a little more, as they do today.Employers who currently
pay 100% of health benefits may continue to do so.
Two parent family with children: Two parent families with
children -- whether one or both parents work -- pay a maximum
of 20% of the family premium offered by the average plan in
their area. If both parents work, they choose how to pay their
family's share. They can have the share deducted monthly out of
either paycheck or write a check to the local alliance.
Couple: Working married couples -- whether one or both spouses
work -- pay a maximum of 20 percent of the average plan
premium. They can have the share deducted monthly from either
paycheck or write a check to the local alliance.
Single-parent family: Working single parents with children pay
a maximum of 20 %
of the average plan premium for a single parent policy.
Individual: Working single people pay a maximum of 20% of the
average premium for an individual policy in their area.
Part-time worker with no unearned income: Part-time workers pay
a maximum of 20% of the average plan premium for their policy
type in their area.
EXCEPTIONS
Exceptions are provided for: (1) the self-employed and
independent contractors; (2) part-time workers who have unearned
income; (3) families with incomes below 150% of the poverty
level; and (4) seasonal workers.
Self-employed/independent contractors: The self-employed and
individual
contractors can deduct from their taxes 100% of their health
care costs. As
with any small business, they pay the employer share. They also
pay an individual
share. If a firm earns less than $24,000 a year, it is eligible
for subsidies.
Part-time workers with unearned income: Part-time workers with
unearned income pay a maximum of 20% of the average plan premium
for their policy type -- individual, couple, two parent, or
single parent family.
The number of hours someone works determines how much of the
premium is paid by the employer and how much by the individual.
For example, an employer would pay 40% of the premium for
someone who works half-time. Payment of the remaining 40% of
the premium depends on how much a person makes in unearned
income, with subsidies provided on a sliding scale for those
whose incomes are below 250% of the poverty level.
Families with incomes below 150% of the poverty level: Families
at this level are eligible for discounted premiums and pay a
maximum of 20% of the employee's share of the average plan
premium. This applies to individuals making $10,455 annually;
couples with incomes of $14,145; families of three earning
$17,835; and families of four with incomes of $21,525.
Seasonal workers: Seasonal workers pay a maximum of 20% of the
average plan premium in the area where they reside. Those whose
incomes are 150% of the poverty level or below are eligible for
discounted premiums. If they have unearned income and are not
working, seasonal workers are treated the same as part-time
workers.
Unemployed and non-working: Unemployed individuals and heads
of household who make less than 150% of the poverty level are
eligible for individual subsidies on a sliding scale. Those with
unearned income pay all or part of what would normally be the
employer's share of the premium.
Those whose incomes are 250% of the poverty level or less
-pensioners, for example -- are eligible for discounts on what
would be the employer's share. They are not eligible for
individual subsidies, and pay the normal individual share of the
health premium.
