How Health-Care Plan Affects You
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Part-time workers would pay more than 20 percent of their premium cost, prorated according to hours worked. Someone who worked 7.5 hours per week, for example, would pay 80 percent of the premium while the employer paid 20 percent. Thirty hours per week counts as full time.Skip to next paragraph
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With a part-time worker and full-time spouse, however, the employers would divide up their 80 percent share of the family-premium by prorating. PREMIUM COSTS
Many details of what individuals would pay for health care are not clear because no one can be sure how the entirely new, highly controlled, health-care marketplace envisioned by the White House would work.
The cost of health insurance premiums should be held down as companies offering health plans compete for customers. Premium increases will also be closely controlled by a National Health Board. But some health-care providers warn that the caps on premiums could draw premium prices upward as companies stay as close to the cap as they can, fearing the next year's increase will be limited.
Premiums may also have to bear more costs. If the administration underestimated the added cost of its universal coverage, then some of that cost will be carried by tax dollars and some by higher premiums.
In two instances, individuals are very likely to pay more than currently. People who contribute less than 20 percent of the cost of their health plan now will probably have to up their ante to that level, although some employers could still opt to pay more than 80 percent. People whose benefits are more generous than the Clinton standard package will lose the right to deduct the extra cost from their taxes, but only after 10 years into the plan.
Most of the relatively few people who still have such generous benefits either work for the federal government or in the health-care industry. Within a plan, premium prices would vary only by family size. Insurers would be barred from charging more to high-risk consumers. CHOICES
For many people, the Clinton plan will expand choices greatly, since most employers offer a very narrow menu of health plans. Alliances must offer any plan that meets all the qualifications, including a requirement that no plan prices its premiums more than 20 percent above the regional average.
Most of the plans will use managed-care networks, such as HMOs. But each alliance is required to offer one traditional fee-for-service plan, where the consumer uses the health-care provider of choice and receives a bill. These plans would have deductibles set at $200 for individuals and $400 for families and would probably be the most expensive plans available.
Eventually, most experts foresee the market narrowing to about a half dozen large insurance companies and a similar number of HMOs.
``I would be surprised [to see] more than 10 to 15 plans in a region,'' says Mr. O'Donnell of Buck Consultants. JOB CHANGES
Changing jobs does not affect coverage, only which employer pays the 80 percent of the premium. Same with losing a job. After six months, the former employer no longer contributes, and the federal government picks up the employer's share. The consumers with unearned income may still pay their share.