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Capitol Endgame: and Then There Were 6

By Marshall IngwersonStaff writer of The Christian Science Monitor / August 11, 1994



WASHINGTON

HERE are the six competing versions of health-care reform most likely to reach floor votes in either the House or Senate. Debate in the Senate over health care will be free-form and unpredictable. Any senator can propose any amendment to the reform bill that majority leader George Mitchell (D) of Maine has put on the floor -

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from minor changes to complete substitution. The House is likely to see a series of up-or-down votes on four discreet versions of health reform.

Common ground

Every current health-reform plan contains a few basic elements.

* They all would change the rules of the health-insurance industry to make policyholders more secure.

* They all would require insurance to be portable from job-to-job, so that people are not locked into their jobs by the threat of losing their health benefits.

* They all would ban insurers from denying coverage to people with health problems that are likely to be expensive to cover.

* All would make insurance coverage more accessible to people who may have trouble affording it but are not poor enough to qualify for Medicaid.

* All supply some level of subsidy or tax credit to people up to at least twice the poverty level. Senate leadership plan

This plan was recently drafted by majority leader George Mitchell from committee bills and other ideas. President Clinton has indicated his support for this bill.

Health insurance would become more standardized and more secure.

All insurers would be required to offer a package of standard health benefits comparable to a standard Blue Cross/Blue Shield policy.

Insurers would be barred by law from dropping coverage of people who change jobs or have health problems.

The bill would improve access by requiring all employers to offer at least three kinds of health insurance policies to employees, although not necessarily to pay part of the premiums.

After 1996, the government would offer subsidies to companies that volunteered to pay 50 percent of their employees' premiums.

The subsidies would prevent health costs at these firms from rising above 8 percent of payroll.

The insurance plans with the fastest-rising premiums would be levied a surcharge.

If 95 percent of Americans are not insured by 2000, then employers with 25 employees or more will be required to pay 50 percent of their health-insurance premiums beginning in 2002.

Costs to the government of the Mitchell plan would be paid by Medicare cuts, higher tobacco taxes, ammunition taxes, and a 1.75 percent tax on health insurance premiums.

Senate Republican plan

This plan was put together as a Republican consensus bill by minority leader Robert Dole of Kansas, who claims the support of 40 Senate Republicans. He is offering it as an amendment to substitute for the Mitchell bill.

Insurers would be barred from denying coverage to people changing jobs or with health problems.

The government would subsidize insurance premiums for low-income families up to about $22,000 in income for a family of four.

The self-employed and others without employer-sponsored insurance could deduct all of their premium costs, just as large companies now can.

The non-economic damages in medical malpractice suits would be capped at $250,000.

People could establish tax-free medical savings accounts, similar to Individual Retirement Accounts, to save up for medical expenses. House Leadership plan