Capitol Endgame: and Then There Were 6

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 -

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

House majority leader Richard Gephardt (D) of Missouri drafted this plan, closely following the bill approved by the Ways and Means Committee.

It is the closest bill still in play to the proposal the Clinton White House produced last fall.

All employers would be required to offer at least two kinds of insurance plans to their employees. Employers would pay 80 percent of the premiums. Small, low-wage businesses and families with incomes up to $38,400 could receive tax credits and subsidies to help pay for insurance.

Insurers could not deny coverage to anyone, regardless of health status.

By 1999, virtually every American would be covered by an insurance policy worth about $5,670 for a family of four.

People not covered by their employers would be insured under an expansion of Medicare. The program would bill premiums to employers and employees as a private insurer does.

The added cost to the government would be funded by a higher cigarette tax and a 2 percent tax on insurance premiums.

House Republican plan

With well over a hundred cosponsors, this plan designed under the direction of minority leader Robert Michel (R) of Illinois has a larger single bloc of support than any other bill.

All employers would be required to offer - but not to pay for - health insurance to their employees. That insurance would have to meet a basic coverage level set by the National Association of Insurance Commissioners. Policies could be ``catastrophic,'' that is, one with a deductible set at $1,800 a year or higher so that it only covered major expenses.

Lesser expenses could be covered with ``Medisave'' accounts, tax-free medical savings accounts that operate like Individual Retirement Accounts. Families could set aside up to $5,000 a year in a Medisave account, as long as they had insurance deductibles set at $3,600 or higher.

Families earning up to twice the poverty level would receive subsidies to purchase insurance.

Insurance companies could not exclude people because of health problems or drop them because of job changes.

The single-payer plan

Drafted by Rep. Jim McDermott (D) of Washington, the single-payer bill was introduced with about 90 signatures, so it represents a significant chunk of the House.

All Americans would be covered under state-administered, government-funded insurance much like the current Medicare program for the elderly. A national board would cap health spending by state. The federal government would fund 80 to 90 percent of health spending, and states the rest. States would negotiate fee schedules with the providers of health care.

Consumers would have essentially no out-of-pocket health-care expenses. The cost would be paid by an additional tax of 2.1 percent of taxable income and payroll taxes up to 8.4 percent.

House bipartisan plan

Ten centrist House members, five from each party, are working on an alternative plan that would change insurance rules so that policies would be portable from job to job, and so insurers could not deny coverage to people with health problems. It also includes subsidies for families earning up to twice the poverty level and phase in tax deductibility of health premiums for the self-employed.

It would privatize Medicaid for the poor, bringing private health plans into the system.

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