Calling adequate medical care a "right," Senate Democrats on Wednesday unveiled legislation to expand health coverage to the nation's 37-million uninsured. The legislation encourages businesses to provide health insurance coverage to their workers. Companies that refuse are hit with a payroll tax that finances a new government program for uninsured workers and the unemployed.
For customers of either private insurance or the government program, the basic, required benefit package would cover hospital and doctor services, diagnostic tests, pre-natal and infant care, mental health benefits and early detection tests like mammograms.
Other portions of the bill are aimed at curbing spiraling health care costs by creating a system to negotiate the fees of doctors and hospitals, reforming the insurance industry and wiping out unnecessary medical procedures.
During the news conference to announce the bill, the Democrats drew comparisons between people living with little or no insurance and the excellent care afforded President Bush during his recent hospitalization for Graves Disease.
"Access to affordable, quality health care should be a right for all Americans, not merely a luxury for those who have the economic means to purchase health insurance," said Majority Leader George Mitchell of Maine, the Senate's top Democrat.
Mitchell predicted a health reform bill would pass the Democrat-controlled by the end of 1992. He was joined by Sens. Edward M. Kennedy, D-Mass., Jay Rockefeller, D-W.Va., and Donald Riegle, D-Mich.
The legislation drew favorable reviews from a number of interest groups, including the American Medical Association (AMA) and National Small Business United. But those two groups called it only a first step, and said they differed with parts of the bill.
"With today's action, the Senate Democratic leadership joins the AMA and many others who believe that it is time to reform U.S. health care," said James S. Todd, AMA executive vice president.
Reviews from the Republican camp were cooler. Several GOP senators praised the Democrats' hard work but said the bill was flawed, especially in the mandates it places on private business.
"It may pass, but it ain't going to be signed into law (by President Bush). Not in the form it's in now," said Sen. Orrin Hatch, R-Utah.
Hatch, among others, suggested that the Democrats were setting up a 1992 political issue. Mitchell denied it, saying, "It is our intention to make law, not a political issue." The GOP senators are drafting their own plan.
Another trouble spot: The sponsors are vague on how it would be financed and how much it would cost.
The first year of the program would cost $6-billion, but it could easily double when the legislation is phased in over five years. To pay for it, the sponsors would cede Congress' traditional tax-writing authority to the secretary of Health and Human Services, who would get the job of setting the level of a new payroll tax the Democrats want. One preliminary suggestion is that the new payroll tax would range from 6 to 8 percent, borne by employers.
The keystone of the plan is a notion called "pay or play" borrowed from last year's recommendations of the Pepper Commission, named for the late Rep. Claude Pepper, D-Fla.
Under the plan, businesses would get a choice: provide coverage to workers or pay the new payroll tax. Employees would be required to accept their company's coverage for themselves and their families, and would pay a share of the insurance costs.
Contrary to a popular misconception, more than two-thirds of the country's uninsured belong to a family where at least one member works full time. More than a quarter of uninsured Americans are children.
Sponsors predict that employers with highly paid workers will choose to provide insurance, if they aren't already. Lower-paying companies may end up sending employees into a second part of the program known as AmeriCare.
The new AmeriCare program would replace Medicaid, the federal-state program that provides health care to the poor. In addition to serving employees of companies without a health plan, AmeriCare would provide care to the uninsured and unemployed.
People with incomes below the federal poverty level would pay no premium for the AmeriCare coverage. The premium would be partly subsidized for those individuals with incomes up to double the federal poverty level.
A third component of the legislation would save, by the sponsors' estimate, $78-billion over five years by cutting costs of health care. The costs of U.S. health care reached $672-billion last year.
About the legislation
Here's a snapshot of Senate Democrats' health care legislation.
What would it do? _ Provide basic health care coverage to 37-million uninsured Americans.
How does it work? _ Employers must provide insurance to workers and their families, or the company would face a payroll tax. A new AmeriCare program provides coverage to the unemployed and workers whose companies don't offer insurance.
What would it cost? _ Employees pay 20 percent of a yet-to-be determined premium. Deductibles would be $250 per individual and $500 per family. Users pay 20 percent of the cost of services, with a limit of $3,000.
Those living below the poverty line would be exempt from the charges.
For employers, the payroll tax may range between 6 and 8 percent.
When would it begin? _ First year: Companies with more than 100 employees provide coverage to their workers and their families or face the payroll tax. All uninsured children and pregnant women are covered, no matter what the size of their company.
Fourth year: All businesses with 25 employees or more are covered.
Fifth year: All Americans are covered. This is first year that unemployed adults would be covered.