The hearing room was thick with lobbyists. There were smiling men from Red Lobster restaurants, serious people from the American Association of Retired Persons and dozens of diligent others from organizations worried about health care reform.
As the lobbyists, reporters and staffers looked on, a House subcommittee Tuesday took Congress' first public step toward writing legislation that could grant health care to all Americans.
The bill that the House Ways and Means subcommittee on health considered on Tuesday would require employers to pay for their workers' coverage and would extend Medicare to low-income workers and the uninsured. It also would cover prescription drugs for everyone, including the estimated 30-million senior citizens and disabled people who are currently Medicare Part B beneficiaries.
Sponsored by subcommittee Chairman Fortney "Pete" Stark, D-Calif., the 167-page bill is less complicated, less generous and quite likely less costly than the massive proposal put forth by President Clinton. But Stark's legislation meets Clinton's goal of creating universal health coverage, and does so by January 1997 _ a year earlier than the president's program.
Stark doubts his bill will be the final version that passes Congress. But it is evidence that _ with several serious proposals floating around Capitol Hill _ none has the 218 votes needed to pass the House and 60 votes to clear the Senate.
"At this point there are 218 separate plans in Congress and one hopes we can narrow that down to three or four," Stark said in jest this week.
By laying out a plan for public inspection, Stark knew he would draw criticism from some and spur action among other lawmakers who don't want to let him get all the credit. Other congressional committees expect to start work in a few weeks.
"Everybody is waiting for something to happen, and then they'll react," Stark said.
No votes were taken Tuesday, as lawmakers and everyone else listened to Stark and his staff explain the legislation. Stark won praise from the White House, congressional Democrats and some Republicans for beginning the arduous process of writing a health care bill. The work in his subcommittee will continue for a couple of weeks.
"We must keep our eyes on the prize. We must have universal coverage," said Rep. John Lewis, D-Ga.
Stark's bill takes particular aim at the problem of uninsured people working for small businesses. His staff estimates that two-thirds of firms with fewer than 100 employees are not providing health coverage, whereas 98 percent of firms with more than 100 employees already offer insurance.
Under his bill, employers with more than 100 workers would be required to provide private health insurance beginning Jan. 1, 1995. These firms would pay at least 80 percent of the premiums.
Companies with 100 or fewer workers have two options. They could buy private insurance. Or they could enroll their employees in a new Medicare Part C program created under the bill, starting Jan. 1, 1997.
Employees who could afford it would pay 20 percent of the premium in any case. The poor would receive a subsidy that would be phased out when their income reached 200 percent of the poverty level. This year, 200 percent is $23,732 for a family of three.
Benefits provided under Medicare Part C would be similar to those available under Medicare now. Hospital stays and doctor's care would be covered, though the deductible paid by current beneficiaries would be slightly lower than now charged. Mental health care would be covered, too, though with a 50 percent co-payment for services.
In addition, Stark's bill would cover prescription drugs for the seniors who are now enrolled in Medicare Part B as well as everyone else. Patients would be responsible for a $500 annual deductible payment and co-payments of 20 percent of the cost of the prescription. Their out-of-pocket prescription drug bills, though, would be capped at $1,000 annually.
By creating Medicare Part C, Stark would put the nation's 37-million uninsured and those at small firms into a government-run health care program that he says would have lower administrative costs than most private insurance plans. In all, Stark's staffers estimate 60-million or so people would be covered by the government program.
Costs of the bill were still hazy Tuesday, because the Congressional Budget Office had not completed its analysis. The legislation tries to keep medical spending down by slowly lowering the amount of money that doctors, hospitals and other health care providers can collect from the new Medicare Part C program.
All in all, Stark's approach is likely to be cheaper than the president's plan, which the CBO said would swell the deficit by $74-billion by 2000.
Stark's plan does not require private insurance plans to be overseen by regional health alliances, like the president's plan does. Stark is not as generous as the president in subsidizing coverage for people age 55 to 64 who retire early. Nor does it begin expanding coverage for long-term health care.
To pay for his proposal, Stark would follow the president's idea and raise cigarette taxes. He also suggests a 0.8 percent payroll tax on all employers that would raise $24-billion a year.
Money raised from these taxes would flow into a trust fund that would finance Medicare Part C. That trust fund would be separate from the account that finances current Medicare benefits, as a way of insuring that those getting coverage now would not be threatened.
What is Medicare?
It is divided into two programs: Part A provides hospital insurance, limited skilled nursing home care and home health care; Part B covers doctor's services, some clinical services, diagnostic tests and medical equipment.
Most people over 65 are entitled to coverage under Part A, and it currently covers an estimated 36-million people. If they go into the hospital, they pay a one-time co-insurance charge set at $696 this year. The stay is free for the first 60 days, and then patients begin sharing the cost of care.
Part B is voluntary, though most seniors enroll in it. Those who do pay a monthly premium, set at $41.10 this year, to help finance the coverage and also are generally responsible for co-payments that amount to 20 percent of the bill.
_ David Dahl