September, 1991 The Broncos' Voice Page 19
"y 1 "y .
Etc., Etc., Etc.
(con't from page 18)
cents of ever>’ premium dollar to
pay for marketing, administration,
and profit instead of paying out
the money in benefits. In the
smallest businesses, insurance
companies keep as much as 40 to
50 cents of every premium dollar.
By contrast, as little as five cents
of the premium dollar is kept by
insurance companies for policies
provided by the largest
businesses.
In addition, small
businesses are often unable to
buy health insurance at any price
if an employee has a serious
illness. Pre-existing condition
exclusions are common. And if
someone in a firm with insurance
becomes seriously ill, the
insurance company often drops
the coverage at the next renewal
period, or premiums may be
raised to such unaffordable levels
that the company is forced to
drop the policy.
HEALTHAMERICA:
AFFORDABLE HEALTH CARE
FOR ALL AMERICANS
(EXECUTIVE SUMMARY) ^
Universal access for all American
families
All employers will be
required to (1) provide coverage
meeting basic standards to their
workers and their families, or (2)
contribute a percentage of their
payroll to a new public insurance
program called AmeriCare.
AmeriCare will provide coverage
to the unemployed, and to
workers whose employers have
chosen to contribute to the public
program. AmeriCare, which will
be administered by the states,
will replace the current Medicaid
program. Premiums under
AmeriCare will be tied to ability
to pay. Through the combination
of coverage on the job or through
AmeriCare, every citizen will be
guaranteed adequate, affordable
health insurance.
The basic benefit package
will set minimum standards for
coverage on the job. The same
benefits also will be provided
through AmeriCare. The package
includes coverage of hospital
care, physician care, diagnostic
tests, and limited mental health
coverage. In addition, key
preventive services are covered,
including prenatal care, well-baby
and child care, pap smears and
mammograms. Services will be
fully covered except for co
payments and deductibles.
AmeriCare will subsidize the cost
of premiums for low-income
citizens, whether working or
unemployed.
Comprehensive Cost Reduction
Program
The cost containment
program in the proposal will
address all four parts of the
problem: cost-shifting,
unnecessary care, excessive
administrative costs and open-
ended reimbursement to
providers. This program has been
conservatively estimated by
Lewin, ICE, a well-known
consulting firm, to save the
nation almost $80 billion in
health expenditures over the next
five years.
Cost-shifting will be
eliminated by universal coverage.
Unnecessary care will be
reduced by (1) a program of
outcomes research to determine
which care is necessary or
unnecessary, (2) development of
practice guidelines to assist
physicians in providing only
necessary care and assist insurers
in deciding what care should be
reimbursed, and (3) an enhanced
program of technology
assessment to help determine the
usefulness of expensive medical
techniques. In addition, the
program will help develop private
and public managed care
programs, which will encourage
patients to use providers who
practice efficient, high quality
medicine.
Excessive administrative
costs will be addressed by
requiring the use of standardized
billing forms, by requiring small
insurers to work together at the
state level for the purpose of
paying bills, and by reforming
the small business insurance
system to cut the overhead costs
paid to insurance companies.
Skyrocketing health care
costs and open-ended
reimbursement to providers will
be curtailed by creating an
independent Federal Health
Expenditure Board coordinated
with state purchasing consortia,
which will be encouraged to
develop innovative cost
containment programs at the state
level. The Board will establish a
process of rate negotiations
between purchasers and providers
of health care within overall
national health expenditure goals.
The Board will also gather and
publish cost and quality data on
providers, so that patients,
insurers and others can use the
most efficient, high quality
providers.
The state consortia will be
able to take additional steps at
the state level to control costs.
For example, the state purchasing
consortia may elect to negotiate
rate and volume levels with
providers within the state. In
addition to these steps, states will
be encouraged to set up new
programs to deal with abuse of
the medical malpractice system
and a new program of research
on cost control will be initiated.
Small Business Assistance
A number of programs to
assist small business are included
in the bill. Small business
insurance reform will reduce the
share of the small business
premium that goes to insurance
companies instead of toward
paying medical costs. The
requirement to provide coverage
or contribute to a public plan will
be phased-in, and will not be
applied to small business if 75
percent of currently uninsured
workers for these businesses are
covered voluntarily. Subsidies
will be provided for small
businesses whose profitability is
so low that they would have
difficulty in affording coverage.
More favorable tax treatment for
health insurance expenses will be
available for the self-employed.
The opportunity to contribute to
public coverage rather than
provide coverage directly will
reduce costs for businesses with
low-wage or part-time workers.
New businesses will not be
required to provide coverage or
make a contribution to the public
program during their first two
years of operation.
The program will be
implemented in three phases. In
the first phase - the first year of
full implementation - firms with
more than 100 employees will be
required to cover their workers
and their families or contribute to
the public plan. All uninsured
children, as well as pregnant
women, will be covered, either
through an employer or through
AmeriCare.
In the second phase,
beginning in the fourth year, all
businesses with 25 employees or
more will be covered either
through private insurance or
through AmeriCare.
In the third and final
phase, beginning in the fifth year,
all Americans will be covered
either on the job or through
AmeriCare. The public program
will be extended to cover
unemployed adults.
The average per worker
cost of coverage is an estimated
$1,680. The employer will be
responsible for 80 percent of this
amount and the worker for up to
*^0 percent. Use of a managed
care plan will reduce these
premiums by an estimated fifteen
percent.
The cost to the Federal
government in the first year of
the plan will be approximately $6
billion. A program of financing
will be developed before this
plan comes to the floor to assure
that it does not add to the Federal
budget deficit.