THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release September 22, 1993
THE HEALTH SECURITY ACT OF 1993
Health Care That's Always There
Every American citizen will receive a Health Security Card that
guarantees you a comprehensive package of benefits that can never be
taken away.
Guaranteeing comprehensive benefits that can never be taken away.
Controlling health care costs for consumers, business and our nation.
Improving the quality of American health care. Increasing choices for
consumers. Reducing paperwork and simplifying the system. Making
everyone responsible for health care. These are the principles of the
Health Security Act of 1993 and they are not negotiable.
In America, rights and responsibilities go hand-in-hand. We will ask
everybody to pay something, even if your contribution is small.
Everyone must assume responsibility. No one should get a free ride.
Most important, we're going to offer new opportunities and new
incentives for people to stay healthy -- and to treat small problems
before they become big ones. Our goal should be to keep people healthy,
not treat them after they become sick.
What's Wrong With the Current System
The things that are wrong with our health care system are threatening
everything that's right with American health care.
Over the next two years, one out of four of us will be without
health coverage at some point. Change jobs, lose your job, or
move -- and your insurance company is currently allowed to drop
you.
Today's system is rigged against families and small businesses.
Insurance companies pick and choose whom they cover. Then they
drop you when you get sick. If you have a pre- existing
condition, you usually can't get any insurance at all.
Insurance companies charge small businesses as much as 35% more
than the big guys. Only 3 of every 10 employers with fewer than
500 employees offer any choice of health plan. Millions of
Americans have almost no choice today.
Twenty-five cents out of every dollar on a hospital bill goes to
bureaucracy and paperwork -- not patient care.
Fraud and abuse are exploding, costing us at least $80 billion a
year. That's a dime of every dollar we spend on health care.
Our nation's health costs have nearly quadrupled since 1980.
Without reform, by the year 2000, one of every five dollars we
spend will go to health care.
The Health Security Plan
Every American citizen and legal resident will receive a Health Security
Card. Once you get your card, you can never lose your health coverage
-- no matter what. If you get sick, you're covered. If you change
jobs, you're covered. If you lose your job, you're covered. If you move,
you're covered. If you have the courage to start a small business,
you're covered.
Your Health Security card guarantees you a comprehensive package of
benefits that can never be taken away. The package is as comprehensive
as the ones that many Fortune 500 companies offer their employees. And
in critical ways -- like paying for preventive care and prescription
drugs - - the package gives you more than big companies provide today.
You will be able to choose your doctor. Everyone will have a choice of
health plans. You'll be able to follow your doctors and nurses into a
traditional fee-for-service plan, join a network of doctors and
hospitals, or join an HMO. Your boss or insurance company won't decide
how or where or from whom you get your care -- you will.
Almost everybody will be able to sign up for a health plan at work, like
you do today. You'll get brochures that give you easy-to-understand
information on several health plans -- which doctors and hospitals are
included, an evaluation of the quality of care, a consumer satisfaction
survey, and prices. If you're self-employed or unemployed, you can sign
up at your area health alliance, which will be run by consumers and
businesses and bargain for affordable health care for you.
The federal government will set up a national health board -- a board of
directors to set standards and make sure you get the comprehensive
benefits and quality care you deserve. State governments will set up
health alliances give consumers and small businesses the power to buy
affordable care; and the businesses with 5,000 or more employees will be
allowed to operate as "corporate alliances."
Insurance companies will be required to use a single claim form to
replace the thousands of different forms they have today. So when you
get sick, you won't be buried in forms -- and neither will your nurse,
your doctor or your hospital.
* Security of guaranteed, comprehensive benefits.
* Health care costs that are under control.
* Improved quality of care.
* Increased choices for consumers.
* Less paperwork and a simpler system.
* Responsibility from everyone.
That's what the Health Security Act is all about.
Principle #1:
Security: Guaranteed, comprehensive benefits.
Over the next two years, one of every four of us will lose health
coverage for some time. The Clinton plan guarantees that you will never
lose your insurance -- no matter what. All Americans will receive a
Health Security card that guarantees you a benefits package that is as
comprehensive as those offered by most Fortune 500 companies...and then
some. Here's how the plan guarantees security:
Makes it illegal for insurance companies to deny you coverage
because of "pre-existing conditions." The Health Security Act
also makes it illegal for insurers to raise your premiums or
drop you because you get sick. All health plans will be required
to accept anyone who applies -- healthy or sick, young or old.
Guarantees coverage if you lose your job. The proposal guarantees
that you will keep your health coverage even if you lose your
job, with the employer portion picked up by Federal revenues and
savings. Under the current system, if you lose your job, you lose
your health insurance.
Guarantees coverage if you switch jobs, move or start a small
business. You will always be protected -- no matter what.
Today, if you switch jobs, move or start a small business, you
can find yourself without health insurance -- and risk
bankruptcy.
Emphasizes preventive care. The comprehensive benefits package
goes beyond virtually all current insurance plans by covering a
wide range of preventive services, including mammograms, Pap
smears, and immunizations -- at no charge to you. It puts a new
emphasis on helping you stay healthy, rather than waiting until
you get sick. Prevention saves money and improves people's
health.
Includes prescription drugs. Many insurance companies and
Medicare have failed to cover prescription drugs. But drug costs
are breaking family budgets, forcing many older Americans to
choose between food and medicine. Health insurance should cover
prescription drugs. The Health Security plan does.
All Americans will be guaranteed coverage of:
* Preventive Care ( i.e., screenings, physicals, immunizations,
mammograms, prenatal care)
* Doctor Visits
* Prescription Drugs
* Hospital Services
* Emergency/Ambulance Services
* Laboratory and Diagnostic Services
* Mental Health and Substance Abuse Treatment
* Expanded Home Health Care
* Hospice Care/Outpatient Rehabilitation
* Vision and Hearing Care
* Children's Preventive Dental Care
Principle #2:
Savings: Controlling health care costs.
Here's how the Health Security Act will control health care costs:
Limits how much insurance companies can raise your premium. Insurance
companies will no longer be able to raise your premiums as they please.
Today, insurance companies hike your premiums -- sometimes at several
times the rate of inflation -- if you get sick, if someone in your
family gets sick, and for any other reason.
Introduces competition to the health care marketplace. The Health
Security plan will release the chokehold that in today's system,
insurance companies have on all of us -- consumers, nurses, doctors,
and businesses. Reform will encourage competition -- forcing costs down
as health plans compete by offering high-quality care at an affordable
price.
Cracks down on fraud. The health security proposal makes health-care
fraud a crime and imposes stiff penalties on those who cheat the
system. It prohibits doctors from referring patients to outside
facilities, like labs, which they own a piece of. It stops the kickbacks
that some laboratories give doctors in an effort to get their business.
Asks the drug companies to hold down prescription drug prices. The
Health Security plan asks drug companies to take responsibility for
keeping prices down, without setting prices. In today's system,
overcharging runs rampant --certain prescription drugs cost Americans
three times more than people pay in other industrialized countries.
Reduces paperwork. All health plans will adopt a single, standard claims
form by Jan. 1, 1995. Along with other measures to streamline the
system and free nurses and doctors from excess bureaucracy, this will
reduce paperwork, cut red tape, and save money.
Squeezes the waste out of Medicare and Medicaid. By slowing the growth
of these government programs, the proposal uses funds that have been
wasted on excessive charges and funnels them into comprehensive
benefits. Under reform, Medicare will be expanded to cover prescription
drugs, and there will be a new long-term care program to help cover
home-and community-based care. Today, Medicare and Medicaid spending
keeps going up and up. But the elderly and poor aren't getting any
extra benefits. Health security will change that.
Principle #3:
Quality: Making the world's best care better.
Emphasizes preventive care. The Health Security plan puts a new emphasis
on preventing illness before it becomes a medical crisis. Prevention
will improve the quality of care by helping people stay healthy rather
than treating them after they get sick. The benefits package fully pays
for a wide range of preventive services; the vast majority of today's
insurance plans don't cover a penny.
Gives consumers the power to judge the quality of care. Consumers will
receive quality "report cards" that provide information on the
performance of health care plans and patient
satisfaction. These report cards will hold health plans accountable for
meeting high standards. The National Quality Program will help states
share information on health plan performance.
Reforms malpractice. The President's proposal will limit lawyers' fees
in order to discourage frivolous medical malpractice lawsuits. It will
also encourage patients and doctors to use alternative forms of dispute
resolution before they end up in court. This will help eliminate the
"defensive medicine" that drives up costs and hurts quality -- doctors
ordering extra tests because they fear lawyers looking over their
shoulders.
Encourages cooperation in rural and urban areas. Rural residents will
have access to the latest technology and emergency services through
telecommunications links set up between local doctors and advanced
networks of specialists and hospitals. In urban areas, the plan will
increase investment in public hospitals and community health centers.
Provides incentives for more family doctors to practice in rural and
urban areas. The health security plan will give financial breaks to
doctors and nurses who work in underserved rural and urban areas. It
will expand the National Health Service Corps. Two of three rural
counties today do not have enough doctors and 111 rural counties have
no physician at all.
Increases funding for prevention research. The National Institutes of
Health (NIH) will expand research in areas like children's health, and
health and wellness promotion. Preventive care keeps people healthier
and saves money at the same time.
Promotes research on the effectiveness of treatments. Today, a lack of
information about the most cost-effective methods of treatment often
leads to expensive defensive medicine and wide variation in treatments
and costs. The plan's investments in research into what treatments
really work will help improve the quality of care.
Principle #4:
Choice: Preserving and increasing what you have today .
Preserves your right to choose your doctor. The proposal ensures that
you can follow your doctor and his or her team to any plan they might
join. Today, more and more employers are forcing their employees into
plans that restrict your choice of doctor. After reform, your boss or
insurance company won't choose your doctor or health plan -- you will.
Increases your choice of health plan. You will be able to choose from
among all the health plans offered in your area -- no matter where you
work. Only one of every three companies with fewer than 500 employees
offer any choice of health plan. After reform, every employee will be
able to choose a health plan.
Puts consumers in the driver's seat. The Health Security Act brings
competition to health care -- unleashing the market forces that will
lower costs and improve quality. Giving small businesses and consumers
the power to band together in alliances will level the playing field and
give them the same bargaining strength as big businesses.
Increases options for long-term care. The President's proposal will
make it possible for more Americans to continue to live in their homes
and communities while receiving care. Today too many families are split
apart when insurance or federal programs only pay for hospital coverage.
The plan will help put an end to this situation and give families the
options they deserve.
Principle #5:
Simplicity: Reducing paperwork and cutting red tape.
Gives everyone a Health Security Card. The card -- with full protection
for privacy and confidentiality -- will allow for electronic billing
and the creation of health care information networks. This will reduce
paperwork and simplify the system.
Requires insurance companies to use a single claim form. The Health
Security Act will reduce the insurance company red tape that forces
doctors and patients to spend their time filling out forms and fighting
bureaucrats. All health plans will adopt a single, standard claims form
by Jan. 1, 1995. It will enable doctors and nurses to spend more time
taking care of you -- and less time wrestling with paper.
Eliminates fine print. Everyone will get a comprehensive benefits
package -- and what you get will be spelled out in easy-to understand
language. If you get sick, insurance companies won't be able to point
to fine print and deny you the coverage you've paid for.
Streamlines billing reimbursement for doctors, nurses and hospitals. The
comprehensive benefits package, a standard rules and codes for payment,
and elimination of excessive government regulations will reduce
confusion. Doctors, nurses, and hospitals will have more time to care
for patients; and all of us will benefit.
Removes the burden on business of negotiating insurance. Groups of
businesses and consumers -- regional health alliances -- will negotiate
for high-quality care at affordable prices. This will simplify today's
system, where hundreds of thousands of businesses negotiate with more
than 1500 insurance companies. The burden of finding insurance will be
lifted --and so will administrative costs -- which can run as high as
40% of total health costs for small business.
Principle #6:
Responsibility: Making everyone responsible for health care.
Cracks down on fraud. The health security proposal makes health-care
fraud a crime and imposes stiff penalties on those who cheat the
system. It prohibits doctors from referring patients to outside
facilities, like labs, which they own a piece of. It stops the kickbacks
that some laboratories give doctors in an effort to get their business.
Asks the drug companies to hold down prescription drug prices. The
Health Security plan asks drug companies to take responsibility for
keeping prices down, without setting prices. In today's system,
overcharging runs rampant --certain prescription drugs cost Americans
three times more than people pay in other industrialized countries.
Emphasizes preventive care. The Health Security plan puts a new emphasis
on preventing illness before it becomes a medical crisis. Prevention
will improve the quality of care by helping people stay healthy rather
than treating them after they get sick. It offers you full coverage of a
wide range of preventive services, but asks you to take responsibility
for keeping yourself healthy.
Reforms malpractice. The President's proposal will limit lawyers' fees
in order to discourage frivolous medical malpractice lawsuits. It will
also encourage patients and doctors to use alternative forms of dispute
resolution before they end up in court. This will help eliminate the
"defensive medicine" that drives up costs and hurts quality -- doctors
ordering extra tests because they fear lawyers looking over their
shoulders.
Everyone contributes, and no one gets a free ride. In America, rights
and responsibilities go hand-in-hand. Everyone will get a Health
Security card that guarantees you a comprehensive package of benefits
that can never be taken away. But we will ask everybody to pay
something, even if your contribution is small. Small businesses and
low-wage workers will get substantial discounts on the cost of
insurance, but everyone must take responsibility.
HOW THE SYSTEM IS FINANCED
The financing proposal was developed under the most rigorous and
conservative forecasting standards. For the first time, representatives
from every federal agency involved in fiscal accounting and financial
projections have been brought together to work out the numbers. Then
teams of actuaries, health economists and other financial analysts from
outside the government served as auditors and consultants, checking and
rechecking.
The system is financed from five major sources:
1) Medicare savings -- The savings from reducing the growth of Medicare
are based on specific, scorable policy proposals. Every penny of these
savings will be channeled back into benefits -- prescription drugs and
long-term care -- for the people which these programs serve.
2) Medicaid savings -- The rate of growth of Medicaid can be reduced
primarily by folding the acute care portion of Medicaid into the
overall health care system. Since everyone will be insured, there will
be savings in "uncompensated care" -- the money that goes to doctors and
hospitals to compensate for caring for the uninsured.
3) Savings from federal employee health care costs -- As all federal
workers are integrated into the overall health care system, there will
be less expense to taxpayers to provide for their health care.
4) Reducing the benefits of tax-free compensation -- By reducing the
rate of growth for health insurance, the President's proposal lowers
the amount of compensation paid as tax-free health benefits, and frees
up money for higher wages, wages for new workers, or profits -- all of
which are taxable and thus bring in new federal revenues.
5) Sin taxes -- There will be some new "sin taxes," the composition of
which is not yet decided.
In addition, there will be other savings. Reducing paperwork and
administration, cracking down on health care fraud, and emphasizing
prevention will save money in the long-run.
PAYMENT SCENARIOS
As a rule, most individuals and families in which at least one person
works will pay a maximum of 20% of the average health plan premium in
their area. Those who choose a lower cost plan -- from among those
offered in the area -- will pay a little less than the 20% average.
Those who choose a more expensive plan will pay a little more, as they
do today.Employers who currently pay 100% of health benefits may
continue to do so.
Two parent family with children: Two parent families with children --
whether one or both parents work -- pay a maximum of 20% of the family
premium offered by the average plan in their area. If both parents
work, they choose how to pay their family's share. They can have the
share deducted monthly out of either paycheck or write a check to the
local alliance.
Couple: Working married couples -- whether one or both spouses work --
pay a maximum of 20 percent of the average plan premium. They can have
the share deducted monthly from either paycheck or write a check to the
local alliance.
Single-parent family: Working single parents with children pay a maximum
of 20 % of the average plan premium for a single parent policy.
Individual: Working single people pay a maximum of 20% of the average
premium for an individual policy in their area.
Part-time worker with no unearned income: Part-time workers pay a
maximum of 20% of the average plan premium for their policy type in
their area.
EXCEPTIONS
Exceptions are provided for: (1) the self-employed and independent
contractors; (2) part-time workers who have unearned income; (3)
families with incomes below 150% of the poverty level; and (4) seasonal
workers.
Self-employed/independent contractors: The self-employed and individual
contractors can deduct from their taxes 100% of their health care costs.
As with any small business, they pay the employer share. They also pay
an individual share. If a firm earns less than $24,000 a year, it is
eligible for subsidies.
Part-time workers with unearned income: Part-time workers with unearned
income pay a maximum of 20% of the average plan premium for their
policy type -- individual, couple, two parent, or single parent family.
The number of hours someone works determines how much of the premium is
paid by the employer and how much by the individual. For example, an
employer would pay 40% of the premium for someone who works half-time.
Payment of the remaining 40% of the premium depends on how much a person
makes in unearned income, with subsidies provided on a sliding scale
for those whose incomes are below 250% of the poverty level.
Families with incomes below 150% of the poverty level: Families at this
level are eligible for discounted premiums and pay a maximum of 20% of
the employee's share of the average plan premium. This applies to
individuals making $10,455 annually; couples with incomes of $14,145;
families of three earning $17,835; and families of four with incomes of
$21,525.
Seasonal workers: Seasonal workers pay a maximum of 20% of the average
plan premium in the area where they reside. Those whose incomes are
150% of the poverty level or below are eligible for discounted
premiums. If they have unearned income and are not working, seasonal
workers are treated the same as part-time workers.
Unemployed and non-working: Unemployed individuals and heads of
household who make less than 150% of the poverty level are eligible for
individual subsidies on a sliding scale. Those with unearned income pay
all or part of what would normally be the employer's share of the
premium.
Those whose incomes are 250% of the poverty level or less -- pensioners,
for example -- are eligible for discounts on what would be the
employer's share. They are not eligible for individual subsidies, and
pay the normal individual share of the health premium.