-
https://clinton.presidentiallibraries.us/files/original/07bd411e4ad0978a97ad41829d9bd84c.pdf
24836ca43aee9469be01f75f72b0edf0
PDF Text
Text
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. Revenue Estimate of High Cos1Plan Assessment
o
.....
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N
A$Sumes Mandate in 2000 (No Premium Caps)
r..>
"
....
(Q
(Fiscal Years; $ Billions)
I-'
1997
1996
1995
1998
1999
2000
2001
2002
2003
2004
1995.....
1999
19952004
35 Percent High Cost P.lan Assessmenl
0
O.
0.6
1.2
2.1
7.5
12.2 .
16.~
21.9.
28.7
3.9
90.3
.25 Percent High Cost PlanAssessment
0
0
0.4
O.B.
1.4
5.1
8.2
10.8
14.7
19.2
2.6
60.6
....
.....
'N
~
N
0
N'
.0)
. NO
N
I-'
Department of the Treasury
Office of Tax Analysis
July 23, 1994
.....
.....
N
NOTE: eased on initial specifications which assumed that any' plan would be subject to the assessment If the premium exceeded target Does not take i
contained in July 21,speclffcation,In w~ich a plan would only be subject to the assessment if, in addition, the weighted average premium for plar.
exceeded the reference premium fOriHe area.
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.....
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N
-~
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Insurance Assessments in July 22 Option
"'
N
c.>
Assessments as Percent of Cost of Average Plan
"'
<0
....
2000
Community
Rated
Plans
2004
Experienced
Rated
Plans
o
-I.
'(
Community
Rated
Plans
Experienced
Rated
Plans
.....
....
....
c.>
~
N
Mandate in 2000
o
N
Academic Health Centers
Risk Assessment 1/
25% High Cost Plan Asses~f!len1 2/
Total
1.75%
1.5%
. 1.75%
1.4%
g.9%
3.2%
1.5%
3.5%
3.2%
5.2%
4.9%
6.7%
99%
71%
100%
100%
1.75%
1~75%
ell
N
N
.....
....
....
t..:>
..
% of plans Subject to High Cast Assessment
o
,"'1
(")
1/ Community:-ra1ed ptans would receive an offsetting payment, equal in the aggregate to the revenues collected by the risk assessment.
21 Based on Initial speCifications which assumed that any plan would be subject to 1he assessment if premium exceeded target.
Does not take Into account modifica1ion con1atned In July 21 speCification, in which a plan would only be subject to the assessment if,
in addition, the weighted average premium for· plans in a region exceed the reference premium 10r the area.
Ratio is the gross revenue as percent of premiums for 1axed plans.
.
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01/25/94:: ~8: 20
U
1aI001
..
"'''.
TH.EWHITE BOUSE
.. WASHINGTON, DC 20500
FAX COVER SHKKf
PATE:
TO:
TIME: _--,-_ _-
__
Bob 'p r;; •
NO~: ____~--------
PHONE: (202) 456-
r;f:[J)
PAGES AFTER COVER: _~ _~
_
�01121/94
raJ 0.::.,:02=--_
18:21
07-25-94 U5:50 PM
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T"'I HlOllleT...... 0' "I:ALf••111= .. ..,..,AN K""'IOU '
,
~he S.fto~.bleAlb~t
........NC fOIll, 111.1:, lUll
June I. 1.94
Core, Jr.
Pr.uUu'!. of't~. Sll'\U.
,W•• ~Ln~tonl De ;0$10
• DaQ Ill.;.
P.I:'esident;
Enclosed· tor c;:ona1dszoaUon tty 'the Cangna. U a drat.t bill
ch.nreG in Medicare aft~ Medica!4 4a~a ~o11eatioD
·~o ~e
'requiramantg.
The 4ralt bill would post~e by 18 Month» the ~.~l~~eftt
f'or IimlPl.oyen to eol1ec:1:. 1111.1 'l:b plan enrolllllen'l: 4ata for the
Mealoare and Ke4ioai4 Cov.rat. gata Sank. the d••ft bill wou14
AlsO require Medicare 1ntl~m.dilr1.1 ana earziars to colleat and
~&t~h data from thei~ p~iy.t. line. of Duainell w1th Med1~.r.
data for t~. p~rpose of earryin9 out the K.diQ~. a.cond~ paye~
prov18ion" and votild nquire u, 'to lend queat1on~a' •• s
.
concernin, p:1vate health plan cov.~.,a to 1ndivlQuala .ho~tll
:
before. their Medicare
cove~aqe
be9in8.
i~pl.m.ntltion of the data bank provi.ion.
~orX with CODgrea. and tbe ~g.1n
p community
'0 enSU~. that the data bank ~tn~le. the burden 0& e.,loy.~a
and 18 eon.11~.nt
c&re reform. ~-requlr...nt tha~
0.1ay1n9 the
would allow us to
••
W'tb bealtb
~oQ!~a:. !nto~o~l.:i.e
and oa:~l.:. 001160t and .etoh p.1y~t.
M.dieare dAta would prevent t~. 1n.pprap:l.~. payment
of'HediGare tund., would ~eduge contl1ot of int.~ •• t p:o~l...,
an4 would lOl18ft thg workload fa: :eGGv.rt•• that ~\11iz. m&~ah~.
with social Seeur1ty and In~ornal Revenue 3,.v1ca aata. The
initial enrollmont ~~Qstioftftaire would 1dent!ly "ft~ eecondar¥
da~a 'vlt~
p~y~!'
belp
aitunic!lnj 'f)e,fen I
beneficiary filed "la1m. In4 would also
topr.vent a1ataxan primarl payments •
0'
• • " lb3'l'&. 18 Dtcnth <Salay in c::oU'lOlt1nlJ heal'th plan en.ollme.rl'c, 6a.tt
. would :c.ult ,1n all .LnGr••••
$348 Million. in endt.lollleAt.
.pend1n; over Uot'l.8.1 years un throuQ'h un. 'but th11 inara..e
wQuld be otf •• t by.savini5 of $350 million to~ th. aame pe.iod
r.,ulting from intermediary and cazrier data oolleetio~ And
roat~h~ng, p~o4~~inq,
.. net five ye•• saving_ of '2
The provisions 0: the draft bill ara
,th. enc::lose4 eection-by-.oction .~~a~f'
W. ur9- ~. eonlJ~e8S to
favor.blQ conaicaration_
I
~1ve
~111on.
a•• c:1bed
the d.l:'&tt bLll its
.
1n dOtl11 1n
p~o~Pt
and
�4'
01123/94
~
•
18:21
07-25-,94
lb'
0.
IilJ003
fi'
05; 50 PM
P03l08
FROM OT.P
Page 2 - The Honorable Alben Gore, Jr.
We a~. advised by ~hR Office of Mana9am.n~ and Ju4get tha~
enac~~.n~ of the 4~att
of ~he p~as~ ••nt.
bl11 would.
be
in Acoor4 with
~b.
protr..
�0'7/23/94
III 004
18:21
07-25-84 05:50 PM
P04/08
Hilt.! niP
SUMKAR't
:or
PROPOSED MEDICARE AND M!DICA.!D
DAfA~COLLEcrtO~ AKE~DKENTS
Sar;Uon 1 A.dina the duft bill
0' 1"4
the .hon: titl. nX8d1ie.re
a.1\1!! M:.:IIIUeaid Oat.. e&:illec:tiQn AmenduntG o:l! U9-1".
I
S.~ti.~n
I.
.
.~ploy.ra
Oa~a Bal\](.
2 !'~.tpcneG by 1.8 lII.nShe the requi••lIIent for
to collect ca~a fer ~n. Me41CarQ and Medicaid ecv.rag.
,
I
S.ction 3 reql.1i'lOllls MedicAre inta~e4h;dg& and caZ'J:'1*r. !:a
"c:'o'lf"Je~ anI! maint.ain data (aa may lM ap.cUbcl ~ U. SISc:rete.ry)
trgm thlli;r.- pdvilt. Un•• v! business, anc! ma~Oll tholla data witlt
Mo~iea~. dat., tQ~ the purpos.of carryin~ .~~ ~ho Me~Lgare
s.ccnr!ary payer provb1cns.
.
,
seeeion 4 raqu1raa the
See~otary ~o
.end a quagt!onnaire
C:ClIncet'n1n'i pdvat.e h'e41th plan CQveraq. ~Ci1 imHv1duils .~
leaat
two Manths ~.for. thoy become entitled ~a M.d1caro Hoepital
In.urano. (IU) ~.n.t,l~. {Qr .~ the time of IPpl1catlen tor
K.4!aa~. ~e~.!!~. hy: indLv!4~.lG not entitlQd to HI covor.g.).
�OT/25/94
IaI 005
18:22
P05/0S
~o
make ch.n9•• in
H.d1oa~a
co~l.ctLen
and M.dicaid data
,t.qu.J..:uafttJl.
$.
$£~t%O~
~,
'QOS$.d by th.B'Ult. ond aquss of
1. IKORT TITLE
~D R£FEl£HC~8
RIPE.''Dt't1y''
Qf
IN AeT.
cal Short T!1;.lo. --1'1118 Act MY 'be e!ted. u
th. "Mecu'c::o:e a:nd.
Me('U.cal0 oat.a. Collec'l:.inn Am.ndments ot Ut4 1!.
(~) R.~Ar.nc••
t:..h~, ~e!al,
security
in
~ct.--Tb. I=Qn4m.~t.
tn tni. Act apply to
Act.
gte. 2. DELAY IN rKPL2M1NTATION or MEDICARE AND MEDICAID COV%IACI
DATA BANK.
S.otion lH4(c) (1.) fA) is .1IIsnd.eCS-· ,
(l) lily st.r1X1"fJ "1994" and. in••rtin9.'11U6It, An4
.
(3) DY 1n.eninq "foX" the six lIol"lth pedod ".,inning en
JUly 1,1995 anC1ri after "para9J'lph (5)4t.
SEC. 1. D1T1'HATCHINC BY
'Cal In
the
l.a~
INTlRHlD1A~IES
G.fto~al.--Tho laa~
AND eARRIBIS.
.,n'ene. Of "Qt1on 18lti(C)(lJ and
.entenc. of aeotion 184Z(b) (a) (A) are
(1) 1:1)", IItdll'.ln9 "II1I1Y
(2~byat~1~1n~
a~t1v£t1.a
not" I.n4
.I~h
1nle~t1119
amaftd84-.
"shall 1t • and
"matcb data oetalne4 other
under thl. part vith data
u~.d
~.n
in
i~.
tn the
'adlllini.tZ'ulQn ot. this part It and in-uttft9 "oon.Clt. an4
maintain dabC.. may be IIplc1f1ed by the SeGJ:'etary) relat.Cl
8003
..
to its acUvitieA (9;' the Aotivities ot
undAr
co~on
ovnersbip
O~ ccnt~Q1)
any 9th,,;,
oth'r than
en~1~y
1t~ act:lv~t1.9
�(\0'
0'7/25/94
..
.,$
18:22'
•
ilJ006
t7
07-25-94 05'SO PM
OLP
F~oM
P05/08
.'
2
u"da~
this part, and mateh thol. daea with
adlaini.t:r&tioft ('!If
(~)
~hi.
~atA
us.d 1ft
P"'l!'t.,".
feohn1oal Am.nd•• nt.--The laat •• ntoncB of section
1116(Q)(1) and the la.t ••ntonc. ot ••ctlon lB4a{b)CI) (A)
•
each
,a.ppiy t,e
Dats.-·Tha
Btt._~lv.
aljlraelllants
~r
Ibi$
cal
enaotment of this Act.
SEt. 4. MEDICARE INtTtlL ENROLLMENT
. ' ,.
ayg•• gt1on
.~8ndm.nt. ~ad. by
anI! contracts. enterl4 l.nto or renawed anal!'
30 day. attar the 4!'ti!!
0»>
.~.
&nIandri b)' Itt,,11dnV "18'71" and in.lllrt:;lni "11'74" •
:urth~r
(~)
~h8
QUESTIONNAI~ZB.
•
(a) In C4ilnaral. --s.eUon un (b) (5)
,
~.a1ft.nd.ct
by &d1l11\1' at
tho end the following:
"(D) obtainin9 tnformation
looet
~w.
montha beto.e an
t~gm
benefloiari••• --At
indlY1Q~al Yil1-~.Qome
entitled (uPQn appl1y&t1on) to b.n.,it_
(or
tn.
When
Secretary is
un~.r
tlr.~ 1n:crm.~
..
Of
part A
~hat
entitlement, it la~er}. or at ~ha'~lme an individual
applies for
an~olll1l.nt
•• ct~on 1818
f~r
under part B (or applies
Gnl'ollment un4,¥
.p'a¥~
A), 'he
. Sea~.t.~ shall provide the individual A
to obtain
lnfQ~.tlon
'eQVe~84 ~n~er
on vh.ther the
un4~
~.~eiDOn.lr.
ind1Yid~.1
1.
0 prl~arl plan and on th. nature ot ~I~
.
eg,(eraqe. ft •
(b]
~tt.ct1v.
Oat•• ··tha amendment made by tUba.et!an (a)
'a,ppl'i@lll ~o entlt.l.ment.1 undu pArt J.
of
tith XVIII at the S6eial
Saeur1eY-Aet thatbeglft litter. and to onroll1ll8nte unciaI' that:.
~itl. ~.~
occur after,
1994.
�07/25/94
18:22
IaJ 007
D7-25-94 05:50 PM
PROM OJ.?
Soot-ton _ __
P07/0B
PARTICIPATION AND LIMITS ON EXTRA-BILLIBG
(a) ",AFeiG:£'A'l'ION.--Any physician or S!uS'pliQr may voluntarily
enter int~ an agreement with a plan to ~9come a ~artlci~~~ln9
pDYS'iClan or I!IUppl1lu;. for purpol!lee of t.hb section., tho to:rm
"p~lclpat!n9' PhY4!floian, 8uppUez or other perlon" lIean. a
physlcilll'l., 8upplier or other persqn 'fhO, betore the. begInning Of
• y.aZ', enter. !n~Q ~n agrQ.m*nt with a plan whiQh pZ'QvI4.a thot
s\loh phya1c1a.n, BUppUVl: or other person will accept asSIgnment
for p.~.ftt for all items and services tuZ'nlahed ~o indlvldualB
enrolled 1n such plan foZ' .ucb year.
.
(b). LIMIT.TION ON AC'l'UALt cItARGES.-
IN GENERAL.-·In the ease of a phy81elan l Ruppl1er or
per.on who 18 not a p~.tlcipatlnQ physician, aupplier az
oth." P01:sort and. who cloe.1!I not aCioept ,aymet\t on an assigl'UllQnt
baste for a sarvic8 furnlshad with ra.pec~ to an IndiVidual
enrolled ln a plan, the follow1~9.rulel apply,
(l)(A)
o~her
(1) APPLICATION OF LIMITING CHARGE.-·NO per.on may
bill or collftCt'.cm .illCtU&l charge fo¥' the aenic:e 1n exce••
of the
limi~ing
onarge
d.8~~1bOd
In paragraph (2).
(11) NO LIABtLITY rOR IIcass C8ARGeS.--No peraon Ie
l1ablo for payment of any amount I billed for tho lorvieo in
Axea•• of suoh.limiting ~harg•• ·
.
(Iii) CORaECTION OF EXCESS
CHARGES.~-It
.ueh a
Buppl1er or o~her person bl1ta, but douD no~
C'QilKt, any act\&al charge for a lJervice In v.101at.1en et·
clau•• {i), the physician, auppl1eJ.', ar other person shall
reouce on a timely basis the actual oha"g~ bl11ed for the
••rvice to an amount not to exceed the limit1ng oharge for
~Ph~~lan,
thCl 1IC11'Vice.
(1v) REF~ OF EXCESS COLLECTIORS.--If much a
physician, supp11.r or other person cOllectB an actual
cllergefor t\ .eervlc:e in v101at1on of ClllUS8 (1), t-he
pbYBLalan, 5uppller, or otheZ' parsonahall provide on a
timely haSia a refund to the 1ndividual charg.~ in an amount
by wb~~h the AmQunt oo~!o~ted exceeded the lImiting aharge
fO~ th. service.
The amount of such a refund .hall be .
rBduCeQ to the .x~ent the ind1vidual h•• an outatandlnq
balance owed. by the Ind1vidu.l to ~hQ p~y81alan. '
(8)
SAMC'1':r:01fs .... -If
ell
phye!cian, auppl1er or other per8on-
(1) knoWingly 4nc ~111fully ~1111 0; collect" tor
••rvicee ,tn 'Vi9latlon of liuDpora qraph (A) (L) en, a npel&t~ bad.,
or
'.~
(11) faLls ~o comply with claus. (!il) or (lv) of
subparagraph (A) on a ti~aly ba.i.~
.
�01123/94
III 008
18:23
01-2.5-94 05:50 PM
P08/08
FROM IiLP
the plan may apPlY sanctions specifted Dy the secretary ot
Health and Ruman Servicee 8Qainlt tne Physician, Supplier or
·othwt 'Person.
(C) ~IM!L¥ BASla.--Fo~ purpose. ofthls paragraph, a
correotion of a bill for an exee.s eha~ga or refund of an amount
with r.epe~t tQ ~ vlQlatlon Of subparagraph (A}(1) 1n th. Ga•• Qf
a .Q~v..1DO 11 conddarGd to .be provided • 011 Ci t1Uly basts I, it
;.he reGuctlon or refund is 11"_ not later than 30 daYIl .tt.~ 'the
date
th. phye1c1an, luppl1er or other
perlo~
is notified by the
plan of Buch violation and of the ¥8qu1remen'ts of
8U.bpara~raph
(A) •
.
(2)
l.IMITING CHARGE DB!'INED ...·Th. "l!mltlnq Charge" shall
be 125 percent of the
recQgnl~.C'l ~~ymant a~ount under tho plan
physician., 8uppllerB or other persons who .re not
,.ertlclpaF1ng phy;1cianst euppl1eZ:08 or othor penon.. For
putpoees; of the prevloue senteneet the "l:eCo;niuc! ,payment
.moimt'· meana t.he fee 8cheg\lle amoun't eltaJ:)118hs4 by the pl«n fo~
phyS1Cians. lJuPJillien Qr perClona wht;l are not pa.l:t.1f;l.\paUng
~hy,.~cian81 suppliers or.othe~ p9racne for that year.
!~
(1:)
INCENTIVES FOR PARTICUATION.--In .applying tho t •• liiIehedul.
tUIt:.abU.hed by " plan 1n 'C.he c::ase Ofa 81!'1rvice furn£.hed by a
ph!"·.1c:Lan, oupplier or other p•.rlon who 1& no'!; a Da%t.1~1patJ.n9'
pIl¥CI·1f;l1an, supplier or otherpa~80ftl the f •• ecne<1ule amount.
aheil be 95 percent of aucn amOunt Qtha~18. applied.
�·,
"
"
~
...
JUL 06'94
ID:
18:15 NO.010 P.01
,
DATE: 7/6/94
TIME: 6:10 pIn
Executive Office of the President
Oflicc of Management and Budget
Health Policy
725 17th Strc~t, NW, Room 7()21
Washington, DC 20503
FAX: (202) 395-3910
To:
Nancy-Anll Min; Chris Jennings; Ken Thorpe
FAx#:
Voice: (202) 395.3844
5..728,9; 6·7431; 40]-7321
Voice #:
From:
Linda BJumberg and Len Nlcho)s
Notes:
. Following Is a secorid \'crsion of 50/50, Including transitional measures outlined by Ken.
Everything needs to be fleshed out, but we wanted to make sure that this is the general
direction everyone is thinking about.
Number of ]'ages (including cover sheet): 3
�·JUL 06'94
ID:
o
Standard benefit package = HSA·8%
o
No mandate until Janunry 1, 1999
o
18:16 No.010 P.G2
Transition period January 1, 1997 through January ]. J999
Transition policies are as follows:
'
=
• .
hnplel'ncnt insurance reforms and standard henefit package rules, including
non-discrimination rules. No suhsidies available to employers.
•
Provide 100% subsidies tu households under 75% of poverty without current
coverage. Phasc-nul percentage of prellifum subsidies between 75% and 150%
of poverty. The same subsidi.es would he available to those losing lheir jobs
that had insurance through their employment.
•
•
provide constrained growth plan pa(;kuge to employers nOl currently offering
insurance in the small group « 25) market. Package would be solicited by the
federal guvernment. from private sector insurers .~ plans would agree to limit
premium increuse$ to 6·7% per year ~. !\ee Florida experience for details of
how to do tIus; If employer contrihuted at least 50% of premium. worker 50%
share would be subsidi7.ed on an income-based schedule).
•
2% free rider assessment
•
Tobacco tax
•
o
Provide a sec(md year of Medicaid funding for those Jeavirig welfare' for work;
Coverage cOlltinues through separate Medicaid program.
1% assessment on 500+. if prOvide (2% if don't
provid~).
Mandate period -- Januarr 1, 1999 and forward.
•
As of January ],1999. implement 50% employer mandate on hrms of >= 20
workers; individual mandate on familics. Tho!>e firms with fewer [han 20
workers have no mandate, but:must pay a 2% of payrol1 asse~sment jf they do
not provide 50% coverage to their workers.
•
. Employers subsidized according to retrcat model 3 (3.5%-7,9%) for 50% share
of standard benefit.
•
Community rating for those at or below 500 workers; experience rating above
500 workers. No opt-in to community ratc. and J % assc~sment on those over
500.
•
'
lmplemcnl a Bradley-esque high cost plan asscssment.
�JUL .06' 94
ID:
18:16 No.010 P.03
CommllnilY Rating Pool: Target is adjusted mean in the community
rated pool. with growth equal to HSA rales plus 1% (lagged to begin in
1997).
.
Experience Rated Group: Targel is adjusted mean in the experience
rated pool, with growth equal to HSA rates plus 1% (lagged to begin in·
1997). PJan premium will be adjusted to take the pool's experience into
account. for firms of < 1000.
~et
sllch that revenue and !Subsidy losses due to growth in excess
of targets is recaptured.
Rate is
•
Household subsidies availahle for 50% worker shan~ for hOllscho1ds up to
200% of poverry. Non-workcr/Carve-out suhsidies available for other 50%
share lO huuseholds up Lo 200% of poverty.
..
Tax credit expansion for individual premium contributions ..
Tobacco tax
..
1% payroll assesssment on the 500+ firms.
�,.
HHS
'6'202 401 i321
18:51
ASPE/HP
. -r'O
ffiGH-COsr PLAN ASSESSMENT
I4l 0021003
?~~~&)) -
/0 7(}
i
(~;'>'. " "
.
:':dlESCRIPUON
};(~,i:'
.
.
'
s;:;>,
The Senate Finance Committee adopted a provision that would place an annual
.
'M~s,essmcnt on high cost health plans. In the view of its proponents, the amendment has two
;:;:purPoses: (1) To achieve market-oriented cost containment by dampening demand for high
';:i,9pst. health plans; and (2) To finance the cost of the legislation.
,
.
,: ~~ .. -';.
.
•
I
,
.
'W,!,:.
The high cost plan assessment would work a,s follows:
The 40% most expensive health plans in each geographic area are subject
to an assessment. The assessment is equal to 25% of the difference between
a plan's premium and the average premium in the area.
•
The 25% least expensive health plans nationwide (adjusted for cost of
living) are exempt fr()m tbe assessment, even if they are among the most
expensive plans in their area. Th1S provision is intended to help areas that
have, in general, kept health care costs down.
The assessment applies to supplemental benefits as well as the standard
benefits package.
·\k,;:. ,
A number of concerns have been raised about this amendment, particularly by
J~~rgani:z;ed labor:
:;~~.>
I
' .'
•
The assessment would penalize plans witb supplemental benefits. Of
particular concern to organized labor is the effect on many self-insured plans'
offered by large employers (which often have lower deductibles and
coinsurance than the standard package),
•
The assessment would penalize plans whose costs are high because of their
structure (e.g. self-insured fee foc service -plans often offered by larger
employen).
•
The assessment would unfairly affect plans whose premiums are bigh
because they serve an older or sicker population. This is partiCUlarly true of
self-insured plans offered by large employers in mature industries, because
(hese plans do not draw their membership from a broad community_ Many of
these plans, for example, have; large retiree populations, whose costs tend to be
quile high.
\
�I
~
. ' 07/06/94
18: 51'
.
\4]003/003
HHS ASPE/HP
'5'202 401 7321.
,
.
, . ,I
.
,
\.
rOSsmLE WAYS :to ADDRESS 'CONCERNS
,
.,
'I
. The aInendrnerit could be cha~ged or~larified in relatively minor 'ways (0 address;
'some 'of the concerns that -have been raised:
.
•
•
,
The asseSs'~ent would ·be applied only aft~r adjustments for: the risk of a
health plan's ·participants.. This means that planS would,not be penalized for
having an older or sicker population~ _
.Since sdf-insured plans ~ffered py ..a:~eremp19yeI:s do bot participate
. risk adjustment,a different assessment ·mechanism, may be appropriate for.
them. One approach. would be to assess self-insured· plans based on their
, . premium increa.scs rather than thei~ actual premit;Im .levels. For example,
self-irisuredplan that had a high 'premiUm because its .D;1einberli were old or
sick, would. be 'subject to an assessment only if its premium incr,eased fa~tcr
than the average ,for other plans.
..
in
a,
"
••
Supplemental benefits could. be treated separately. For example, in the
. Health Security Act, employer-provided supplemental l?enefits were treated as
t~able income for employees beginning in 2004.. Of partIcular importance to
organized labor is 'the fact that the Health Security Act did' not subject
~rnployet-provided·costshadng coverage (Le. supplemental coverage ·that .
lowers deductiblesor coinsurance) to taxation,
•
.
\
'
I
{.
" I
','
.
�LIST (7/6/94 Revised) '"
1~
Alabama
Sen.
Sen.
Rep.
Rep.
Shelby
Heflin'
Bevili
Browder
2. Virginia' ,
Sen. ,Robb
,Rep. BO'l.l.cher
Rep. Byrne
Rep., Payne
Rep. Pickett
Rep. Sisisky'
Texas
3.'
Rep. Anp,rews
Rep.' Bryant
Rep. Chapman
, Rep. ' Edwards,"
' 'Rep; Geren,
Rep. Green
,Rep., 'Laughiin
Rep. pi~kle
Rep., Sarpalius
,:Rep. Wilson'
,
"
,
,,"
\
4.
North Dakota
5'.
New Jersey
, Sen. Conrad+
Sen. Dorgan
Rep,. Pomeroy
Sen. Lautenberg
Sen. BradleyRep. Pallone,
6;
Louisiana
Sen~ Breaux
\,
Sen. Johns,ton
7. ' Nebraska
Serio Kerrey
, Sen. Exon
, 8.
Kentucky
Sen.
Rep.
Rep.
Rep.
9.
Ford·
Baesler
,Barlow
Mazzoli
r
Georgia
Sen."Nunri
Rep. Bishop
Rep. Darden'
\:
�"
y
I '
10. Missouri
Sen. Danforth
Sen. Bond,
Rep. Skelton
'I
',\
11. Mi~nesota
Sen. Durenberger '
Rep. Minge+
Rep. Penny
Rep. Peterson
12. ,South Carolina
Sen. ,Hollings
Rep. Spratt
13. Arizona:
Sen. Deconcini
Rep. 'English
14.Callfornia'
Sen. Feinstein
Rep. Harman'
Rep. Lehman
Rep. Schenk
15. Pennsylvania
Sen. Specter
Rep'. Holden
Rep. Klfnk
Rep. Margolies-Mezvinsky
Rep. McHale'
16. Oklahoma
Sen. Boren,
R~p. McCurdy
17. Wisconsin
Sen. Kohl
'Rep. Barca
"
18. Colorado
Sen. C9mpbell+
Sen. Brown
"
,
19. Oregon
, Sen., Hatfield
,
Sen.' Packwood
20. Nevada
,Sen. Bryan
"
21-
Connecticut~
Sen. Leiberman,
, 22. Delaware
Sen. 'Biden
23. Rhode Island
Sen. Chafee
,
\
"
\
\
�24. Maine
Sen.' Cohen
2.5 • North Carolina
Rep. Lancaster
Rep. Neal
Rep. Valentine
\
26. Ohio
-Rep. S. Brown
Rep'. Fingerhut
Rep. Mann
\
.
27. Indiana
Rep. Hamilton
Rep. Long+
-Rep. Roemer'
28~
Kansas
Sen. Kassebaum
29. New Mexico
Sen. Domenici
30. Michigan
Rep. aarcia
Rep. "Stupak'
3,1. Illinofs
Rep. Lipinski
Re.p. Sangmeister
.
'.
32. Washington
Rep. Caritwell
Rep. Inslee
33. F'iorida
Rep: Hutto
34. 'Tennessee
. Rep.
.
I
Clem~nt
35. Idaho
Rep. Larocco
36. Arkansas
Rep. Lambert
37. West Virginia'
Rep.- Moliahan
38~
Massachusetts
Rep. Meehan
+
.
(
= HSA,Cosponsor
�(.
Uninsured
ALL YEAR
Uninsured
Part Year.'
37
TOTAL~
58
.
\
36
~----------~-----~---~-------------~---
NOTE: Most of those uninsured part year are workers in-between
jobs.
\ .
\
/
.
\
/.
-"
\
,
I
.
.
�
Dublin Core
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Title
A name given to the resource
Chris Jennings - Health Securities Act
Creator
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Domestic Policy Council
Chris Jennings
Health Securities Act
Is Part Of
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<a href="http://clinton.presidentiallibraries.us/items/show/36173" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/647904" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
The Health Security Act (HSA) was an effort by the Clinton Administration to provide universal health care in the form of a comprehensive national health care bill which emphasized managed care and called for the creation of regional health care alliances. This series contains material which provides a detailed analysis of the Health Security Act. A chronological subseries within this file focuses on legislative strategies to enact the HSA, as well as efforts on the part of the Clinton Administration and its supporters to counter intense opposition to the legislation from opponents in Congress and powerful interest groups. This file also contains material which examines in detail the alternatives to the Health Security Act, particularly single-payer plans and a compromise proposal from a bipartisan group of moderates in Congress called the Mainstream Coalition. This series contains memoranda, correspondence, reports, press releases, briefing papers, statistical data, graphs, legislative drafts, publications, and news clippings related to the Health Security Act.
Provenance
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Clinton Presidential Records: White House Staff and Office Files
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Clinton Presidential Library & Museum
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293 folders in 16 boxes
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Title
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Analysis of the Health Security Act 1993-94 [14]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Chris Jennings
Health Securities Act
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 33
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/JenningsHSA.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/647904" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
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Adobe Acrobat Document
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Clinton Presidential Library & Museum
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10/26/2011
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647904-analysis-1993-4-14.pdf
647904