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�I
Fact Sheet No. 1
DPC Health Care Reform Fact Sheet
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and providing
factual information on the issues in question.
Thursday, August 11,1994
MYTH:
FACT:
Senator Dole: 'The key issue in the debate is whether we will trade in a health
care system based on individual freedom for one based on government control."
(Washington Post, 8/10/94)
Senator Mitchell's bill builds on the existing, private sector system. The
Washington Post said that "the governmental role would be kept to a minimum
[in the Mitchell bill]." {Washington Post, 8/3/94)
The bill eliminates the acute care portion of Medicaid, one of the largest
government programs, and integrates millions of recipients into private health
insurance plans. • ..
.
'
MYTH:
FACT:
Senator Wallop: "It's really a job killing payroll tax." (Press re/ease, 8/11/94)
Any number of independent studies—from the Employee Benefits Research
Institute to the Economic Policy Institute—have found that the employer mandate would have a negligible or slightly positive job impact. Hawaii's experience
, proves that you can have strong economic growth with shared employeremployee responsibility. The GOP charges against health care reform today
sound a lot like the ones they made a year ago about the deficit reduction plan..
Those charges were proved wrong and millions of new jobs have been created.
MYTH:
FACT:
Senator Gregg: ""This bill... includes 18 new taxes." {Press release, 8/11/94)
When in doubt, it seems the Republicans have to fall back on tired and false tax
charges.' The Washington Post said that the Mitchell bill is "hardly tax heavy."
(Washington Post, 8/8/94) In fact, the Mitchell bill contains more tax cuts than
provisions which raise revenue. The bill is financed almost entirely by cuts in.
spending.
MYTH:
Senator Dole: [Quoting a constituent letter forwarded to him by Senator Gregg]
"In the scheme of things that the President proposed, we would not have been
able to send our son to Boston [to see a specialist].' The penalty for.'going
against the plan' would be a $10,000 fine, and possible.jail sentence." (Senate
floor debate, 8/10/94)
Opponents of health care reform are using scare tactics. In fact, the Mitchell bill
greatly expands the options consumers have to choose different doctors and
different health plans. The Mitchell bill guarantees you the choice of. at least
three health plans, including a fee-for-service plan that allows you to see whatever doctor you want. (Section 1301)
FACT:
Democratic Policy Committee • United States Senate • Washington, D.C.'20510 • (202) 224-3232
�MYTH:
Senator Packwood: "What does the Clinton-Mitchell bill promise? ...less freedom of choice." {Senate floor debate, 8/10/94)
FACT:
The Mitchell bill guarantees more choices of plans and doctors than most people
have under the current system, and certainly more than the Republican incremental bills. The Mitchell bill guarantees every individual the choice of at least
' three health plans, including one fee-for-seryice plan which allow patients to see
any doctor they want.
MYTH:
Senator Chafee: 'The Mitchell bill involves pure community rating." {Senate
floor debate, 8/10/94) .
FACT: . We gladly admit that under the Mitchell proposal, insurers may not charge people
more for being high-risk, having a history of illness, or having a pre-existing
condition. This provision is known as community rating. But Senator Chafee's
attack is. inaccurate because the Mitchell proposal does allow for age-adjusted
premiums as the legislation is phased in. However, over time, age rating phases
out..
.
•
' We challenge the Republicans to explain to older Americans why they should be
charged four times as much for premiums as other Americans, as in the Dole
bill. (Section 1116)
MYTH:
Senator Durenberger: 'The Mitchell bill takes away incentives for groups, to
. negotiate [with insurers]." (Senate floor debate, 8/10/94)
FACT:
Wrong. The Mitchell bill increases the purchasing power of firms and groups by
allowing them to form voluntary, competing purchasing cooperatives, which will
give individuals and small and medium-sized employers the bargaining power
they don't have under the current system.
MYTH: . Senator Durenberger: "The Mitchell bill increases,cost shifting." (Senate floor
debate, 8/10/94)
FACT:
Unlike the Republican bills, which shift the health care costs of tens of millions of
uninsured Americans onto businesses and individuals with coverage, the Mitchell
bill dramatically reduces the number of uninsured—dramatically reducing cost
shifting in the system.
MYTH:
Senator Domenici: "Benefits for the mental health conditions are not treated
with parity in the Mitchell bill." (Senate floor debate, 8/10/94)
FACT:
That's a distortion. The Mitchell bill instructs the^National Benefits Board to treat
mental illness exactly as other illnesses: are treated—for example, the same
cost shares and deductibles would be applied-. In fact, the Mitchell bill is the first:
national health insurance bill which treats mental illness with parity. If the Board
finds that reaching parity creates undue cost sharing burdens on all services,
then the Board is given explicit instructions'on ways to bring costs in line.. By
contrast, the Dole plan provides no certainty, that mental health services will be
covered at all. •
-
�I
Fact Sheet No. 2
DPC Health Care Reform FACT SHEET
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and providing
factual information on the issues in question.
Friday, August 12,1994
Mitchell Bill Protects Good Benefits
CHARGE: Senator Gramm: "If you have a provision'in your health insurance that you want
but the Mitchell bill does not want you to have it, there is up to a 66 percent tax on
that benefit." (Congressional Record, 8/11/94, p. S11197)
,
FACT:
Like so many charges by opponents, the attack is simply not true. The Mitchell
proposal protects people who have fought hard and sacrificed wage increases for
good benefits. Current tax treatment, which lexcludes health benefits from taxation, will continue for the entire range of benefits in the standard benefits package, as well as for unlimited cost-sharing supplements, vision and dental benefits. The bill provides that beginning in the year 2004, the exclusion for health
care benefits will be limited so that extraordinary health benefit protections do not
remain tax subsidized.^ Elaborate health benefits for such things as cosmetic
surgery will no longer be tax-favored.
Mitchell Bill Discourages Skyrocketing Premium Increases
CHARGE: Senator Gramm: "If you have an insurance policy and the cost of your insurance
goes up by more than 2 percent in real terms, the Government taxes your policy
and the increase with a 25 percent tax." (Congressional Record, 8/11/94,
P: S11197)
FACT:
This provision affects insurance companies who excessively raise premiums—
not American families. The Mitchell bill discourages insurers from excessively
raising rates and protects American families and businesses. Insurance companies that increase premiums in excess of a target amount are subject to a
25 percent assessment on that excessive growth. The 25 percent assessment
applies only to the excess, not to the entire premium. If costs exceed the growth
limit by 2 percent, the amount assessed against the insurance company is
0.5 percent. Insurance companies can raise' their rates 5 percent a year without
being subject to any assessment. The assessment does not affect supplemental
benefits.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�Mitchell Bill Eliminates Pre-existing Condition Exclusions
i
CHARGE: Senator Doie: "Under Dole/Packwood bill, insurers would not be allowed to deny
coverage because of preexisting conditions.'' (Congressional Record, 8/11/94, p.
S11246)
FACT:
The Dole plan limits, but does not eliminate, the ability of insurance companies to
forestall coverage for preexisting conditions for up to a year. While all agree
preexisting bonditions limitations are a necessary transition tool to universal coverage, the exclusions under the Dole bill never go away.
The Mitchell plan eliminates the ability of insurance companies to deny coverage
for pre-existing conditions.
'
Mitchell Bill Streamlines Private System—Eliminates Bureaucracy
CHARGE: Senator Kassebaum: "The Mitchell bill woulid complicate rather than simplify the
administration of health care, ...and add nevy bureaucracy, red tape and government regulation." (Washington Post, 8/10/94). Senator Gramm: Forty different
new government agencies and bureaucracies. Senator Specter: 170 new agencies boards and programs.
FACT:
The fact is that the Mitchell plan streamlines ithe private health insurance system.
Health care would be simpler, more affordable and more secure. The Dole plan
would leave much of the existing bureaucracy in place, and would add new bureaucracy to administer the plan, with little reduction in the number of uninsured.
The legislation eliminates the acute care portion of Medicaid, a major government insurance program, and allows beneficiaries to enroll in private health plans.
instead. As a result, about 20 million people will enroll in private insurance, instead of getting their coverage through the government. (Department-of Health
and Human Services)
All serious approaches to health care reform require administration and over^
sight. In its report on the Senate Finance Committee bill, the Congressional Budget Office said: "For the proposed system to function effectively, new data would
have to be collected, new procedures and adjustment mechanisms developed,
and new institutions and administratively capabilities created."
Mitchell Bill Phases-ln Voluntary System
CHARGE: Senator Packwood: "Mandatory cooperatives appear to be back." (Congressional Record, 8/11/94, p. S11200)
FACT:
The Mitchell plan assists Americans in voluntarily purchasing private insurance
as it phases in universal coverage. The Mitchell bill increases the purchasing
power of firms and groups by allowing them to form voluntary, competing purchasing cooperatives, which will give them the bargaining power they don't have
under the current system. Employers will have a choice of competing voluntary
purchasing alliances, Employers and families will be able to choose which one
they wish to join. These cooperatives guarantee that American families have a
choice of plans so that they—npt their employers, not the government—can choose
the plan that best suits their needs.
�I
Fact Sheet No. 5
!
DPC Health Care Reform FACT SHEET
i •
In an effort to keep debate focused, on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and providing
factual information on the issues in question.
Tuesday, August 16,1994
FACT OF THE DAY: The Mitchell bill will extend private health care coverage to as many as
9 million uninsured children by 1997— 8 million children, will be eligible for premium assistance to purchase private health insurance. (Department of Health and Human Services)
Unfair insurance practices — denials for pre-existing conditions, refusal of coverage, and
other abuses — will be outlawed, enabling middle class families to afford private insurance
for their children.
1
More than 6 million children will be eligible for full piemium subsidies to purchase private
health insurance. An additional 1.8 million children will beleligible for premium subsidies on a
sliding scale. (Department of Health and Human Services)
REPUBLICAN DELAY: Since Senator Dodd (D-CT) introduced his children's amendment,
. there have been over 30 hours of debate. During that time, more than 28,000 children (15.7
per minute) have lost their health insurance. (Families USA, 8/16/94)
f
The Mitchell Bill Protects Consumers and Strengthens Choice
t
CHARGE:
"You can keep your plan, unless your plan is less generous... or unless your
plan is more generous. On page 145, sec. 1,309, this bill states that if your plan
does not conform to the benefit package mandated by the Clinton-Mitchell bill,
employers will be subject to civil penalties of $10,000 per employee." (Press
Release, Office of Senator Don Nickles (R-OK), 8/16/94) .
FACT:
Protecting consumers from insurance policies that are long on fine print and
short on benefits is one of the most important elements of reform. Like both
Democratic and Republican insurance market reform bills, the Mitchell bill provides for a standard benefits package to help consumers choose between competing health plans, based on price and quality. Consumers are guaranteed a
choice of plans. Employers will provide a choice of at least three health plans,
including a traditional fee-for-service plan.
Employers and individuals are free to purchase more generous coverage through
supplemental insurance that offers more benefits and lower cost-sharing.
Individuals also may purchase an alternative standard benefit package with higher
deductibles and a lower actuarial value.
The $10,000 civil penalty provision in section 1309 that Republicans cite is a
general enforcement sanction on employers who violate the requirements of
the bill — i.e., fail to offer a choice of . plans or discriminate against certain
employees.
'
.
Democratic Policy Committee • United States Senate * Washington, D.C. 20510 • (202) 224-3232
�I
Mitchell Proposal Prevents Abuse and Discrimination
f
CHARGE:
FACT:
Republicans have charged that employers will be subjected to a 35 percent tax
if they give employees more than the defined benefits package.
This is a complete distortion of the truth. Under the Mitchell proposal, employers are free to offer all employees more benefits, or pay the full premium for their
employees, if they so choose. An anti-abuse provision protects taxpayers'
dollars by preventing employers from selectively denying benefits to low-income
workers, based upon their eligibility for subsidies. Employers who discriminate
against workers by giving some employees more benefits than others have violated the anti-discrimination provision and are subject to a penalty. ,
�V
fr
Health Care Reform
Iseue Sheet No. 2
August 12,1994
DPC Health Care Reform ISSUE SHEET:
The Mitchell Proposal—
A Private Health Care System
Charge:
Republicans claim that the Mitchell proposal creates a massive new government-run program. They used the same rhetoric in the Medicare debate. The
Republicans are pulling out the old, tirod rhetoric about bureaucracy that they
have used for decades to block health care refpmn.
Response:
Nothing could be further from the truth. The Mitchell proposal streamlines
and consolidates a duplicative and chaotic system of health care into one that
will be far more responsive to the needs of American families.
A Private System, the Mitchell proposal retains the private health insurance
structure and provides a guarantee to middle class Americans that they cannot
lose the hoalth insurance they have now. Instead of a hew government program,
the Mitchell proposal provides subsidies to Americans to assist them in purchas. ing private health insurance.
Eliminates Government Program. The legislation eliminates the acute care
portion of Medicaid for AFDC and non-cash recipients, a major government insurance program, and allows beneficiaries to enroll in private health plans instead. As a result, about 20 million people will enroll in private insurance, instead
of getting their coverage through the government.
Accountability. A key goal of the Mitchell proposal is to eliminate bureaucracy .
and increase the power of consumers to demand accountability from their heaith
plans.
Streamlines System. The Mitchell proposal streamlines the health care system
through the use of purchasing cooperatives. Purchasing cooperatives increase
the power of the working American and the small business owner to obtain a
better deal from insurance companies. They allow thousands of Americans to
band together to negotiate better rates from insurance companies. They reduce
the high administrative costs in today's system and reduce wasteful paperwork.
1
Administrative Simplification. The Mitchell proposal will reduce paperwork .
and administrative waste in the current system. Electronic claims processing
and national standards for automation of insurance transactions will help eliminate much of the administrative waste in the current system.
hpmnnratic Policv Committeo • United States Senate • Washington DC 20510 • (202) 224-3232
�•I
Bureaucracy in the Current System
!
• The number of health administrators and bureaucrats has increased by
300 percent during the past decade. At the same time, the number of physicians grew by only 18 percent.
1
• Massachusetts Blue Cross employs more bureaucrats to insure 2.7 million
subscribers than Canada employs to insure 25 million people.
2
• Private insurance carriers and insurance agents employ more than 2.4 million
(1990) — more than the number of employees in all the legislative, judicial and
nondefense executive agencies of the American federal government including
postal workers.
3
• Children's Hospital in Washington, D.C. reports that it spends more than
$2 million a year filing out forms that have nothing to do with the treatment of
patients.
4
The number of hospital administrators is growing at four times the rate that the
number of doctors is growing .
1 5
Insurance overhead accounts for nearly 25 percent of total spending. By contrast, administrative costs in other industrialized countries total 11 percent or
less.
6
'Health Security: The President's Report to the American People,'p.'SO.
^"Wasted Health Care Dollars," Consumer Reported June 1992.
'DPC Special Report, "Health Care Questions Most Often Asked," SR-26 Health, November 20,
1990.
•ibid.
'
,
'Health Security: The President's Report to the American People, p.60.
ii i c rwjrtmant of Commerce. U.S: Industrial Outlook, 1994, January 1994.
�J
Fact Sheet No. 6
DPC Health Care Reform FACT SHEET
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and providing
factual information on the issues in question.
Wednesday, August 17,1994
FACT OF THE DAY:
The Mitchell proposal outlaws "lifetime limits." Seventy-six
percent (76%) of privately insured Americans have policies with life,time limits.
1
Over the past few days, Republicans have engaged in an effort to portray the Mitchell bill as
anti-choice and anti-consumer, when in fact, the opposite,is true.
Today's DPC Health Care Reform FACTSHEETprov\<ies information on important consumer
protections in the Mitchell proposal.
The Mitchell Proposal Protects Consumers From "Lemon" Insurance Policies
FACT:
Protecting consumers from insurance policies that are long on fine print and
short on benefits is one of the most important elements of reform.
Like other Democratic and Republican insurance market reform bills that have
been proposed, the Mitchell proposal provides for a standard benefits package
to protect consumers from fine print, and to help consumers choose between
competing private health insurance plans, based on price and quality. '
A standard package of benefits protects consumers by preventing insurance
companies from selling "lemon" policies which include such things as "lifetime
limits," which cut off coverage when consumers need it the most.
Lifetime limits are the insurance companies' Insurance policy. Lifetime limits
allow insurance companies to stop paying medicail costs, if a person with an
expensive illness or injury, uses up a certain dollar amount of coverage^ They
protect insurance companies, not consumers, from financial loss.
' "Employees in Medium and Large Private Establishments," Bureau of Labor Statistics, 1991.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�The Mitchell Bill Expands Choice
CHARGE:
"You can keep your plan, unless your plan is less generous... [or unless your
plan is more generous.] On page 145,,sec. 1309, this bill states that if your plan
does not conform to the benefit package mandated by the Clinton-Mitchell bill,
employers will be subject to civil penalties of $10,000 per employee." (Press
Release, Office of Senator Don Nickles (ROK), 8n 6/94)
FACT:
The opposite is true. No one is forced to give up coverage that they like. Period.
Today, only 16 percent of employers who offer insurance offer a choice of insurance. Under the Mitchell proposal, all consumers are guaranteed choice of
private health insurance.
1
•
Employers must offer their employees at least three choices of private insurance, including a traditional fee-for-service plan.
•
Purchasing cooperatives provide an array of private health insurance plans
to everyone in a,community.
Consumers choose the amount of private insurance they want.
•
Employers and families can purchase a guaranteed standard benefits package, and know what they are covered for in advance.
•
Employers and families can purchase more generous supplemental policies
with more benefits and lower cost sharing.
•
Individuals can purchase a less generous policy by choosing an alternative
standard benefits package with higher deductibles and copayments, and lower
cost.
[
•
The Mitchell bill is a voluntary system. No one is required to purchase
insurance.
Kaiser Family Foundation, KPMG Peat Marwick survey, 6/15/94.
�Fact Sheet No. 4
DPC Health Can* Reform FACT SHEET
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and pro viding
factual information on the issues in question.
Monday, August 15,1994
CHARGE: Senator Cohen [bn an employer/employee share responsibility]: Employers
are not going to bear the cost of that insurance. Workers will, in the form of.
lower wages, lost benefits and lost jobs. And CBO's analysis confirms that.
FACT:
The real threat to worker wages and benefits are the skyrocketing health
care costs of the current system, which have forced employers fo cut benefits and hold, down wages. The percentage of families who received full
employer-paid medical coverage fell from 32 percent in 1988 to
.19 percent in 1992. {Hay/Huggins Benefits Report, 1992) And If health care
had been reformed in 1975, American workers would have more than $1,000
in extra wages each year. Without reform, by the year 2000, American workers will lose almost $600 in wages each year, just to keep the health benefits
they have today. (Commerce Department, Office of Management and Budget) As for the charge that an ^employer mandate would lead to a loss of
jobs, any number of independent studies — from the Employee Benefits
Research Institute to the Economic Policy Institute — have found that such a
requirement would have a negligible or slightly positive job impact. And the
CBO analysis itself states that "the loss of jobs from this mandate would
likely be very limited." (A Preliminary. Analysis of Senator Mitchell's Health
Proposal 8/9/94)
'
CHARGE: Senator Cohen: A national council on graduate medical education will set
quotas and will tell medical students what specialties they can
practice.
FACT:
There are no quotas in the Mitchell bill dictating the number of specialists,
surgeons, or ophthalmologists who would be trained. The only thing specified in the bill is the balance between generalists and specialists. Currently
more than 65 percent of the doctors practicing in the United States are specialists. No other country in the world has more than 50 percent. This imbalance contributes to the shortage of primary care doctors, particularly in rural
and urban areas, and helps drive up health care costs. The, American Medical Association, the'American College of Physicians, and the Association of
American Medical Colleges support bringing the existing balance between
primary care physicians and specialists more in line with the nation's needs.
And this is also why Senator Dole's own bill sets up an Advisory Commission
on Workforce to make recommendations on the appropriate composition the
nation's health care workforce and how to achieve it. (S. 2374, Title V,
sec. 501(C)(4)(i))
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�CHARGE: Senator Cohen: It's almost certain that the spending associated with
the new entitlements and the subsidies in the bill is going to exceed all expectation and will further fuel the deficit that threatens to cripple this economy
right now.
FACT:
Untrue. The CBO estimates that the Mitchell bill will save the Federal government $8.6 billion over ten years. The bill protects the Federal budget
through a fail-safe mechanism which guarantees that the cost of the bill will
never increase the Federal deficit. Under this fail-safe provision, if spending
. is higher than now anticipated, spending would be reduced to ensure deficit
neutrality.
CHARGE: Senator Coats: "Do we want a government run health care system? The
American people have said 'no.'" Senator Mack: "The choice is between a
government-controlled, government-dictated health care system with less
quality, less choice and less freedom, on the one hand. Or a market driven
health care system with high quality, more choice and freedom, on the other."
FACT:
Republican Senators may enjoy railing against the.straw man of a government-run health care system but it has nothing to do with the bill offered by
Senator Mitchell. As the Washington Post noted, the government role would
be kept to a minimum [under the Mitchell bill]." {Washington Post, 8/3/94).
His bill builds on the existing private sector system. And by eliminating the
i acute care portion of Medicaid and enrolling recipients into private he.alth
insurance "plans, it moves millions of Americans from government insurance
to private insurance.
CHARGE: Senator Bennett: "The Mitchell bill will fail to decrease the number of
uninsured."
FACT:
Not according to the Congressional Budget Office. Their analysis of
Senator Mitchell's bill concludes that, in their estimation, his proposal would
meet its target of 95 percent of the population covered by the year.2000.
CHARGE: Senator Mack: "The Dole bill encourages Americans to join Federal
Employee's Health Benefits plan (FEHBP). Unfortunately, the Clinton/Mitchell
plan takes a good program full of choices and obliterates it.
FACT:
That's just wrong. The Mitchell plan retains the FEHBP and makes it available to families and individuals working in businesses with fewer than
500 employees, the self-employed, and those between jobs. It provides the
same choice of high-quality health care plans that Federal employees enjoy
today.
;
�HMtth Care Reform
Iseue Sheet No. 4
August 17,1984
|
DPC Health Care Reform ISSUE SHEET:
The Mitchell Health Reform BillHealth Reform That Works for
Middle-class Families
A key force behind the drive for health care reform has been the support of working, middleclass Americans. A fundamental test of reform must be whether it works to solve the problems
of the middle class.
Risk of Financial Devastation. As medical costs have grown far beyond what families can
hope to pay on their own, not having or losing insurance has become tantamount to risking
complete financial devastation. This frightening sense of insecurity among the middle class
— not just a lack of insurance — has provided much of impetus behind reform.
For decades, insurance companies have run the show—charging customers what they choose;
dropping coverage when people become ill; refusing coverage; devising complex schemes to
exclude anyone who might get sick; and using indecipherable and unpredictable fine print to
stack the odds in their favor.
As a result, many insured middle-class families find themselves covered only for illnesses
they don't have — a result of pre-existing condition exclusions — and cut off from benefits
when they need them most — a result of lifetime limits. ,
The Mitchell Proposal
Works for Middle-class Americans. Senator Mitchell's proposal makes critical changes in
the structure of the health care system and the insurance market to protect middle class
families. As a condition of participation in the health insurance market, insurance companies
will have to adhere to certain rules. People that currently are insured or in danger of losing
their insurance will be guaranteed that their coverage will continue.
A Case History. Consider the hypothetical example of Sam, a middle-aged, middle-income
American:
Sam /s not poor or uninsured, yet he is still at the mercy of today's health insurance
companies. His health care coverage comes with a $2,500 deductible, yet his premium is still $3,600 a year—$300 a month. He must accept this deductible and this
price because there is only one insurance company willing to provide him coverage.
Sam is typical of many middle income Americans in today's system, who are insured, yet lack
health security., Nothing prevents his insurance company from dropping his coverage, raising
his rates, or cutting his benefits. If Sam's income goes down or he loses his job, nothing
stands in the way of him losing that coverage permanently. The Mitchell proposal dramatically
improves the coverage of people like Sam and provides a real guarantee that he will not iose
this insurance.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�The Mitchell proposal will protect the financial and health security of middle-class
Americans like Sam in the following ways:
•
A Standardized Benefits Package. Sam will be guaranteed a standard package of benefits. He will have a choice of at least three plans and will be better able to compare plans
to decide which best meet his needs. Sam will not have to fear that fine print will deny him
coverage. He and every other American will know in advance what their benefits are.
•
Guaranteed Issue. Guaranteed issue means that insurers are prohibited, by law, from
denying Sam coverage — for any reason. Sam will be able to shop around for better
coverage, at a better price.
•
Guaranteed Renewal. Sam's insurer will not be able to drop him. Whether he is changing jobs, moving to another state, or retiring, Sam's insurer will not be able to drop him
from coverage. As long as Sam wants to buy this coverage, he will be able to retain it.
•
Elimination of Pre-existing Condition I>enials. No insurance company will be able to
charge Sam more for a pre-existing condition, deny him coverage, or permanently exclude
pre-existing conditions from coverage. To prevent people from buying coverage only after
they become sick, individuals who have not had coverage for an extended period of time
may still be subject to waiting periods.
•
Contains Costs. Purchasing cooperatives use market forces to keep health care costs
down and increase consumer buying power. In addition, insurers are discouraged from
the unreasonable rate increases prevalent in today's system through an assessment on
excessive growth in premiums. These provisions will keep Sam's premiums affordable.
•
Cuts the "Hidden Tax." Currently, Sam absorbs the cost of the uninsured in a "hidden
tax" in his health insurance premium. As the Mitchell proposal increases the number of
insured Americans, Sam's uncompensated care "hidden tax" will be reduced and ultimately
eliminated.
•
Reduces Bureaucracy and Cuts Red Tape. The bill will reduce paperwork for American
families by simplifying insurance forms. Many consumers will no longer have to submit
claims to their insurance companies.
•
Expands Choice. The proposal will expand choice of physicians and health plans for
millions of middle-class Americans. The bill requires every employer who offers health
insurance to his employees to offer a choice of at least three plans, including a fee-forservice plan.
•
Provides Long Term Care and Prescription Drug Coverage. The Mitchell bill provides
home and community, based long-term care to millions of disabled and elderly Americans.
This benefit will provide relief for millions of middle-class families who provide 80 percent
of the "infprmar care for their elderly parents and disabled children. In addition, a prescription drug benefit will help millions of Medicare beneficiaries afford prescription drugs.
Today, millions of elderly Americans must choose between filling drug prescriptions and
buying groceries.
,
�.J
Health Care Refonn
Issue Sheet No. 3
August 15,1994
DPC Health Care Reform ISSUE SHEET:
Hawaii: A Health Care System
That Works
Recently, the Governor of Hawaii, John Waihee, joined President Clinton at the White
House to discuss Hawaii's health care system. The President cited Hawaii as a model for
national health care reform and noted correctly that business is thriving in Hawaii.
Since then, the National Federation of Independent Business (NFIB) has issued misleading and inaccurate information about Hawaii's health care system. The NFIB charges that
Hawaii's employer mandate has not achieved 100 percent universal coverage; that
Hawaii has failed to contain health care costs; and, that Hawaii has a poor business
climate.
In fact, between 96 percent and 98 percent of Hawaiians have health insurance.
Employer-paid premiums in Hawaii are 30 percent lower than they are nationally. And
Hawaii has a healthier workforce, a lower unemployment rate, and a lower business failure rate than the national average. An MIT study (Entrepreneurial Hot Spots: The Best
Places in America to Start and Grow a Company, 1993) showed Hawaii to, be the "entrepreneurial hot spot" of the United States.
The trend in Hawaii is insurance coverage for more people, with more choice, at less cost.
Nationally, the trend is insurance coverage for fewer people, with less choice, at greater
cost, and no security.
Hawaii's Universal Coverage System
CHARGE:
FACT:
The NFIB charges that 90 percent of Hawaiians already were insured prior
to the 1974 enactment of Hawaii's health Care plan.
Wrong. Today, only two to four percent of hawaiians are uninsured. In fact,
, in 1971, over 17 percent of Hawaiians lacked health insurance coverage and
nearly 12 percent lacked hospital coverage; according to the Legislative Reference Bureau.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�•J
I
CHARGE:
The NFIB says that fifteen years after passage, Hawaii's coverage rate is
91.9 percent.
FACT:
The numbers NFIB is using are outdated.and wrong. From 96 percent to
98 percent of Hawaiians have health insurance coverage — compared to
only 85 percent of all Americans. ,
:
.
i,
•
A sun/ey by the Hawaii Department of Health Survey, which included a larger
sample than the Current Population Survey (CPS), found that only
3.75 percent of residents lacked health insurance coverage. A 1992
National Governors' Association (NGA) study found that 98 percent of Ha:
waiians had health insurance.
•
CHARGE:
The NFIB charges that CPS data show that total "private insurance coverage" in Hawaii reached only 80.1 percent of the non-elderly population.
Private coverage levels are as high in other States which don't have a
mandate.
FACT:
This statement reflects the NFIB's continuing effort to misuse numbers to
present a distorted picture of the truth. The estimate reflects Hawaii's large
number of active and retired military personnel who are publicly insured. This
results in the appearance of a large "privately uninsiured" number.
Current Population Survey numbers do illustrate that coverage rates in
Hawaii are increasing among working families — contrary to the national
trend. Since 1988, Hawaii saw a 15 percent drop in working uninsured while
the number of working uninsured in America increased by 21 percent.
(CPS and Census data, 1988,1993)
Hawaii's Health Care System —
Lower Costs For Business
CHARGE:
Hawaii has failed at cost containment.
FACT:
Employer paid premiums in Hawaii are 30 percent lower than they are
nationally. (GAO, 2/94; Hawaii Department of Health, 11/92)
CHARGE:
The NFIB claims that by 1990, per capita health care costs were $2,469 in
Hawaii, vs. the national average of $2,318.
FACT:
This data is inaccurate. The NFIB information is taken from a questionable
Lewin ICF study done in 1991. In fact, the State of Hawaii itself reports that
Hawaii's health care costs are well below the national average. For example,
Medicaid expenditures per recipient, Medicare expenditures per recipient,
and small business costs are well below the national average.
�Small.businesses in Hawaii can purchase insurance at rates well below those
facing a small business virtually anywhere else in the Nation. A Harris study
found the 1993 insurance costs for Hawaii's small businesses were more
than $250 less than average U.S. small: business insurance payments in
1991. Tracked over time, a typical Hawaii business was paying about the
same as its California counterpart in 1974. Now it pays 60 percent .of a
California business for comparable coverage.
Hawaii's Business Climate
CHARGE:
NFIB charges that Hawaii's employer mandate has brought about an adverse business climate.
FACT:
The fact is that since Hawaii began asking all employers to provide insurance in 1974: the unemployment rate has dropped to one of the lowest in the
nation; small business creation has remained high; and the rate of business
failures was less than half the national rate [Hawaii Department of Labor
and Industrial Relations; Dun and Bradstreet, Monthly New Business Incorporation Rate; Journal pf the American Medical Association, 5/19/93)
;
CHARGE:
FACT:
The NFIB claims that in 1992, the number of business failures in that State
increased by 290 percent. It is significant that Hawaii led the Nation in job
loss in 1993.
NFIB's selective statistics reflect the devastating impact on small businesses
of .the recession in both the U.S. and Japan, and of Hurricane Iniki. Hurricane Iniki was the largest natural disaster in Hawaii's history. It severely
affected small businesses in 1992, which already were suffering from the
, Nation-wide recession. Iniki's effects were felt well through 1993. Private
insurance claims exceeded $1,674 billion. Despite this, there has been a
steady growth of business from fewer than 18,000 employers in 1970 to 27,000
in 1993. Hawaii's business failures in 1993 are sf/7/ below the national
average.
Hawaii — The Entrepreneurial Hot Spot
CHARGE:
The NFIB claims that Hawaiian health plan has had serious negative consequences for business.
FACT:
In fact, Hawaii has a lower unemployment, rate than the national average, a
lower business failure rate than the national average, and a healthier
workforce. An MIT study shows Hawaii to;be ^©"entrepreneurial hot spot"
of the United States.
�Background and Interest of the NFIB
The NFIB has an annual budget of more than $60 million. It has 30 Washington lobbyists,
and it runs a PAC that spent $785,000 on campaign contributions and political "education"
during the 1991-92 election cycle. According to the Wall Street Journal (1/5/94), "the
group has turned into a big business." In fact, their grassroots lobbying effort in opposition
to health care reform is funded by huge corporations including K mart, J.C. Penney, General Mills, McDonald's, Pespsico, and Marriott. (Politics of Health Care Reform, 8/10/94)
There are other groups representing small business. The Small Business Coalition
For Health Care Reform, formed on May 3, 1994, is composed of 29 national organizations which represent more than 626,000 small businesses employ more than 5.6 million
people. The Coalition's numbers continue to grow.
Health care reform through employee/employer shared responsibility enjoys wide
support — 72 percent of Americans support shared responsibility for full-time workers.
(Washington Post/ABC Poll, Washington Post, 6/28/94) In June, 1300 leading organizations and businesses endorsed shared responsibility. These groups represent over
93 million Americans — 155 times the membership of the NFIB.
What the NFIB Won't Tell You:
What Small Business Owners Believe
The Small Business Coalition For Health Care Reformj reports that according to a 1992
study conducted by Professor Charles P. Hall of Temple University for NFIB:
•
92.4 percent of small business owners agree that the cost of health insurance is a
serious business problem;
•
90.3 percent of small business owners believe that!health care is becoming prohibitively expensive;
•
69 percent of small business owners agree or agree strongly that every
American has a right to basic health insurance;,
•
64 percent agree or strongly agree that all Americans should receive a minimum level
of health care regardless of their ability to pay;
,
•
64 percent said that they would like to provide better or some health insurance for their
workers; and,
•
60 percent of responding small business owners who provide coverage said they do
so because their employees needed it. On the other hand, Hall found that almost twothirds of those who don't cover their employees cite high premiums as the reason why.
�Health Care Reform
Issue, Sheet No. 1
August 12,1994
,
DPC Health Care Reform ISSUE SHEET:
Republican Attack on "New Taxes"
Charge:
The Republicans charge that the Mitchell proposal includes 17 newjtaxes.
Response:
This is a game that Republicans play to avoid talking about the real and.serious issue of health care reform.
Their charge is not true and they know it. It is an attempt to politicize the issue rather than debate substance.
It is demeaning to the health care debate and an insult to the public.
There are not-17 tax increases in the Mitchell bill. In fact, the Mitchell proposal contains more tax cuts than
provisions to increase revenue.
1
"Mitchell's bill is hardly tax heavy,"says the Washington Posts Dana Priest in an article about the loss of bipartisanship in the health caire debate. [ Washington Post, 8/8/94], The subsidies in the Mitchell bill are
financed almost entirely by spending cuts.
Most of the items on the GOP list are compliance rules or clarifications of law. One of them is just a direction
to Treasury to submit a legislative proposal in the future. Other items on the list, like reduced subsidies for
high-income Medicare beneficiaries, do generate savings. Since the provision reduces subsidies based on
income, it is collected through the tax system. However, it really accomplishes a reduction in spending. This
particular idea was originally proposed by the Bush Administration.
;
'
•
"
I
'
,
Examples of So-called "Taxes" on GOP List
1.
Retiree health benefit funding. This anti-abuse provision prevents corporations from bunching their
deductions for the cost of retiree health.
2. Tax treatment of tax-exempt health care organizations. This includes numerous provisions overhauling in a revenue-neutral way the treatment and standards that apply to nonprofit health care organizations. According to the Joint Committee on Taxation, this has a negligible revenue effect; i.e., basically no measurable effect.
3. Disclosure of taxpayer return information. Safeguards are established with respect to the sharing of
Federal tax information with States in the administration of subsidies.
4.
Risk adjustment. The bill establishes a mechanism whereby experience-rated plans would share in
the cost of somei of the higher risk populations in the community pool. This is a transfer between
insurance pools, not money that goes to the government. Without this provision, companies in the
community-rated market would be asked to bear a disproportionate cost-shifting. This is not a tax, no
money goes to the government, and it saves money for small business.
5.
Limitation of prepayment of medical insurance premiums.' This is an anti-abuse rule to prevent
bunching of deductions to take advantage of the 7.5% of Adjusted Gross Income (AGI) rule to deduct
the cost of health care. The revenue gain is negligible, according to Joint Committee on Taxation.
'There are only eight provisions that raise revenue. There are more provisions -p nine — which cut taxes. Increasing the tax on
hollow point, exploding bullets actually results in a reduction of revenues since the tax is so high these bullets will no longer be sold,
denying the government the modest excise tax now collected.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
�6.
Penalty for failure to file correct information returns, with respect to non-employees. This provision encourages compliance with the law by increasing the penalty from $50 per employee to the greater
of $50 or 5% of the amount required to be reported. Revenue gain is negligible, less than $1 million a
year.
7.
Definition of employee. Treasury is directed to submit a legislative proposal with respect to the classification of workers. This is a legislative proposal.
8. Equal Contribution Rule. This provision originated in the bipartisan rump group. It provides that
employers may not deduct the cost of health benefits that are not offered equally to all employees.
Tax Cuts In Mitchell Bill
1.
Change the definition of salary income for partnerships with inventory income to reduce Medicare
Hospital Insurance (HI) taxes.
2.
Provide self-employed with a health insurance deduction.
3. Treat long-term health insurance as accident and health insurance, with respect to tax treatment of
employer-provided benefits, and with respect to tax treatment of long-term care benefits provided through
an employer plan.and an individually purchased plan.
4.
Provide insurance companies with more favorable reserve treatment for long-term care insurance.
5.
Permit accelerated death benefits paid to terminally ill to be treated as life insurance benefits paid to a
deceased's estate.
6. Tax credit for physicians ($1,000 a month) and other medical personnel ($500 a month) serving
underserved areas.
7.
Increase expensing for medical equipment in undersen/ed areas.
8. Tax credit for personal assistance services required by disabled working individuals.
9.
Removal of the $150 million per institution cap on the amount of bonds which may be issued by 501 (c)(3)
organizations.
Items With Revenue Implications
1.
Increased tax on tobacco products.
2.
Funding for Medical Research. 1.75% tax on insurance premiums to pay for academic health
centers, graduate medical education, and biomedical research.
3. Cost containment assessment. To encourage cost containment, insurers increasing premiums at
unreasonable rates will be assessed on these increases.
4.
Medicare Part B Income Related Premium. This is actually a reduction in the subsidy for Medicare
Part B benefits that are received by high-income elderly households, although it is collected through the
tax system for ease of administration. This proposa^has been in several deficit reduction and health
care reform bills proposed by Republicans over the last few years.
5. Service related income of Subchapter S owners. This provision treats owners of Subchapter S
corporations, who receive salary income, like partners for purposes of the 1.45% Medicare tax..
6. Extension of Medicare HI tax to State and local workers. This provision, to extend Medicare coverage to State and local government workers hired before April, 1986, has been included in several budgets proposed by Presidents Bush and Reagan.
7.
Health benefits may no longer be provided in a cafeteria plan.
8.
Limitation on health insurance exclusion beginning in 2004.
�{•
Fact Sheet No. 3
DPG Health Care Reform'FACT SHEET
,-
i
i
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining charges
made about Democratic proposals and providing
factual information on the issues, in question.
Saturday, August 13,1994
Mitchell Proposal Provides Long Term Care
CHARGE: Senator Simpson: "It promises long-term care benefit that will be
there when they need it most. It won't be. It will be yanked away."
FACT:
The Mitchell proposal will provide millions of America's senior citizens
home and community-based long-term care. This benefit is one of
the reasons the American Association of Retired Persons (AARP) has
endorsed the bill calling it "an historic opportunity to provide each of
us with affordable high quality health care and long-term care." The
long-term care benefit is a capped entitlement to the States.
On the other hand, the Republican plan,sponsored by Senator Bob
Dole contains no long-term care program at all. It cuts billions of
dollars from the Medicare program, yet provides no additional benefits for senior citizens. No long-term care. No prescription drugs.
Mitchell Bill Protects Consumers Against Fraud
CHARGE: Senator Lott: "The bill contains extremeicriminal penalties for harmless behavior. Under section 5324, if you tip your doctor to get extra
services, you could go to prison."
FACT:
Senator Lett's statement is a clear example of a real scare tactic. The
Mitchell bill contains important consumer protections against fraud.
The provision mentioned by Senator Lott protects consumers from
"bribery and graft." Those who try to cheat the system and profit at the
expense of American families are subject to penalties.
Democratic Policy Committee • United States Senate •Washington, D.C. .20510'» (202) 224-3232
�•A
Mitchell Bill Protects Middle Income Families
CHARGE: Senator Lott: "Middle-income families will pay more for less health
care."
FACT:
In today's system, even insured middle class Americans are at the
mercy of insurance companies. Senator Mitchell's plan gives insured Americans the peace of mind that comes from insurance
that is there when it's needed. The Mitchell proposal guarantees
that middle-income families won't losei their health insurance and
protects them from insurance companies who cut their benefits or
raise rates excessively.
Partial reform proposals exemplified by the Dole bill, do not .guarantee middle-income families that they will always be covered. Proposals like Senator Dole's "increase premiums^for middle-class
people and cou/d increase the number of uninsured." (Winners
and Losers, Newsweek, 7/25/94)
L
CHARGE: Senator Hutchison: [Regarding the people the President met during town hall meetings who have had; problems with the current
health care system.] "Most people would be covered under the Dole
'
plan."
FACT:
Not true. Senator Dole's bill offers little help for people like Daniel
Lumley, who lost his insurance when he lost his job. The Dole
proposal contains no financial protection for Daniel Lumley to af. ford insurance until he gets a new job. Each day of Republican
delay, hurts Daniel Lumley and millions more like him.
�Fact Sheet No. 7
DPC Health Care Reform FACT SHEET
In an effort to keep debate focused on policy and set
the record straight, the DPC is examining'charges
made about Democratic proposals and providing
factual information on the issues in question.
Friday, August 19, 1994
FACT OF THE DAY: The Federal Employees Health Benefits Program (FEHBP) enrolls 10 million people in
50 states and contracts with hundreds of private health insurance:plans. Yet, the entire program-is administered by 164 people and has very low administrative costs. {Office of Personnel Management, March
1994) Enrollees may choose from an array of,private health insurance plans — i 4 different fee-for-service
and point-of-service plans and more than 200 health-maintenance organizations, which are included in a
total of 320 possible options. ("Health Care Reform: FEHBP," CRS Report 94-392 EPW, 5/5/94)
FEHBP is community-rated so that young, old, healthy, and sick participants pay the same price for the
same health care insurance. The FEHBP plans may not charge participants more for a history of illness or
a pre-existing condition.
. ,
FEHBP is the'program through which the President, Cabinet Secretaries, and members of Congress get
their health care coverage. It is a system of shared responsibility. Government employees pay a portion
(28 percent) of their premium and their employer, the government', pays the rest (72 percent).
The Mitchell Proposal Expands FEHBP to Working Families
CHARGE:
Senator Stevens (R-AK): "The FEHB Program has been successful in holding down costs —
over the last 12 years, the program's average premium cost per person rose approximately
3.5 percent less than private sector premiums for large businesses. The system holds down
growth in costs by forcing insurers to compete for customers by providing the best service at
the lowest premiums."
"The program provides flexibility through its annual open enrollment season, which allows
individuals and families to change their policy to adjust to changing circumstances. And the
FEHB Program gives its participants the abilility to choose the health care plan which is offered
that is best for them...
;
"For example, FEHBP includes the ability, with copayment or deductibles, to choose one's own
physician; it basically insures everyone, regardless of pre-existing condition; and there is no
cancellation of FEHBP insurance for catastrophic illness...." (Congressional Record, p. S12027)
"... The Mitchell bill would open up the FEHB program to...employers with fevyer than 500
employees, the self-employed, and the unemployed."
Surprisingly, Senator Stevens is opposing allowingAmerican taxpayers, who pay for this
"government-run program," to enroll in it. He said:
"Under this system, [the Mitchell.proposal]...it is not that the American public will have
what we have now, we will have what they have..." (Congressional Record, p. S12030)
FACT:
Senator Stevens is correct that FEHBP — for those lucky enough to have this option — offers
good benefits, a fair price, a choice of doctors, and a choice of private insurance plans.
The Mitchell proposal-will expand the same quality, prjvate insurance to all Americans —
the same choice enjoyed by members of Congress and other Federal employees. In fact,
Americans will have the option of enrolling in the same plans as Members of Congress.
Democratic Policy Committee • United States Senate • Washington, D.C. 20510 • (202) 224-3232
i
�!
The Price of Delay
i
During the time the Senate has been considering the "Children First"
amendment-- children have continued to suffer.
~
In the four days the Senate has considered the pending amendment:
* 5,479 babies were, born to women who had no health insurance
(March of Dimes);
•
* 2,544 babies were born to mothers who received late or no pre-natal
health care (National Center for Health Statistics);
* 3,648 babies were born to mothers with private insurance that does not
cover maternity care'(March of Dimes);
* 3,204 babies were born at low birthweight (National Center for Health
Statistics)
,
;
* 224 babies died before they were one month old (National Center for
Health Statistics); and
* 440 babies died before they were one year old
(National Center for Health Statistics).
1
Prevention Pays Off.
Delay Costs.
$1
spent on prenatal care saves....
. $3.38
on the care of low-birthweight infants (Institute of Medicine)
Every time a low-birthweight delivery is prevented, it saves
between $20,000 and $50,000 (Instituteiof Medicine).
Every time a very low-birthweight delivery is prevented,
it saves approximately $150,000 or more on.neonatal intensive care
costs (National Commission on Children).
Routine preventive checkups can avoid hospitalizations that cost
$600 a day (Children's Defense Fund).
�1
Tomorrow,
tomorrow,
tomorrow.
And while we wait another day —
i
••
* 1,370 babies will be born to women who have no health insurance
(March of Dimes);
i
* 636 babies will be born to mothers who receive late or no pre-natal health
care-(March pf Dimes);
'
.
* 912 babies will be born to mothers with private insurance that does not
cover maternity care March of Dimes);
* 801 babies will be bom at low birthweight (Children's Defense Fund)
* 56 babies will die before they are one month old
(Children's Defense Fund); and
;
* 110 babies will die before they are one year bid
(Children's Defense Fund).
And this will be true -- not just tomorrow -- but everyday
until we ensure that all pregnant women and children in America
receive the preventive health services which we know will save
both money and lives.
�Tomorrow, tomorrow, tomorrow.
Each hour we wait
"
* 57 babies will be born to women who have no health insurance
(March of Dimes) - nearly 1 every minute
* 27 babies will be born to mothers who receive late or no pre-natal health
care (National Center for Health Statistics) - nearly 1 every 2 minutes;
* 38 babies will be born to mothers with private insurance that does not
cover maternity care (March of Dimes) -- nearly 1 every 2 minutes;
* 33 babies will be born at low birthweight (National Center for Health
Statistics)--nearly 1 every 2 minutes;
* 2 babies will die before they are one month old
(National Center for Health Statistics) - 1 every 30 minutes; and
r
* 5 babies will die before they are one year old;
(National Center for Health Statistics) --1 every 12 minutes.
This will be true every hour until we ensure that aH pregnant
women and children in America receive the preventive health
services which we know will save both money and lives.
�'
UPDATED: August 16, 1994 10:50 a.m.
LIST OF HEALTH CARE MATERIALS
MITCHELL
General
Information
DPC Health Care Reform Briefing Book (including section on Cost Containment)
8/8/94
Changes from August 9 Mitchell Health Proposal
8/9/94
'
Statement of Senate Majority Leader George J. Mitchell
Regarding Introduction of Health Care Reform Legislation (Floor)
8/2/94
Statement of Senate Majority Leader George J,, Mitchell
Regarding Health Care Reform Legislation (Press Conference)
8/2/94
8/2/94
8/2/94
8/2/94
8/2/94
Mitchell Health Care Legislation Executive Summary
Summary of Mitchell Health Care Legislation
Mitchell Chart Packet
.
.
.
Sources of Mitchell Health Care Reform Bill
.
i
Statement of Senate Majority Leader George J. Mitchell Regarding
Health Care Reform Legislation (Opening Floor Statemeht)
Preliminary CBO Charts
. '
'
A Preliminary Analysis of Senator Mitchell's Health Proposal
' List of Sections Affected -- Technical Changes to Legislation
Statement of Senate Majority Leader George J. Mitchell, Regarding Endorsement
of Health Care Plan By American Association of Retired Persons
CBO Validates The Mitchell Bill
8/9/94
8/9/94
8/9/94
8/9/94
8/10/94
�Talking Points on Mitchell
The Mitchell Proposal: Health Reform that Works
for Middle Class Families
.
'
The Mitchell "You're Covered" Plan
8/11/94
The Mitchell Bill Provides Strengthened Protection
and New Benefits for Older Americans
Problems with Reducing the Threshold for Community Rating
Letter of Support from the
American Occupational Therapy Association, Inc.
8/11/94
Talking Points on Comparison of Mitchell vs. Dole
Setting the Record Straight
Fact Sheet: Republican Attack on "New Taxes"
-
8/12/94
Fact Sheet: Response to Republican Attack on Community Rating
Fact Sheet: The Republicans Bogus Charge of Bureaucracy
Fact Sheet: The Mitchell Proposal: A Private Health Care System
. 8/12/94
DPC Health Care Reform Fact Sheet #1
•
8/11/94
-Payroll Tax, 18 New Taxes, Community Rating, Mental Illness, Cost Shifting
DPC Health Care Reform Fact Sheet #2
8/12/94
-The Mitchell Bill: Protects good Benefits, Discourages Skyrocketing Premium Increases,
Expands Private Insurance,. Makes Insurance Portability Real,
Uses Market Forces to Control Costs, Eliminates Pre-existing Condition Exclusions,
Streamlines Private System, Eliminates Bureaucracy, Phases-ln Voluntary System
DPC Health Care Reform Fact Sheet #3
-The Mitchell Bill: Provides Long Term Care, Protects Consumers Against Fraud,
Protects Middle Income Families
CHILDREN
.8/13/94
ISSUES
"The Price of Delay" Statistics - Talking Points
Children and Health Care: The Problem Today - Talking Points
Rebuttal To Republican Arguments - Argument/Response Sheet
.
8/15/94
�AMENDMENTS
Children's Amendment Information Packet
8/12/94.
Disability Amendment Information Packet
8/12/94
REPUBLICANS
Summary of Dole/Packwood Health Reform Proposal (long summary)
The Dole Proposal (short summary)
,
Bob Dole Plan: "You're Out of Luck" Talking Points
Letters Opposing Dole Plan
Republicans Have Favored Mandates in the Past
Republicans on Delay - Talking Points
8/4/94
Republicans Remarks on Mitchell Plan
Labor Committee packet on the Dole-Packwood Bill
HISTORICAL
PERSPECTIVES
Republican Opposition to Medicare
DPC Special Report- Dire Predictions on Health Care Reform
DPC Special Report- A History of Health Care Reform:
Six Decades of Debate
8/8/94
11/3/93
STATES
DPC Talking Points: Health Care Reform Benefits to the States
10/27/93
DPC Special Report: States of Emergency: Costs and Savings
of Health Care in the 50 States
5/26/94.
DPC Special Report: Health Across America, Part II, Spring 1993
2/01/93
EMPLOYERS
DPC Special Report: Health Care Through Shared Responsibility
DPC Background Brief: Small Business Talks to Clinton About Health Security Act
3/25/9.4
5/2/94
�MISCELLANEOUS
DPC Special Report: Health Care Questions Most Often Asked
DPC Special Report: Straight Talk About Health Care Reform
DPC Background Brief: Workers' Compensation and the Health Security Act
DPC Talking Points: Recent Medical Journal Articles Underscore Need for Reform
11/20/93
.2/2^/94
5/3/94
5/26/94
DPC Talking Points: AMA Journal Praises Health Security Act
Common Myths and Realities about the Heaith Security Act (Clinton)
CURRENT
SYSTEM
DPC Special Report: Believe It or Not: Incredible Facts
About'Am'erica's Health Care Crisis
People with Disabilities: The Current System >
Rural Communities and Health Care: The Problem Today
5/20/93
�August 16; 1994
Publication: SR-40-Health
dpc
special
report
The State of America's
Health Care System
& Health Care Crisis:
A Reference Guide
The Facts and Nothing But the Facts
DPC Staff Contact: Dave Corbin (202-224-3232)
DPC Media Contacts: Debra Silimeo (202-224-3232); Diane Dewhirst (202-224-2939)
E
Democratic Policy Committee
United States Senate
Washington, D.C. 20510
George J. Mitchell, Chairman
Thomas A. Daschle, Co-Chairman
�Contents
Introduction
1
Americans Without Health Insurance
2
Growing Number of Uninsured
2
Uninsured by Age
Number and Percent of Uninsured Americans Under Age 65 (1988-1992)
Percent of Uninsured Americans by Age (1991)
3
3
The Uninsured: Families Who Work
Percent Distribution of the Insured, 1992
Uninsured Worker by Firm Size, 1991
4
4
National Costs of Health Care
5
National Health Expenditures: Aggregate Amounts for Selected Years
(1960-1993)
Health Expenditures as Percent of GDP (CBO Projections for 1993-2000)
National Health Care Spending
National Health Spending (CBO Projections)
Per Capita Spending
CBO Estimated Insurance Premium by Type of Policy
Health Care as A Source of Growth in Federal Spending, FY 1981 -1993
Total Health Spending Financed by the Government
Health Programs as a Percent of the Federal Domestic Budget
Health Expenditures Growing as a Share of Federal Outlays
Family Expenditures on Health Care
Health Care Payments Per Family
Family Spending on Health Care
Health Payments as A Percent of Family Income (Pre-tax)
5
6
6
7
7
7
8
8
8
9
10
10
10
- 10
Prescription Drug Costs
11
The Health Care Bureaucracy
12
Employers
14
Health Insurance Premiums as a Percent of Payroll
The Cost of Non-Insuring Firms
14
15
Total Business Payments for Health Care
Increasing Costs of Employer-Sponsored Health Benefits
(Health Coverage Costs Per Employee)
How Businesses Pay for Health Care
Business Taxes for Health Care
-1 -
15
16
16
16
�Small Business
18
Reductions in Health Care Benefits
20
Workers
21
Job Lock
23
Relationship Between Health Care Costs and Average Wages, 1965-1992
Relationship Between Health Care Costs and Wages; 1995-2020
(projections based on trends during 1980-1992)
International Comparisons on Health Care Spending
Annual Rate of Real Per Capita Health Care Spending in the 1980s
Per Capita Health Care Spending (1991)
Average Change in Per Capita Health Care Spending (1985-1991)
Percent of GDP spent on Health Care, 1991 ..:
International Health Care Spending
Medicaid
24
24
25
25
25
26
26
27
28
Medicaid Outlays
Medicaid Beneficiaries by Assistance Status (FY 1991)
Medicare
<
Medicare Outlays
29
29
30
31
Mortality Rates
32
Leading Causes of Death in U.S., 1990
Mortality for Selected Cancers, 1990
Estimated Annual Economic Costs of Disease in U.S
Infant Mortality Deaths/First Year of Life per 1,000 Births, 1990
32
32
33
33
Percent of Uninsured Persons by State (1992)
34
Number of Firms, Establishments, Employment, and
Annual Payroll by Legal Form of Organization and
Firm Size for 1991
35
- ii -
�The State of America's Health
Care System & Health Care Crisis:
A Reference Guide
The Facts and Nothing but the Facts
As the health care debate continues, you may need to find facts about our
health care system quickly. This report provides facts and reference data on
many facets of the American health care system. It includes data on the
number and different groups of people who are insured or uninsured — with
a State-by-State table; costs; the health care bureaucracy; how businesses
pay for health care; benefits; and, international comparisons.
There is also a section on Medicare.
We hope this will be a useful reference source.
DPC Special Report — The State of America's Health Care System
p. 1
�Americans Without
Health Insurance
•
37.5 million Americans (15 percent) are without any form of
health insurance coverage (1992).
1
2
•
2,248,000 Americans lose their health insurance each month.
•
46 Americans lose their health insurance every minute.
•
58 million (or 17 percent of the population) were uninsured for
at least some part of the year.
3
4
•
60 percent of the uninsured adults said they could not afford
coverage.
5
6
Growing Number of Uninsured
1992
1991
1990
1989...
1988
37.5
36.6
36.0
34.7
33.9
million
million
million
million
million
1
Congressional Research Service (CRS), Health Insurance, IB-91093, March 14, 1993. (EBRI
uses 38.5 million.)
2
Families USA, "How Americans Lose Health Insurance," April, 1994.
3
The Health Security Act of 1993: Peace of Mind for America's Families; Families USA, Special
Report, Summer, 1993.
4
Joint Economic Committee (JEC), The 1994 Joint Economic Report, May 1994.
5
Kaiser Foundation, cited in JEC 1994 Annual Report.
6
Employee Benefits Research Institute (EBRI); Democratic Study Group (DSG) Special Report,
"A Health Care Plan We Cannot Afford: The Status Quo," No. 103-16, September 20, 1993.
/
DPC Special Report—The
State.of America's Health Care System
p. 2
�Uninsured By Age
Almost all Americans aged 65 and over are covered under Medicare.
Therefore, nearly all the uninsured are under 65.
1
Number and Percent of Uninsured
Americans Under Age 65 (1988-92)'
1992
1991
1990
1989....
1988
1987
37.0
35.2
34.4
33.0
32.4
30.7
million
million
million.
million
million
million
16.6%
15.9%
15.7%
15.3%
15.1%
14.4%
s
Percent of Uninsured Americans by Age (1991)
Under 18.....
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 and over
Total
22.1%
18.8%
23.4%
16.7%
10.7%
7.3%
0.9%
100.0%
A full 22 percent of the uninsured (8.34 million) are children.™
7
CRS, Health Insurance, IB91093, March 14, 1993.
8
House Committee on Ways and Means, Green Book, 1994, p. 951.
9
ibid., p. 944.
10
U.S. Dept. of Health and Human Services.
DPC Special Report — The State of America's Health Care System
p. 3
�The Uninsured: Families who Work
The vast majority of uninsured Americans — 72 percent — have incomes
above poverty. Nearly one in three uninsured Americans is a member of a
family making more than $30,000 a year.
11
12
•
84 percent of uninsured Americans are in working families.
•
47.7 percent of all uninsured workers are either self-employed
or working in firm with fewer than 25 employees (1991).
13
Percent Distribution of Uninsured, 1992"
Full year/full time
Part year/full time
Full year/part time
Part year/part time
Nonworker
46.4%
22.0%
7.2%
8.3%
16.1%
15
Uninsured Worker by Firm Size, 1991
Fewer than 25 employees
25-99 employees
100-499 employees
500 or more employees
47.7%
16.1%'o
11.4%
24.9%
11
U.S. Department of Treasury, 1994.
12
EBRI Data, 1992: CRS, Health Insurance, IB91093, March 14, 1993.
13
Facts From EBRI: Sources of Health Insurance and Characteristics of the Uninsured, January
1993.
,
u
House Committee on Ways and Means Green Book, 1994, p. 947.
15
EBRI; cited in DSG Special Report, "A Health Care Plan We Cannot Afford: The Status Quo,"
No. 103-16, September 20, 1993, p. 16.
DPC Special Report — The State of America's Health Care System
p. 4
�National Costs
of Health Care
Health care consumes (1993):
•
14.3 percent of GDP; and,
•
one dollar out of every seven.
16
National Health Expenditures:
Aggregate Amounts for Selected
Calendar Years (1960-1993)
17
1960
1965
1970
1975
1980
. 1985
1990.......
1991
1993
....$27.1 billion
$41.6 billion
$74.4 billion
$132.9 billion
$250.1 billion
$422.6 billion
$675.0 billion
$751.8 billion
$898.0 billion
16
JEC, The 1994 Joint Economic Report, May 1994: 1994 Economic Report of the President.
17
Health Care Finance Administration (HCFA); Office of the Actuary; cited in 1994 Green Book.
DPC Special Report — The State of America's Health Care System
p. 5
�Health Expenditures as a Percent of GDP
18
(CBO Projections for 1993-2000)
1989...!
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999..
2000
11.5%
12.2%
13.2%
14.0%
14.6%
15.1%
15.7%
16.3%
16.9%
17.5%
18.2%
18.9%
National Health Care Spending
19
Now (1993): 14 percent of GDP
Year 2000: 18 percent of GDP (CBO projection)
Year 2003: 20 percent of GDP (CBO projection)
18
JEC, The 1994 Joint Economic Report, May 1994.
19
Congressional Budget Office (CBO) Memorandum, Projections of National Health Expenditures:
1993 Update, October 1993.
DPC Special Report — The State of America's Health Care System
p. 6
�In less than 10 years, one dollar out of every five dollars earned by people
living in the U.S. will go to cover the cost of health care.
20
National Health Spending (CBO Projections)
1992
1993
1994
1995
1996
1997 ......
1998
. 1999
2000
2002
2003.....
$823 billion
$900 billion
$982 billion
$1069 billion
$1163biilion
$1263 billion
$1372 billion
$1488 billion
$1.6 trillion
$1.75 trillion
$2 trillion
Per Capita Spending
Now (1993)....
Year 2003
21
22
$3,358
$7,000
CBO Estimated Insurance Premium by Type of Policy
Single person
Married couple
Single-parent family
Two-parent family...
23
$2,100
$4,200
$4,095
$5,565
20
U.S. Department of Commerce, Industrial Outlook, January 1994.
21
CBO Memorandum, Projections of National Health Expenditures: 1993 Update, October 1993.
22
ibid.
23
CBO, An Ana/ys/s of the Administration's Health Proposal, 1994.
DPC Special Report — The State of America's Health Care System
p. 7
�Health Care as a Source of Growth
in Federal Spending, FY 1981-1993"
Medicare and Medicaid
Net Interest
Social security (& other retirement)
Other entitlement
(aid/poor, farm supports, etc.)
Defense
Domestic discretionary
International affairs
% Increase
113.0%
57.5%
6.5%
3.6%
1.9%
-7.0%
-15.3%
Twenty-one percent of Federal government revenues are devoted to health
care.
25
Total Health Spending Financed by the Government
Now (1993)
Year 2003.
26
46%
50%
CBO projects that the escalating costs of health care will be the dominant
force in driving the deficit by the end of the decade.
27
Health Programs as a Percent
of the Federal Domestic Budget
FY 1998
FY 1993
FY 1980
28
35%
27%
16%
" DSG Special Report, "A Health Care Plan We Cannot Afford: The Status Quo," No. 103-16,
September 20, 1993, p. 13!
25
1994 Economic Report of the President.
26
CBO Memorandum, Projections of National Health Expenditures: 1993 Update, October 1993.
27
1994 Economic Report of the President.
26
CBO data; DSG calculations, cited in DSG Special Report, "A Health Care Plan We Cannot Afford:
The Status Quo," No. 103-16, September 20, 1993 p. 14.
DPC Special Report — The State of America's Health Care System
p. 8
�Health Expenditures Growing
as a Share of Federal Outlays
29
(outlays in billions of dollars)
Fiscal Year
1970
, $95
Health Care
$14
Social Security
$30
Other Domestic
$51
Defense
$82
International Affairs
$4
Net Interest.....
$14
Total Federal Budget
$196
Health Care aS a %
of Domestic Budget
14.6%
Health Care as a %
of Total Federal Budget ....7.1%
1980
1990
1993
1998
$392.....;. $755
$944 ... $1,237
..$62
$168
$254
$434
$119
$249....... $305
$388
$211
$339
$385
$415
$134
$299. $293
$291
..$13
$14
$18
$20
..$53 ..$184
$198
$292
15.8%
22.2%
26.9% .... 35.1%
10.5%
13.4%
17.5% .... 23.6%
If health care costs had been kept under control—that is, if health care costs
had increased at the rate of growth in overall economy for the last 12 years:
• the Federal government would have saved $79 billion in 1992
alone — enough to cut this year's Federal deficit by 27 percent.
Over the last 12 years, the Federal government would have:
•
saved $391.2 billion — enough to fully fund all Federal grant
programs to States and localities at 1982 levels, with an
additional $160 billion left over for reducing the Federal debt
and investing in education and training.
30
29
CBO data cited in DSG Special Report, "A Health Care Plan We Cannot Afford: The Status
Quo," No. 103-16, September 20, 1993, p. 60.
30
Service Employees International Union (SEIU), "Out of Control, Into Decline: The Devastating
12-year Impact of Health Care Costs on Workers Wages, Corporate Profits and Government
Budgets," Data provided by Lewin-ICF, October 1992.
DPC Special Report — The State of America's Health Care System
p. 9
�Family Expenditures
on Health Care
31
Health Care Payments Per Family
Average payments per family, 1993
Average payments per family, 2000*
% increase, 1980-1993
% increase, 1993-2000*
Payments as a % family income, 1993
$7,739
$14,517
199% ($2,590 to $7,739)
88% ($7,739 to $14,517)
13.1%
Family Spending on Health Care
1993
2000
33
$5,190 (three times the amount they paid in 1980)
$9,993 (projected, without reform)
According to the Commerce Department, without reform, the annual cost of
health care for a family could reach as high as $14,000 by the end of the
decade.
32
34
Health Payments as a Percent of Family Income (Pre-tax)
1980.
.;
1993
2000 (projected, without reform)
9.0%
..13.1%
18.4%
Last year, total household spending of $196 billion was 26 percent of national
health spending.
35
31
Democratic Policy Committee (DPC) Special Report, Sfafes of Emergency: Costs and Savings
of Health Care in the 50 States, May 26,1994.
32
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
33
U.S. Department of Commerce, Industrial Outlook, January 1994.
34
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
35
1994 Economic Report of the President.
DPC Special Report — The State of America's Health Care System
p. 10
�Prescription Drug Costs
More than five million Americans over the age of 55 say they have to choose
between buying food and paying for medication.
36
Prescription drugs are the largest cost of dialy living for 45 percent of all
people over age 65.
37
On the average, Americans pay 54 percent more than Europeans pay for
25 prescribed drugs.
38
Since 1987:
• the drug Premarin (estrogen) increased 101 percent; and,
• the drug Zantac (used for ulcers) increased almost 50 percent.
39
36
American Association of Retired Persons (AARP) cited in President's Report on Health Security.
37
ibid.
38
"Why Drugs Cost More in the U.S.," New York Times, May 24, 1991.
39
DPC Special Report, Health Care Questions Most Often Asked, SR-26-Health, November 20,
1993.
,•
DPC Special Report — The State of America's Health Care System
p. 11
�The Health Care Bureaucracy
There are more than 1,500 health insurers in the U.S.
40
Each insurance company (all 1,500 of them) has its own forms that physicians
are required to fill out when they provide care for patients.
41
Hospitals have to fill out 15 or more forms for one patient's hospital stay.42
Lack of standardization in forms results in high administrative costs. In 1991,
over six percent of all health care expenditures went towards administrative
expenses — this exceeds total spending on all public health service programs.
43
The number of health administrators and bureaucrats has increased by 300
percent during the past decade. At the same time, the number of physicians
grew by only 18 percent.
44
Massachusetts Blue Cross employs more bureaucrats to insure 2.7 million
subscribers than Canada employs to insure 25 million people.
45
Private insurance carriers and insurance agents employ more than 2.4 million
(1990)—this is almost as many people employed in all the legislative .judicial,
and nondefense executive agencies of the American Federal government,
including postal workers.
46
40
Health Secunty: The President's Report to the American People, p. 50.
4,
ibid.
42
ibid.
43
1994 Economic Report of the President.
44
Health Security: The President's Report to the American People, p.' 50.
45
"Wasted Health Care Dollars," Consumer Reports, June 1992.
46
DPC Special Report, Health Care Questions Most Often Asked, SR-26-Health, November 20,
1993; Office of Personnel Management (OPM); JEC.
_
DPC Special Report — The State of America's Health Care System
p. 12
�Children's Hospital in Washington, D.C. reports that it spends more than
$2 million a year filling out forms that have nothing to do with the treatment of
patients.
• 47
The number of hospital administrators is growing at four times the rate that the
number of doctors is growing.
48
Insurance overhead accounts for nearly 25 percent of total spending.
By contrast, administrative costs in other industrialized countries total
11 percent or less.
49
4
DPC Special Report, Heatf/7 Care Questions Most Often Asked, SR-26-Health, November 20,
1993.
48
President's Report on Health Security.
49
U.S. Dept of Commerce, Industrial Outlook, January 1994.
DPC Special Report — The State of America's Health Care System
p. 13
�Employers
The average cost of providing health coverage to employees increased more
than 100 percent between 1984 and 1992. The average cost per employee
was $3,968 in 1992 compared with $1,645 in 1984.
S0
Between 1987 and 1992, average premium for health benefits for a single
employee rose 108 percent — about 16 percent a year.
51
The cost of coverage per employee has more than doubled since 1987, to
$3,968 in 1992.
52
Health Insurance Premiums
as a Percent of Payroll
53
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
10.7%
11.5%
12.4%
13.5%
14.8%
.16.1%
17.7%
19.3%
21.0%
22.9%
50
Facts from ERBI: Employers Spending on Health Care and Initiatives to Reduce Health Care
Costs, August 1993
51
CRS, Health Insurance, IB91093, March 14, 1993.
52
JEC, The 1994 Joint Economic Report, May 1994.
53
ibid.
DPC Special Report — The State of America's Health Care System
p. .14
�The Cost of Non-Insuring Firms
Employers who provide health insurance spent $26.4 billion covering dependents who are employed by non-insuring firms.
54
Employers providing health insurance pay an additional $10.8 billion (1991)
in premiums to cover uncompensated hospital care — nearly half of which
was provided to workers in firms that do not provide coverage and to .the
dependents of those workers.
55
If health care costs had been kept under control—that is, if health care costs
had increased at the rate of growth in overall economy, for the last 12 years:
•
employers would be paying an average $1,015 less per employee per year for health insurance coverage. ($1,015 of the
$3,054 spent per employee per year, on average, is attributable
to excess health care cost growth).
56
Businesses are responsible for one-third (33 percent) of all health care
payments.
Total Business Payments for Health Care
57
1980.... $75 billion
1993.... $279 billion (3.7 times higher)
2000.... $512 billion (nearly double the amount
they paid in 1993 and 6.8 times greater
than in 1980)
M
National Association of Manufacturers (NAM), Employer Cost-shifting Expenditures, prepared by
Lewin/CF, December, 1991.
ss ibid.
56
57
SEIU, Out of Control, Into Decline: The Devastating 12-year Impact of Health Care Costs on
Workers Wages, Corporate Profits and Government Budgets, Data provided by Lewin-ICF,
October 1992.
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
DPC Special Report — The State of America's Health Care System
p. 15
�Increasing Costs of Employer-Sponsored Health Benefits
Health Coverage Costs Per Employee
58
1992
1991
1990
1989
1988
1987
1986
1985
$3,968
$3,605
$3,217
$2,748
$2,354
$1,985
$1,857
$1,724
How Businesses Pay for Health Care
$279 billion, 1993
Insurance premiums
General Taxes
Medicare Payroll Taxes
Other
59
57%
23%
13%
8%
Business Taxes for Health Care
1993 ....$63 billion in general taxes to support public health
programs. (This is 4.6 times the amount paid in 1980.)
$35 billion in Medicare payroll taxes. (This is 3.4 times
the amount paid in 1980.)
2000 ....$142 billion in general taxes to support public health
programs. (Projected, without reform.)
$55 billion in Medicare payroll taxes. (Projected, without reform)
60
58
Foster Higgins Annual Health Benefits Survey, cited in DSG, Special Report, No. 103-16,
September 20, 1993, p. 9.
59
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
60
ibid.
DPC Special Report — The State of America's Health Care System
p. 16
�Health care costs add more than $1,000 to the price of every car manufactured in the United States. Japan spends half this amount.
61
In 1990, General Motors spent $3.2 billion in medical coverage for its
1.9 million employees and retirees. That is more than the company spent on
steel.
62
61
U.S. Department of Commerce, Industrial Outlook, January 1994.
62
ibid.
DPC Special Report — The State, of America's Health Care System
p. 17
�Small Business
If health care costs had been kept under control — that is, health care costs
had increased at the rate of growth in overall economy, for the last 12 years:
•
small businesses would be paying an average $1,283 less per
employee per year for health coverage.
63
Small businesses premiums have risen as much as 50 percent a year.
64
The Small Business Coalition for Health Care Reform was formed to give a
unified voice to smaller employers across the country — and to insure that
health care reform will include thecritical elements needed to meet the special
requirements of small businesses. According to its research:
•
more than. 90 percent of small business owners agree that
health care is becoming prohibitively expensive and is a serious
business problem;
•
70 percent of small businesses insure their employees;
•
nearly 70 percent of small business owners want to offer their
employees better health care benefits and agree that all Americans have a right to basic health insurance;
•
small businesses now pay 35 to 50 percent more than large
firms for the same insurance. Large corporations can offer
more benefits at a lower cost, thus putting smaller firms at a
great disadvantage;
63
SEIU, Out of Control, Into Decline: The Devastating 12-year Impact of Health Care Costs on
Workers Wages, Corporate Profits and Government Budgets, Data provided by Lewin-ICF,
October 1992;
64
U.S. Department of Commerce, Industrial Outlook, January 1994.
DPC Special Report — The State of America's Health Care System
p. 18
�•
paperwork and administrative burden on small businesses that
offer employee coverage bosts small firms as much as 40 cents
out of every health care dollar while large firms average only a
nickel;
•
small businesses can pay up to 40 percent more than large
businesses for the same coverage;
•
by the year 2000, without reform, health care costs may eat up
60 percent of businesses' pre-tax profits; and,
•
an NFIB poll found that 64 percent of small business owners
would like to provide some or better health insurance to their
workers.
DPC Special Report — The State of America's Health Care System
p. 19
�Reductions in
Health Care Benefits
In 1988, neariy nine out of ten employers offered health care plans that let
employees choose any doctor in their community. By 1993, only six out of ten
employers offered this option.
65
More and more businesses are eliminating or reducing benefits. A survey of
larger corporations found:
•
12 percent of companies have eliminated or plan to eliminate all
retiree health benefits ; and,
66
•
56 percent have reduced, or plan to reduce, health benefits
covered.
67
Percent of full-time employees in medium and large establishments received
employer-sponsored health insurance as an employee benefit:
1980
1991
65
99 percent
92 percent
68
White House Fact Sheet, "America's Health Care Crisis: The Facts."
Survey excerpted in Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November
1993.
67 ;
ibid.
68
Facts from ERBI: Employer Spending on Health Care and Initiatives to Reduce Health Care
Costs, August 1993.
DPC Special Report — The State of America's Health Care System
p. 20
�Workers
Over the past 20 years, the wages of American workers have fallen in real
terms while health care costs have climbed 10 to 15 percent each year.
69
Between 80 and 100 percent of business insurance spending ultimately is
paid for by workers through reduced wages, or slower wage growth.
70
If business spending on health insurance were the same share of total
compensation today as in 1975, average wages per employer could be as
much as $1,000 higher than they are now.
71
Because of the increase in health care costs, American workers took the
equivalent of a 5.3 percent pay cut (take-home) in 1992.
Workers now earning the average wage must work 5.4 weeks a year to pay
household health costs compared to 4.8 weeks two years ago.
72
If health care costs had been kept under control — increased at the rate of
growth in overall economy, for the last 12 years:
•
personal wages would not have declined; and,
• the average working family could have saved $12,000.
73
69
U.S. Department of Commerce, U.S. Industrial Outlook, January 1994.
70
JEC, The 1994 Joint Economic Report, May 1994: 1994 Economic Report of the President.
71
1994 Economic Report of the President: JEC, The 1994 Joint Economic Report, May 1994.
72
DSG Special Report, A Health Care Plan We Cannot Afford: The Status Quo, No. 103-16,
September 20, 1993, p. 1.
73
SEIU, Out of Control, Into Decline: The Devastating 12-year Impact of Health Care Costs on
Workers Wages, Corporate Profits and Government Budgets, Data provided by Lewin-ICF,
October 1992.
DPC Special Report — The State of America's Health Care System
p. 21
�If health inflation continues as projected, workers will lose another $600 per
year in real wages by the year 2000.
74
Average employee contribution for family insurance coverage doubled in
three years:
1988.... $48 per month
24% of average total premium. '
1
1991 .... $98 per month
28% of average total premium.
75
74
Commerce Department and Office of Management and Budget (OMB) data, White House
Domestic Policy Council, Health Security: The President's Report to the American People ;
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
75
Families USA, "Skyrocketing Health Inflation, 1980-1993-2000," November 1993.
DPC Special Report — The State of America's Health Care System
p. 22
�Job Lock
Three out of every 10 workers say that they are staying in jobs they wanted
to leave only because of a need to keep their company health coverage.
76
Health coverage reduces job mobility by as much as 25 percent. 77
76
77
1991 New York Times/CBS News poll, cited in JEC, The 1994 Joint Economic Report, May 1994.
1994 Economic Report of the President.
DPC Special Report — The State of America's Health Care System
p. 23
�Relationship Between
Health Care Costs and Average Wages, 1965-1992
78
($ amounts in constant 1990 dollars)
Year
Health costs
as % of
earnings
Weeks of work
needed to pay
heaith costs
1965,
1970
1975,
1980.,
1985
1990,
1992,
6.6%.
,6.6%.
,6.9%.
6.6%.
,8.2%.
9.5%.
10.8%
,3.3
.3.3
,3.4
,3.3
.4.1
.4.8
5.4
Relationship Between
Health Care Costs and Average Wages, 1995-2020
79
(Projections based on trends during 1980-1992)
78
Year
Health costs
as % of
earnings
1995
2000
2005
2010
2015
2020
12.5%
16.1%
20.8%
27.0%
35.5%
46.6%...,
Weeks of work
needed to pay
health costs
6.3
.8.0
10.4
.......13.5
17.7
23.3
DSG.Special Report, A Health Care Plan We Cannot Afford: The Status Quo, No. 103-16,
September 20, 1993, p. 57.
"ibid.
DPC Special Report — The State of America's Health Care System
p. 24
�International Comparisons
on Health Care Spending
Anyway you measure it, health care spending in the U.S. far exceeds that of
other nations.
The U.S. spends 14.3 percent of its GDP on health care compared to less
than nine percent of GDP among other industrialized nations (1993).
80
The U.S. spends twice as much on health care as the average for the
24 industrialized countries in Europe and North America.
81
Annual Rate of Real Per Capita
Health Care Spending in the 1980s
•
82
4.4 percent for U.S. (Thiswasthree
times greater than GDP growth per
capita.)
3.2 percent (average) for Canada,
France, Germany, Japan, and U.K.
83
Per Capita Health Care Spending (1991)
U.S
Canada
Australia
Germany
Japan
U.K
$2,867
$1,407
....$1,035
$1,659
$1,267
........$1,035
0
' JEC, The 1994 Joint Economic Report, May 1994.
81
8J
83
U.S. Department of Commerce, U.S. Industrial Outlook, January 1994.
1994 Economic Report of the President.
CRS, Health Care Fact Sheet: International Health Spending, November 15, 1993.
DPC Special Report — The State of America's Health Care System
p. 25
�Average Change in Per Capita
Health Care Spending (1985-1991 J
U.S
Canada.
Australia
Germany
Japan
U.K
84
5.0%
3.6%
2.1%
2.1%
4.2%
3.3%
Percent of GDP spent on Health Care, 199185
U.S
Canada
Germany
Australia
Japan
U.K
M
65
!
13.2%
10.0%
8.6%
8.5%
6.8%
6.6%
CRS, Heallh Care Fact Sheet: International Health Spending, November 15, 1993.
ibid.
DPC Special Report — The State of America's Health Care System
p. 26
�86
International Health Care Spending
Country
Mozambique
Bangladesh
Egypt
India
Bolivia
Poland
Mexico
Brazil
South Africa
South Korea
U.K
France
Canada
Sweden
US
Income
Spending % GDP
per capita* per capita** (1990)
$80
$220.
$610
$330
$650
$1,790
$3,030
$2,940
$2,560
$6,340
$16,550
$20,380
$20,440
$25,110
$22,240
$5
$7
$18
$21
$25
$83
$89
$132
$158
$377
$1,039
$1,869
$1,945
$2,343
$2,763
5.9%
3.7%
2;6%
6.0%
4.0%
5.1%
3.2%
4.2%
5.6%
6.6%
6.1%
8.9%
9.2%
8.8%
12.6%
* Gross Domestic Product Per Capita, 1991
** Health Care Expenditures per capita, 1990.
Internationally, health care spending amounted to an estimated $1,700 in
1990, eight percent of the world's income. The U.S. accounted for approximately 40 percent of global spending on health care.
87
86
World Bank, World Development Report, 1993, in U.S. Department of Commerce, U.S. Industrial
Outlook, i 994, January 1994.
87
U.S. Department of Commerce, U.S. Industrial Outlook, January 1994.
DPC Special Report — The State of America's Health Care System
p. 27
�Medicaid
Medicaid serves 31.4 million persons (FY 1992).
88
Medicaid has the combined cost to Federal, State, and local governments of
$118.8 billion (FY 1992).
89
Medicaid is estimated to have constituted about 15 percent of total national
health Spending (FY 1992).
90
The Federal share of Medicaid spending is about $67.8 billion (about
57 percent of the total). State and local governments pay the remainder.
91
Medicaid is available to persons with very low incomes. However, the
program covers less than one-half (47 percent) of the non-institutionalized
population with incomes below the Federal poverty line.
92
Medicaid has become one of the fastest growing components of both Federal
and State budgets:
•
between FY 1989 and FY 1992, spending on Medicaid nearly
doubled; and,
•
by FY 1997, spending on Medicaid is projected to double
again.
93
86
CRS,Health Care Fact Sheet: Medicaid, 92-371, March 31, 1993.
89
ibid.
90
ibid.
91
CRS, Medicaid: An Overview, 93-144, January 22, 1993.
92
CRS, Health Care Fact Sheet: Medicaid, 92-371, March 31, 1993.
93
ibid.
•
,
DPC Special Report — The State of America's Health Care System
p. 28
�Medicaid Outlays
94
(dollars in billions)
FY
1980
1985
1989
1990
1992
1993
1995
1997
Federal
spending
$14.6
$22.7
$34.6
$41.1
$67.8
$80.3
$105.0
$131.0
Total
spending
$25.8
$0.9
$61.2
$72.5
$118.8
$140.7*
$183.8*
.....$229.4*
* Based on CBO projections
Medicaid Beneficiaries
by Assistance Status (FY 1991 )
AFDC
:
SSI.:
Non-AFDC Families,
Pregnant Women, Children
Non-SSI Aged, Blind, Disabled
Medically Needy
Other/Unknown
94
CRS, Health Care Fact Sheet: Medicaid, 92-371, March 31, 1993.
95
CRS, Medicaid: An Overview, 93-144, January 22, 1993.
95
45%
16%
18%
7%
12%
2%
DPC Special Report — The Sfafe of America's Health Care System
p. 29
�Medicare
Medicare is the Nation's largest health care program.
96
Medicare is the Nation's second largest entitlement program in the Federal
budget after Social Security.
97
Medicare covered 35 million people in FY 1993.
98
Medicare outlays amounted in the top 9.3 percent of the Federal budget in
F Y I 993."
i
Total Medicare outlays were estimated at $149.2 billion in FY 1993. Net
Medicare outlays (after deduction of $15.1 billion in beneficiary premiums)
are estimated at $134.1 billion.
100
Total Medicare outlays increased from $32 billion in 1980 to $131 billion in
1993, an average annual rate of growth of 11.5 percent.
101
More than 95 percent of the aged population was enrolled in Medicare in
1991.
102
96
CRS, Health Care Fact Sheet: Medicare, 93-344, March 25, 1993.
97
CRS, Medicare: President's FY 1995 Budget Proposal, 94-223, February 25, 1994.
96
CRS, Health Care Fact Sheet: Medicare, 93-344, March 25, 1993.
99
CRS, Medicare: President's FY 1995 Budget Proposal, 94-223, February 25, 1994.
,00
CRS, Health Care Fact Sheet: Medicare, 93-344, March 25, 1993.
101
CRS, Medicare: President's FY 1995 Budget Proposal, 94-223, February 25, 1994.
102
House Ways and Means Committee, 1993 Green Book. p. 238.
DPC Special Report — The State of America's Health Care System
p. 30
�More than three-quarters of the Medicare enrollees had some form of
supplemental coverage.
103
Medicare spending constitutes 53 percent of total Federal outlays for health
in FY 1992.
Medicare expenditures constitutes 16 percent of total national health expenditures.
104
Medicare Outlays
105
(in millions of dollars)
FY
1971
1975
1980
1985
1990
1991
1992
Total
Outlays
Percent Increase/
Prior Year
$7,875.......
,......$14,782
.....$35,025...
:
$71,384
,....$109,709
,......$116,657
$132,256
10.2%
30.3%
20.1%
14.3%
13.6%
6.3%
13.4%
CBO projections
1993
1994
1,995
1996
1997
1998
$149,494
$169,692
$191,481
$213,776
..$237,130
$262,038
103
House Ways and Means Committee, 1993 Green Book. p. 238.
104
CRS, Health Gare Fact Sheet: Medicare, 93-344, March 25,1993.
105
House Ways and Means Committee, 1993 Green Book, p. 192.
13.0%
13.5%
12.8%
11.6%
10.9%
10.5%
DPC Special Report — The State of America's Health Care System
p. 31
�Mortality Rates
Leading Causes of Death in U.S., 1990
106
Cause of Death
Number/Deaths
Heart Disease
720,058 .
Cancer
505,322
Stroke
144,088
Accidents
91,983
Chronic Obstructive Pulmonary Disease
86,679
Pneumonia and influenza
79,513
Diabetes
47,664
Suicides
30,906
Chronic Liver Disease
25,815
AIDS
25,188
Homicide
24,932
Kidney Disease
20,764
All Causes
.2,148,463
Mortality for Selected Cancers, 1990
Lung, Bronchus, Trachea
Colon, Rectum, Anus
Breast
Prostrate
Pancreas
Non-Hodgkin's Lymphoma
Leukemia
Ovary
Bladder
Mouth, Lip, throat
Skin:
Uterus
Cervix
All types of cancer
107
141,285
56,525
43,663
32,378
25,082
18,601
...18,574
12,566
10,341
8,405
6,420
6,028
4,627
505,322
106
CRS, "Leading Causes of Mortality in the United States and Their Associated Economic Costs,"
93-653, July 15, 1993.
10?
ibid.
DPC Special Report — The State of America's Health Care System
p. 32
�Estimated Annual Economic Costs of Disease in U.S.
Cause of Disease
108
Medical Cost*
Cardiovascular Disease (heart disease and stroke)
Cancer
Chronic Obstructive Pulmonary Disease*
Emphysema
Chronic Bronchitis
Asthma
Influenza
Pneumonia
Diabetes
Chronic Liver Disease
AIDS
Kidney Disease
1
$99.8 billion
$35.0 billion
$0.6 billion
$2.5 billion
$3.6 billion
$0.9 billion
$1.2 billion
$20.4 billion
$16.0 billion
$10.3 billion
$6.0 billion
Direct Medical Costs includes treatment, hospital and nursing home care,
physician and other professional; services, and prescription drugs.
Infant Mortality Deaths/First Year of Life
per 1,000 Births, 1990
109
Japan
Sweden
Canada
Germany
France
U.K,
Australia
Italy
U.S.
Average
4.6
6.0
6.8
7.1
7.2
7.9
8.2
8.2
9.2
7.5
,08
CRS, "Leading Causes of Mortality in the United States and Their Associated Economic Costs,"
93-653, July 15, 1993.
, M
OECD Health Data Bank, cited in DSG Special Report, "A Health Care Plan We Cannot Aflord:
The Status Quo," No/103-16, September 20, ,1993, p. 28, 66.
DPC Special Report — The State of America's Health Care System
p. 33
�Percent of Uninsured Persons by State (1992),110
U.S
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
1,0
14.4%
16.6%
16.1%
14.9%
19.8%
19.3%
12.4%
•8.1%
10.3%
...19.5%
19.0%
6.0%
16.3%
12.9%
10.9%
10.1%
.,10.8%
.14.6%
..22.1%
11.1%
11.2%
10.4%
9.9%
8.1%
19.2%
14.3%
Montana
Nebraska
Nevada..
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota.....
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin..
Wyoming
9.3%
9.3%
22,7%
12.6%
13.0%
19.3%
13.5%
13.8%
8.3%
11.0%
21.6%
13.2%
8.5%
9.3%
17.0%
15.0%
13.6%
22.4%
11.7%
9.4%
14.5%
:.. 10.2%
15.4%
9.0%
11.8%
U.S. Department of Commerce; Bureau of the Census, 1992.
DPC Special Report — The State of America's Health Care System
p. 34
�Number of Firms, Establishments,
Employment, and Annual Payroll by Legal Form
of Organization and Firm Size for 1991
Employment Size of Firms
Iota!
Firm
Establishments
Employees
Payroll
(in thousands)
100-249
53,468.
164,150
8,027,967
25-49
50-74
75-99
4,642,171 .
4,734,562
21,184,366
$431 million
223,104
282,762
7,606,640
$155 million
70,3113
113,238
4,229,557
$87 million
33,122
66,204
2,838,660
$59 million
250-499
500-999
1.000-2.499
2.500-4.999
5.000-t-
14,870
96,445
5,115,423
6,842
81,740
4,715,151
$107,065,336
4,362
110,405
6,701,359
$161,582,065
5,051,025
6,200,859
92,307,559
$2.1 billion
$169,420,799 $110,016,099
111
£t24
1,407
1,366
469,029
82,319
27,179,042
4,709,396
$120,210,33 $743,143,809
U.S. Department of Commerce, Urban Institute Tabulations of Current Population Survey.
DPC Special Report — The State of America's Health Care System
p. 35
�.4
•6'
August 22, 1994
Publication: LB-85B-Health
n
bulletin
SUPPLEMENT B to
Legislative Bulletin, Part i
«
Mitchell Substitute to S. 2351,
Health Care Reform Bill
POSSIBLE AMENDMENTS
DPC Staff Contact: Rindy O'Brien (202-224-3232)
Democratic Policy Committee
United States Senate
Washington, D.C. 20510
George J. Mitchell, Chairman
Thomas A. Daschle, Co-Chairman
n
�1
}
Amendments
1. Strike Ammunition Excise Tax (Baucus): amendment to strike the
10,000 percent excise tax on hollow point ammunition. Cosponsors: Baucus,
Hatch, Shelby, Breaux, Craig, Murkowski, Wallop, Stevens, BoVen,
Simpson, Heflin, and Johnston. (Nick Giordano, 4-2651.)
i
2. Critical Rural Access Hospitals (Baucus): designates 30 percent of
the 1.5 percent aissessment on insurance premiums toward strengthening
critical rural access hospitals (this'amount is less than 15 percent of the
funds for teaching hospitals). (Maureen Testoni, 4-2651)
3. Enhanced State Waiver/State Opt-out (Graham): provides for enhanced State waiver authority to allow State universal health care coverage
and cost-containment demonstration projects. (John Lovejoy, 4-3041)
4. Repeal Section 1512 on Licensure (Graham): strikes provisions
relating to the override of restrictive State practice laws. (John Lovejoy,
4-3041)
5. Repeal Section 1511 on Medical Waivers (Graham): strikes provisions
relating to pre-emption of certain State laws relating to health plans. (John
Lovejoy, 4-3041)
6. Research Funding. (Graham): includes funding for prevention and
primary care research. (John Lovejoy, 4-3041)
;
7. Lifestyle Incentives (Graham): allows health plans to provide incentives (discounts or rebates) for its members to join health, clubs. (John
Lovejoy, 4-3041)
8. High Medicare Hospitals/Report (Graham): requires a report on high
Medicare hospitals by the Prospective Payment Advisory Committee (ProPAC).
(John Lovejoy, 4-3041)
9. Medical Specialties Providing Transition Services (Moseley-Braun):
requires the Secretary of Hesalth and Human Services (HHS) to identify any
non-primary care medical specialties that provide primary care services in
underserved areas "during the transition period. (Francesca Cook, 4-2854)
DPC Legislative Bulletin — S. 2357, Health Care Reform Bill
p. 1
�10. Standards for Essential Community Providers (Moseley-Braun):
ensures that health professionals have a long standing/established practice
in the target area in order to be designated as an essential community
provider. (Francesca Cook, 4-2854)
11. Disclosure of Federal Employee Health Benefits Program (FEHBP)
(Moseley-Braun): requires the Internal Revenue Service (IRS) and Office of
Personnel Management (OPM) to annually provide information on the range,
type, and cost of health plans available offered to members of Congress and
Federal employees through FEHBP. (Francesca Cook, 4-2854),
12. Traditionally Black Hospitals as Essential Community Providers
(Moseley-Braun): allows traditionally black hospitals to be included as
essential community providers. (Francesca Cook, 4-2854)
13. Supplemental Security Income (SSI) Children (Moseley-Braun): continues requirements that States pay disproportionate share payments for SSI
children. The Secretary of HHS would be required to develop recommendations for designation of hospitals serving disproportionate numbers of SSI
persons. (Francesca Cook, 4-2854)
14. Tax-Deductibility for Self-Employed (Harkin): provides for full tax
deductibility for the self-employed. (Anne Ford, 4-6265)
15. Out-of-Network Coverage (Harkin): would give individuals the opportunity to obtain coverage for out-of-network options and services. (Anne Ford,
4-6265)
16. Drug Donation Insert Card Act (Dorgan): requires the Secretary of the
Treasury to include organ donation information with individual income tax
refund payments. (Steve Kroll, 4-1185)
17. International Prescription Drug Pricing (Dorgan): requires the Secretary of Health and Human Services to examine prescription drug prices in
foreign countries and issue quarterly reports. (Steve Kroll, 4-1185)
18. International Prescription Drug Prices (Dorgan): if prices exceed a
certain index, manufacturers must show the cause of disparity at a public
hearing by the Secretary of Health and Human Services. (Steve Kroll,
4-1185)
'
-, .
DPC Legislative Bulletin — S. 2351, Health Care Reform Bill
p. 2
�19. Cost Containment (Bingaman): combines the National Health Benefits
Board and National Cost Containment and Coverage commission; and,
establishes checkpoints to ensure that the Commission and Congress are
accountable to the American People for decisions relating to costs of the
standard benefits package, the availability of subsidies, and overall health
care system cost containment. (Carrie Billy or Linda Scott, 4-5521)
20. Shared Responsibility (Bingaman): modifies the employer-employee
mandate provision for firms with 25 or more employees and the individual
mandate for employees of firms with fewer than 25 employees which is
triggered under the act if 95 percent coverage is not achieved by January
2000: (1) stipulates that before these mandates become effective, the
National Commission on Cost and Coverage would make recommendations
to be considered by the bongress to ensure that low-wage employees of
exempt firms would not be disproportionately burdened in terms of premium
costs vis-a-vis low-wage employees in non-exempt firms; (2) clarifies that the
"trigger" for universal coverage is 95 percent of the non-medicare eligible
resident population; (3) requires that before an employer contribution becomes effective for a part-time worker, a worker must be employed for at least
a month and requires the Secretary of Labor to submit a report to Congress
on the economic impact of the mandate on seasonal employees. (Carrie Billy
or Linda Scott, 4-5521)
21. Direct Billing (Bingaman): changes, in section 1128 (h), "clinical
laboratory services" to "ancillary health services, such as clinical laboratory
services, and other ancillary health services as defined by the Secretary."
(Carrie Billy or Linda Scott, 4-5521)
22. Tobacco Use Disincentive (Bingaman): permits health plans to offer
premium discounts to individuals who do not smoke or who enroll in smoking
cessation programs. (Carrie Billy or Linda Scott, 4-5521)
23. Uncompensated Care- Undocumented Workers (Bingaman): helps
ensure a stable funding source for hospitals providing significant amounts of
uncompensated care. (Carrie Billy or Linda Scott, 4-5521)
DPC Legislative Bulletin —S. 2351, Health Care-Reform Bill
p. 3
�24. School Health Education (Bingaman): increases funding for school
health education to a level more consistent with the amount authorized in
President Clinton's Heaith Security Act. {Carrie Billy or Linda Scott, 4-5521)
25. Workforce Development (Bingaman): amends the Advisory Board on
Health Care Workforce Development section to ensure that where appropriate, the Department of Education is involved in Federal workforce education
and training initiatives and program support; and, authorizes the National
Academy of Sciences to issue a report assessing the ability of the current
health care workforce to meet the Nation's needs (baseline) and making
projections on health care workforce need in the future. (Carrie Billy or Linda
Scott, 4-5521)
26. Cataract Centers of Excellence (Bingaman): strikes, in section 4303,
"cataract surgery" from the services which Medicare would cover through
competitive contracts with "centers of excellence," and requires that the
Secretary's discretion to add new services to such contracting procedures be
limited to "such other intensive in-patient services as the Secretary determines to be appropriate." (Carrie Billy or Linda Scott, 4-5521)
27. Preventive Care (Bingaman): improves clinical preventive health
services and encourages basic research on preventive health care. (Carrie
Billy or Linda Scott, 4-5521)
28. Outpatient Rehabilitation (Bingaman): adds outpatient neuro-psychology to the standard benefits plan (this is a clarifying change and would not
add to the cost of the benefits package). (Carrie Billy or Linda Scott, 4-5521)
29. Long-Term Care (Wofford): improves long-term care provisions. (Darrel
Jodrey, 4-6324)
30. Self-Employed Premium Deduction (Wofford): increases deduction
for heath insurance premiums for self-employed to 100 percent. (Darrel
Jodrey, 4-6324)
31. Annual Report Card (Wofford): requires annual report cards on trends
in health care coverage and costs and biannual recommendations by the
Coverage and Cost Commission. (Darrel Jodrey, 4-6324)
DPC Legislative Bulletin — S. 2357, Health Care Reform Bill
p. 4
�32. Affordability (Wellstone): ensures affordability of premiums and protection of cost-sharing subsidies for low- and middle-income Americans.
(Ellen Shaffer, 4-5641)
33. Small Business (Wellstone): ensures small business fair-share contributions. (Ellen Shaffer, 4-5641)
34. Small Business Employees (Wellstone): protects individuals in small
(less than'25) firms from exorbitant cost of "individual mandate." (Ellen
Shaffer, 4-5641)
35. Cost Control Trigger (Wellstone): cost-control trigger vs: cuts to
subsidies and coverage. (Alex Clyde, 4-5641)
36. Accelerated Trigger (Wellstone): accelerates dates for reports on
95 percent coverage to January 1, 1998, effective mandate date of
January 1, 1999, and other relevant dates. (Ellen Shaffer, 4-5641)
37. Declining Coverage (Wellstone): implements employer mandate in
any year in which coverage declines. (Ellen Shaffer, 4-5641)
38. Domestic Violence (Wellstone): implements domestic violence riskassessment measures. (Sherry Ettleson, 4-5641)
39. Guns and Violence (Wellstone): denies access to guns to people with
histories of domestic violence. (Ellen Shaffer, 4-5641)
40. Community Representation (Wellstone): provides for representation
of low-income Americans and other consumers on boards and commissions.
(Ellen Shaffer, 4-5641),.
41. Health Care As Good As Congress (Wellstone): provides for health
care as good as Congress receives. (Ellen'Shaffer, 4-5641)
42. Mental Health (Wellstone): (Ellen Weissman, 4-5641)
43. Consumer and Provider Protection (Wellstone):
4-5641)
DPC Legislative Bulletin — S. 2351, Health Care Reform Bill
(Ellen Shaffer,
p. 5
�44. Medicare Competitive Bidding For Laboratory Services (Reid): strikes
this provision. (Kim Bengtson, 4-3542)
45. Medicare Competitive Bidding For Radiology Services (Reid): strikes
this provision. (Kim Bengtson, 4-3542)
46. Medicare Copayments for Laboratory Services (Reid): amends
collection requirements for Medicare copayments for laboratory sen/ices.
(Kim Bengtson, 4-3542)
47. Federally Qualified Blood Centers As Essential Community Providers (Reid): (Kim Bengtson, 4-3542)
48. Employer contribution (Rockefeller): strengthens employer contribution requirement from 50 percent to 72 percent, the average Federal employer
contribution for employees of the Federal government, including Congress
and the President. (Mary Ella Payne or Tom Morgan, 4-6472)
49. Cost containment (Rockefeller): (Mary Ella Payne, 4-6472)
50. Special Needs Children Study (Rockefeller): provides for institute of
Medicine study on how managed care plans (HMOs) effectively treat special
needs children. (Howard Rabinowitz, 4-6472)
51. Primary Care Research (Rockefeller): establish a primary care research center at Agency for Health Care Policy and Research. (Howard
Rabinowitz, 4-6472)
52. Veterans (Rockefeller): (Diana Zuckerman or Kim Lipsky, 4-9126)
53. Increase Tobacco Tax (Simon): increase tobacco tax and earmark for
expansion of long-term care and prescription drugs for the elderly, or
increased subsidies, or reduction of low-income cost-sharing. (Judy Wagner,
4-2152)
i
54. Coverage Trigger (Simon): redefine the 95 percent trigger to exclude
individuals already guaranteed coverage under Federal programs such as
Medicare. (Judy Wagner, 4-2152)
DPC Legislative Bulletin — S. 2351, Health Care Reform Bill
p. 6
�55. Americans-Abroad (Simon): to permit private sector employees working abroad to purchase non-subsidized insurance policies through OPM-run
program. (Judy Wagner, 4-2152)
56. The Community Scholarship Program under the National Health
Service Corps program (Daschle): would be funded at $2 million annually
from FY 1996 to 2000. (Lucia Guidice, 4-2321)
57. Medicare Prescription Drug Benefits (Boxer): grandfathers in drugs
now covered under Medicare part B. (Rebecca Rozen, 4-8130).
58. Prior Authorization (Boxer): modifies the prior authorization provision
for prescription drug benefits. (Rebecca Rozen, 4-8130).
59. Tobacco Tax (Simon): increases tax to seventy-five cents, effective
immediately. Revenue goes to 100 percent deduction for self-employed,
beginning 1995. The remainder shall go to long-term care, implementing the
program in 1996 as funds become .available, for a total increase of
approximately $30 billion over ten years. (Cheryl Young, 4-2152)
60.
Standard Benefits Package for Indian People (Inouye): would
insure that Indian people have full access to the standard benefits package.
(Yvette Joseph-Fox or Pat Rogers, 4-2251).
DPC Legislative Bulletin — S. 2351, Health Care.Reform Bill
p. 7
�Senate Action on Amendments
Amendments Adopted
1. Prenatal and Infant Care (Dodd): requires health plan sponsors to
include prenatal and infant care and immunizations, without cost-sharing
requirements, before 1995. Approved, 55-42, August 16, 1994.
2. Employer Penalty (Nickles/Moynihan): would strike from the Mitchell
substitute amendment the $10,000 civil penalty per employee for employers
who do not offer the standard benefit package as defined in the Health reform
bill. Approved, 100-0, August 17, 1994.
3. Rural Health Amendments
1994.
•
•
•
•
•
•
•
•
•
•
•
(Daschle) Approved, 94-4, August 17,
Rural Based Managed Care Program
Office of the Assistant Secretary for Rural Health (OASRH)
Technical Amendments to Medical Assistance Facilities
(MAF)
Antitrust Safe Harbors for Rural Health Providers
Medicare Bonus Payments for Non-physician Practitioners
Amendment
Rural Representation on Advisory Committees and
Councils
National Health Sen/ice Corps
Allocation for Participation of Physicians Assistants in NHSC
Scholarsthip and Loan Program
Eligibility of RHC's to Receive Funds
Grants for Systems to Transport Rural Victims of Medical
Emergencies
Grants for telemedicine-funding of $15 million for FY 1996
- FY 2001
4. Federal Advisory Committee Act Compliance (Mack): requires actions of all boards and commissions created by Health Security Act to be
subject to provisions of Federal Advisory Committee Act. Approved, 100-0,
August 18, 1994.
DPC Legislative Bulletin — S. 2357, Health Care Reform Bill
p. 8
�•i •
5. Provisions Regarding Nonpayment of Premiums (Mitchell): states
that a health plan may terminate coverage for nonpayment of premiums by
an individual or individual's family members after proper notification and after
a period of not less than 60 days. Approved, by voice vote, August 18, 1994.
6. Strikes Surcharge Under Federally Operated System (Hutchinson):
strikes provision which allows Secretary of HHS to impose a 15 percent tax
on health plans in a state that is found not to be in compliance with new
Federal Health care regulations. Approved, by voice vote, August 19, 1994.
7. Flexible Services Option (Harkin): allows health plans the flexible
option of providing, with consent of the enrollee, items and services that are
not listed in the standard benefits package, but which the plan determines to
be the most cost-effective way to provide appropriate treatment to the
enrollee. Approved, by voice vote, August 19, 1994.
DPC Legislative Bulletin — S. 2351, Health Care Reform Bill •
p. 9
�DPC'f!
Friday, August 19,1994
From the DPC
Latest Schedule
Senate Convenes
at 9 AM
dpc-tv
channels
The Senate will convene today at
9 a.m.
A period of morning business will extend
until 9:30 a.m. with Senators permitted to
speak for up five minutes.
•
•
•
Floor Action
Bill Summaries
Amendments
Floor Action/Unanimous Consent Agreement
Senate to Vote on Conf. Rpt to Commerce, State, Justice;
Continue Debate on Health Care Reform
Today, at 9:30 a.m., the Senate will begin debate on the Conference Report to H.R. 4603,
the Commerce, State, Justice Appropriations, FY 1995. There will be one hour of debate
equally divided with a roll call vote on the Conference Report immediately following debate.
Following disposition of the Conference Report to H.R. 4603, the Senate will return to
consideration of the Mitchell Substitute to S. 2351, the Health Care Reform bill.
Recent Highlights
Senate Approves Daschle Rural Health Amendment
Yesterday, the Senate continued debate on the Mitchell Substitute to S. 2351, the Health
Care Reform bill. In related action the Senate approved, 94-4, a Daschle amendment
establishing a grants program for the development and operation of rural managed care
plans; and, approved, 100-0, a Mack amendment requiring actions of all boards and
commissions created by Health Security Act to be subject to provisions ot Fed Advisory
Committee Act.
On The Democratic Agenda...
Attention Democratic
Health Care Policy Staff:
•
Daily briefing oh current health care reform status. 9 a.m. in SD-608.
•
Please call Rindy O'Brien, DPC Health Policy Advisor, at 4-3232
with new Health Care Reform bill amendments.
�•4
What Others Are Saying Regarding...
THE HEALTH
CARE REFORM
LEGISLATION
Senator Tom Harkin:
"Perhaps nowhere else is the health care crisis more acute than in rural America. Rural
Americans are more often poor, more often uninsured, and more often without access to
healthcare.
'
"Now, the Mitchell bill provides funding to build up the health care infrastructure in rural
areas. It provides grant money and loans to help local communities develop health care
networks and plans...
"The grant program in the Mitchell bill would encourage the development of telemedicine
networks which can play a critical role in ensuring that people in rural areas have access
to high quality health care. Telemedicine puts technology to work to improve the delivery
of health care. It uses technology to link patients and their doctors in rural or remote
hospitals with highly trained medical specialists in state-of-the-art medical technology
located hundreds or even thousands of miles away. These linkages will allow more
patients to receive care in their community and will ease the burden oh specialists in
undersen/ed areas. By increasing the education and training opportunities for providers
in these areas, these links will also help underserved communities recruit and retain
physicians...
"Senator Mitchell's bill will expand access to care for rural Americans, access to the
Federal Employees Health Benefits plan, or another purchasing cooperative will help
keep the cost of coverage down for rural residents. Many people in the rural areas are
either self-employed or work in small businesses, and currently pay much more than big
businesses for the same benefits. And they face much higher administrative costs.
"The insurance reform provisions in the Mitchell bill are critical for rural residents,
particularly for our farmers. Farming is now the most dangerous occupation in America
with annual death rates at 52 per 100,000 workers, almost five times the national average.
Under the Mitchell bill, farmers will have access to a community rated plan. This means
that farmers in a given area will be charged the same premium for health insurance
regardless of their occupational risk. In addition, health plans will nbt be able to deny
coverage because of preexisting conditions...
"If any group of Americans need health care reform, it is the people who live in our small
towns in rural America. They are not getting access because they do not have the
providers. They do npt have the providers because the system is skewed against
providers being able to serve in underserved areas.
"The Mitchell bill addresses all of that. It does it in a very forthright manner.... [It] is most
critical to make sure that our people in rural areas have the kind of access and quality of
care that they not only need, but they deserve."
Idpc
1
Democratic Policy Committee
United States Senate
Washington, D.C. 205.10
George J. Mitchell, Chairman
Thomas A. Daschle, Co-Chairman
u.s.s.
Friday, August 19,1994
THE
DAILY
REPORT
�Monday, August 22,1994
Latest Schedule
Senate Convenes
at 10 AM
The Senate will convene today at
10 a.m.
From the DPC
Supplement to Health Care
Reform Bulletin Available
Today the DPC delivered, via inside mail,
Supplement B to Legislative Bulletin
Part I, on the Mitchell Substitute to
S. 2351, Health Care Reform bill. Extra
copies are available in SH-5i2 (4-1414).
The DPC contact is Rindy O'Brien
(4-3232).
Floor Action/Unanimous Consent Agreement
Senate Continues Debate on Health Care Reform
Today, at 10 a.m., the Senate will return to consideration of the Mitchell Substitute to
S. 2351, the Health Care Reform bill. A Moynihan/Packwood amendment on Work Force
Modification is expected. No votes will take place prior to 6 p.m.
Items possible for consideration during the upcoming week include:
•
•
•
conference report to accompany H.R. 3355, The Omnibus Crime bill;
any other available conference reports; as well as,
any Legislative or Executive calendar business by unanimous consent.
Recent Highlights
Senate Debates Health Care Reform;
Passes Commerce, Justice, State Conference Report
On Friday, the Senate continued debate on the Mitchell Substitute to S. 2351, the Health
Care Reform bill. In related action, the Senate, by voice vote, adopted a Hutchison
amendment to strike the surcharge under a federally operated system; and adopted a
Harkin amendment that allows health plans the flexible option of providing, with consent,
items and services which are not listed in a standard benefits package, but are costeffective.
In other action, the Senate passed, 88-12, the Conference Report to H.R. 4603,
Commerce, Justice, State, the Judiciary, and Related Agencies Appropriations, FY 1995.
emocratic
aybook
On The Democratic Agenda...
Attention Democratic
Health Care Policy Staff:
NOTE:
A Weekly Update was not delivered
this week. Any hearings scheduled
during this week will be announced in
the Daily Report.
Daily briefing on current health care
reform status. 9 a.m. in SD-608.
Please call Rindy O'Brien, DPC
Health Policy Advisor, at 4-3232
with new Health Care Reform bill
amendments.
�What Others Are Saying Regarding...
HEALTH
CARE REFORM
LEGISLATION
Senator Carl Levin:
"We hear over and over again, Govemment-run insurance, Govemment-run health
insurance. That is the attack on the Mitchell bill, despite the fact that the Democratic
leader has over and over again gotten up and said this is not Govemment-run insurance.
This is private insurance which, hopefully, will be made available to every American the
way private insurance is made available to Members of Congress, our families, and all
Federal employees.
"So I wanted to be sure that point is clear, that the so-called Government insurance that
is made available to us is not Govemment-run insurance. It is made available to us by
the Government — mostly at taxpayers' expense — but it is private insurance. All those
companies with all those plans that are offered to us on that menu are private
insurance...
"It is not just us, it is 9 million Federal employees and their families who have this
insurance. If it is good enough for us, why is it not good enough for the rest of the people
of America? Is it the best plan in America? No, there are some better. Yes, there are
some companies that offer even better plans than this. That is not the issue...
"There can be a lot of give and take as to what is good and what is bad. But one thing
is real clear, and that is this green booklet... In that book, on page 4, it says that we are
guaranteed 'protection that can't be canceled by the plan.' Listen to this one...: 'Coverage
without restrictions because of age, current health or.preexisting medical condition. No
Federal employee can be denied health care because of a preexisting medical
condition.'
"It is right here in the book. If we hire someone on our staff back in our home State or
here in Washington, that person could have diabetes, could have a heart condition,
could have skin cancer. That person is entitled tp health coverage.
"Some of us are trying to provide that kind of assurance to every American. We provide
it to ourselves and 9 million Federal employees and their families. Why is it not good
enough for every American family? The answer is: it is. They are paying our salaries.
They are paying three-quarters of our health care. They ought to have the same
opportunity as every Federal employee has...
"All Americans should have the same opportunity that we do for health care. That is what
some of us are trying to achieve. It is not right that we have access to health care which
is not available to all Americans, that we can obtain health insurance despite any
preexisting condition, but other Americans do not have that opportunity."
i
dpc
'
Democratic Policy Committee
United States Senate
Washington, D.C. 20510
George J. Mitchell, Chairman
Thomas A. Daschle, Co-Chairman
u.s.s.
Monday, August 22,1994
THE
DAILY
REPORT
�I
DPC Daily Report
Thursday, August 18,1994
Latest Schedule
From the DPC
Today's DPC Lunch:
Health Care
Senate Convenes
at 9:30 A.M.
The Senate will convene today at
9:30 a.m. for morning business during
which Senators may speak up to five
minutes each, with Senator Hatch recognized for 10 minutes.
dpc-tv
channel 6
•
•
•
•
Floor Action
Bill Summaries
Amendments
Alerts
At today's DPC lunch Democratic
Senators will discuss health care reform.
12:30 p.m. in S-211. (Senators only)
Supplement to Health Care
Reform Bulletin Available
Today the DPC delivered, via inside mail,
the revised Supplement A to Legislative
Bulletin Part I, on the Mitchell Substitute
to S. 2351, Health Care Reform bill. Extra
copies are available in SH-512 (4-1414).
The DPC contact is Rindy O'Brien
(4-3232).
Floor Action/Unanimous Consent Agreement
Senate Continues Debate on Health Care Reform Bill
Today, at 10 a.m., the Senate resumes consideration of the Mitchell Substitute to S. 2351,
Ihe Health Care Reform bill.
Recent Highlights
Senate Adopts Nickles/Moynihan Amendment
Yesterday, in continued discussion of the Mitchell Substitute to S. 2351, the Health Care
Reform bill, the Senate adopted, 100-0, a Nickles/Moynihan amendment that strikes the
$10,000 civil penalty per employee for employers who do not participate in the Federal
health care program.
emocratic
*0aybook
Hearings Today
Judiciary Cte.: nomination of Lois Jane
Schiffer, Washington, D.C, to be Assistant Attorney General. 9:30 a.m.,
SD-226.
Judiciary Cte.: nominations of Nancy
Gist to be director of the Bureau of
Justice Assistance; Laurie Robinson to
be Assistant Attorney General for the
Office of Justice Programs, Jan Chaiken
to be Director of the Bureau of Justice
Statistics, and Jeremy Travis to be Director of the National Institute of Justice.
10 a.m., SD-628.
On The Democratic Agenda...
Attention Democratic
Health Care Policy Staff:
Daily briefing on current health care
reform status. 9 a.m. in SD-608.
Please call Rindy O'Brien, DPC
Health Policy Advisor, at 4-3232
with new Health Care Reform bill
amendments.
�; What Others Are Saying Regarding...
Health Care Reform Legislation
Senator Barbara Boxer:
"In my State of California, 6 million people live without the security of health insurance —
6 million people. One in four Califomians under the age of 65 is uninsured; 59 percent of
those without health insurance are in families headed by someone who works. So these
are working families; 1.3 million are children.
"My State's uninsured rate is five points above the national average, making my State the
eighth worst among the 50 States and D.C. These statistics are chilling. In four years, the
number of uninsured in my State exploded by more than one million people...
"So let us put to bed this notion that we do not have a problem in America. You have to be,
frankly, completely insensitive and, frankly, out of touch to say that this is not a problem.
"It goes well beyond the uninsured, as I have pointed out, because those of us with
insurance are walking on a tightrope. It is like Russian roulette. What is going to happen?
Who is going to pull the trigger? Will my body get a disease that takes me out of the
insurance pool? We have to stop this. It is un-American...
"I like to think America is about more than just speaking out for things when you need it. I
hope we would be more of a community. I have already shown you by telling you the
problems that we face — those of us with insurance — that it really is our problem anyway.
Why do you think we pay five or ten dollars for aspirin in a hospital when we are insured.
Because there are so many uninsured Americans who are using the emergency room. It
is so expensive, they do not carry their weight and we, those of us who are insured, have
to carry their weight. So we need to insure as many Americans as possible. That is what
the Mitchell bill tries to do...
•
'*
v
"I close with this. Any American who is watching today, please listen for certain things.
Listen for the scare tactics. Listen to the facts. Make up your own mind and let your voice
be heard because we are still threatened by a filibuster, a filibuster that would mean we could
not move forward on this issue, and this whole issue of health reform will languish into the
next century... '•'
"I will be here as long as it takes, as late as it takes to do what I can to help bring this to fruition.
I think we will be proud when that moment comes that we send a bill to the President of the
United States and we can say, when we are old and very gray, to our children and our
grandchildren and our great grandchildren, we did something to help the people of
America."
/
^•iiifF-
dpc
-r'
„•>,
x
w
f
Democratic Policy Committee
United States Senate
Washington, D.C. 20510
George J. Mitchell, Chairman
Thomas A. Daschle, Co-Chairman
u.s.s.
Thursday, August 18,1994
THE
DAILY
REPORT
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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[Democratic Policy Committee]
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Jason Solomon
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 37
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12093764" 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
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12093764-20060885F-Seg2-037-008-2015
12093764