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�The Health Security Act
P R O T E C T I N G AGAINST F R A U D AND A B U S E
Health care fraud and abuse rob American taxpayers of billion's of dollars
each year. Common examples include overcharging for services, charging for
medical care that was never delivered, delivering unnecessary services and providing
financial incentives to doctors to refer patients to certain facilities.
Simplifying the health insurance system will eliminate opportunities for fraud
based on exploiting today's complex system, both public and private. Reforms such
as the adoption of standard forms throughout the industry and a uniform coding
systeiTi will not only reduce administrative costs but also reduce opportunities for
fraudulent billing. Other major reforms, such as a national uniform health plan
benefit structure and uniform health insurance rules will also reduce wasteful
administrative steps and lessen vulnerability to fraud and abuse. In addition,
specific initiatives to counteract fraud and abuse would be establishes. Among them
are:
Criminalization of Health Care Fraud
•
For the first time, health care fraud will be a crime, and violators will face
stiff penalties.
•
A new health care fraud statute, modeled after existing mail and bank fraud
laws, will establish penalties for schemes that defraud health plans.
•
A new federal criminal statute will prohibit deliberately making false
statements to health plans, health alliances or state agencies.
•
A new federal criminal statute will ban the payment of bribes, gratuities or
other inducements to employees of health plans, health alliances or state
government agencies.
Federal Anti-Fraud Efforts
•
The scope of federal anti-fraud efforts will extend beyond
government programs to include fraud in the private sector.
•
The Departments of Justice and Health and Human Services
will organize an All-Payer Health Care Fraud and Abuse
Enforcement Program to coordinate federal, state and local lawenforcement activities.
•
Federal authority to seize assets from fraudulent providers and
to levy criminal penalties for health care fraud expand to
include filing false claims against health plans and other
fraudulent activity. Assets seized will be used to help support
anti-fraud efforts.
�Protecting Against Fraud and Abuse
Page 2
Enforcement of Anti-Kickback Laws will be Enforced
•
The existing anti-kickback law will protect all health plans,
prohibiting the payment or receipt of any item of value as an
inducement to refer patients for any type of health care service.
•
With specific exceptions to ensure adequate services, physicians
and other health professionals will be prohibited from referring
patients to laboratories or treatment centers in which the health
professionals have a financial interest.
May 10, 1994
�The Health Security Act
Q U A L I T Y A S S U R A N C E AND I M P R O V E M E N T
Mos£ Americajis report being satisfied with the quality of their present health
care. The Health Security plan embraces those aspects of today's health care that
work and then goes one step further.
Quality assurance programs in the current health care system rely on external
checks, forms and complex process manuals. Insurance carriers, peer review
organizations, and state and federal inspection agencies audit the work being done in
hospitals, doctors' offices and laboratories, and penalize providers if they fail to
follow rules or fill out forms properly. At best patients play a minor role in this
process. They lack access to even the most basic information on the quality of health
plans, professionals and treatments.
Health reform will transform the current paper-driven process into a patientdriven quality system focused on measuring the performance of health plans and
providers and continuous research into the most effective treatments for measuring
the performance of health plans & providers.
Provides Uniform Information on Quality
•
Under the Health Security Act, consumers will receive quality report cards
that provide information on patient satisfaction and the ability of health
plans, doctors and hospitals to provide access to appropriate & effective care.
It will include a listing of participating providers, their specialties and where
their offices are located.
•
Providing easy-to-understand, comparative information on the quality of care
will help consumers pick the health plans that are best for them. For
example, consumers will be able to compare two health plans based on their
immunization rates, success in treating coronary disease, or number of
Cesarean sections.
•
These steps will also enable health plans and providers to evaluate and
improve the quality of their care and aid in the assessment of quality in the
system as a whole.
�Quality Assurance and Improvement
Page 2
Protects Consumers by Setting Plan Standards
•
Each health plan will have to meet nationwide quality standards.
Compliance will be monitored by the board of the local health alliance, which
will have the power to exclude a plan from offering coverage if it fails to meet
certain standards. These include:
----------
consumer rights and responsibilities;
confidentiality;
complaints and grievance procedures;
truth in marketing;
fiscal soundness;
credentialing of providers;
disclosure of utilization controls;
internal quality management; and
data management and reporting.
Streamlines Quality Oversight
•
The Health Security Act will strengthen and significantly streamline two
quality assurance programs -- the Clinical Laboratories Improvement Act
(CLIA), and licensure and certification standards for institutional providers.
•
By limiting duplication, the plan will alleviate the unnecessary burden these
programs place on providers.
Enhances Cutting Edge Management
•
Better information about the effectiveness of treatments, increased
development, of practice guidelines, and collection of data to examine
variation in practice patterns will give health plans and providers the
management tools they need to improve quality.
•
The Health Security Act will support research on topics central to quality
management, including ways to share treatment advances, quality
measurement, and design of information systems.
•
Funding for outcomes research, particularly on the cost effectiveness of
procedures and technologies for common conditions and high-cost procedures,
will be increased.
May 10, 1994
�The Health Security Act
RESEARCH
The history of American medicine is in large part the story of
tremendous advances in medical research that has saved lives, improved the
quality of care and helped reduce health care costs. Advancing research and
technology increases the potential for more effective, low-cost treatments.
Small investments in research have historically paid billion-dollar
dividends in decreased costs and restoration of productivity. A recent NIH
report estimated that approodmately $800 million invested in clinical and
applied medical research could realize a one-year savings of between $5.2
billion and $6.7 billion.
Advances in medical science and technology, the development of new
medications and innovations in the way we get health care will lead to
increased efficiency in the health care system, and a higher standard of living.
Expands Prevention Research
•
The National Institutes of Health will expand preventive research in
priority areas including:
Alzheimer's disease
Bone and joint disease
Cancer
Child health
Health and wellness programs
Heart disease
Mental health
Reproductive health
Substance abuse
Vaccine development for AIDS, tuberculosis, and other
infectious diseases
Expands Health Services Research
•
The Health Security plan will also expand research the effectiveness
and appropriateness of clinical practice. Priority areas will include
quality and outcomes research and the dissemination of clinical
practice guidelines that will save lives and money in the long run.
�Research
Page 2
Consumer Choice and Quality Information:
•
The Health Security plan will fund research to help consumers choose
their doctors and other health providers based on cost and quality.
•
Prospective research includes:
-- customer satisfaction,
-- forms of information most helpful for consumers,
-- consumer awareness of benefit plans,
-- effect of consumer knowledge on selection of plans,
-- data cost sharing and utilization,
-- supplemental coverage.
May 14, 1994
�The Health Security Act
R U R A L COMMUNITIES
America's rural communities pose special challenges in health care- both for
those who need services and those who provide them. A total of 34 million peoplehalf of them with incomes under 200 percent of poverty-live in rural areas with
inadequate health care.
The fragile economies of rural areas often mean that many residents have little
or no insurance, making it difficult for rural communities to attract and keep doctors
and maintain local hospitals. Twenty-one million rural residents are without
consistent access to primary care providers, and the population of younger rural
physicians has not expanded to replace those who retire. Rural communities worry
that the current shortage of physicians will continue, and limit their access to care
even further.
Americans living in rural areas also have a harder time getting to the services
they need. More than half of the rural poor do not own a car, and nearly 60 percent
of the rural elderly are not licensed to drive.
The Health Security Act will create a system that meets the unique needs of
rural communities.
The plan will develop strategies for delivering and financing
health care in rural areas, making care more easily available, and attracting doctors
and nurses to and keeping them in rural areas.
Guarantees Universal Coverage
•
The plan guarantees comprehensive health benefits for all Americans, no
matter who they are or where they live. Since rural areas have a
disproportionate number of uninsured, underinsured and Medicaid
recipients, providing universal coverage will help channel significant new
resources into rural health care systems.
•
Self-employed people (including family farmers) can deduct 100% of their
health insurance premiums.
•
Urban plans will have incentives to serve rural areas in their region.
Increases Access to Providers
•
New workforce initiatives, including tax incentives, increased
reimbursement, retraining, scholarships, and loan forgiveness programs, will
encourage health care providers to practice in rural underserved areas.
�Rural Communities
Page 2
•
The Health Security plan will expand the National Health Service Corps,
placing at least 3,000 primary care practitioners in rural areas by the year
2000.
Encourages Health Networks
•
Under the Health Security plan, technical and financial assistance will be
provided to develop networks. This will help the rural communities that need
outside expertise to establish links with larger referral centers and academic
health centers.
•
The Health Security plan includes grants to support the development of
telecommunications links between underserved providers and other
providers, health care centers, and institutions. This will help facilitate
"group practices without walls," allowing easier consultation and
coordination among rural providers and with urban providers.
•
New grants will be provided to academic health centers to help build
information and referral infrastructure needed to support rural health
networks.
•
Investment in currently successful programs, such as community and
migrant health centers, will be increased to help them establish and enhance
contacts with other providers.
Assures Participation of Essential Community Providers
•
For the first five years after implementation, the Health Security plan will
designate as "essential providers" qualified practitioners and facilities in
underserved areas.
•
These providers will either be offered contracts with plans, or receive
reimbursement on a fee-for-service basis to ensure access to care and
continuity of care for rural and other vulnerable populations.
•
After universal coverage is achieved, funds which had been used to provide
health services to the uninsured will be redirected and combined with new
grants to pay for support services to ensure access to care. These services
include outreach, follow-up, home visits, transportation, and child care
during office visits.
April 3, 1994
�The Health Security Plan
SAVINGS
Experience proves health care should not be capitalized. Spending can be
slowed by increasing competition, eliminating cost shifting through universal
coverage and moving aggressively to cut out waste -- streamlining
administrative
overhead and increasing the productivity of doctors, nurses and other health care
workers.
Our international competitors spend much less than we do on health care - yet they insure all of their people, provide better benefits and have similar quality
outcomes. In this country, evidence from communities, companies and regions
illustrates that providers can and will cut costs substantially and quickly.
Providing
incentives to deliver more cost-effective care and reducing administrative costs can
free up dollars to make health care more affordable and help insure all Americans.
Cost Control Here and Abroad
•
C a l i f o r n i a hospitals have kept their growth rates well below the national
average -- 9% versus 30% between 1983 and 1990.
•
The State of Minnesota's public employees h e a l t h plan has kept its
annual rates of increase 2% below statewide trends for the last two years, as
bargaining power has increased and individuals have opted for lower-cost
high-benefit plans.
•
The Mayo Clinic has kept its growth down to 3.9%.
•
Germany and Japan have been able to keep annual growth in health care
costs down to GDP while our nation's has grown at 9% and 10%.
Increases Competition
•
The major source of cost containment under the Health Security plan will
come from bringing market forces to bear on the health care system
increasing efficiency through competition. Budgeting the rate of growth acts
as a backstop to competition - a commitment to downward pressure on costs
that can further bolster competitive savings.
�Savings
Page 4
•
Washington State and Minnesota have recently passed health reform
legislation that combines principles of competition with strict cost
containment measures. I n Minnesota, the law says that health care
spending must grow at least ten percent slower each year for five years,
beginning in 1993.
Strengthened Consumer Power
•
Larger pools mean lower costs. The Health Insurance Plan of California -- a
new state alliance for small businesses -- received bids that were as much as
55% lower for a plan also offered today by the Federal Employees Health
Benefits Plan.
•
Focusing on quality can also drive costs down. I n Orlando, the 78-member
Central Florida Health Care Coalition persuaded hospitals to analyze why
costs and quality of care differed for patients with the same illnesses, then
used the information to negotiate better prices. Costs per hospital discharge
fell 2% -- and the cost savings enabled the county school board to save 20
teaching slots it had planned to cut.
Consumer Cost Consciousness
•
The Health Security plan will give consumers, not their employers, the power
to decide among health plans, based on price and quality. Since choosing a
higher-cost plan will mean that individuals & families pay more out-ofpocket, competition will drive providers to find ways to become more efficient.
Under today's system, consumers often do not know how much health care
costs. Employers pay their premiums; insurers pay the tab.
•
Evidence from Minnesota's state employee health plan indicates that
consumers respond to changing incentives and in turn annual rates of
increase can fall. The Minnesota program - changed five years ago from
paying for 100% of a fee-for-service plan to 100% of the lowest-cost plan
serving a given county - has seen cost increases stay 2% below statewide
trends since 1991. Estimated savings have been $23 million over the last
three years, $12 million in 1993 alone.
Changed Incentives for Doctors
•
The Health Security plan will work under a budget that provides discipline,
changing the incentive to attracting patients through quality and efficiency.
No longer will we pay doctors solely on the quantity of tests and procedures
they perform.
�Savings
Page 3
•
I n managed care plans, where the incentive to provide more services is
removed, patients receive less unnecessary services in Northern California,
members of Kaiser Permanent health plans have 25% fewer hospital days per
capita than other residents.
•
I t will also bring down the cost of defensive medicine by reforming our
malpractice system -- encouraging disputes to be settled out of court and
reducing lawyers' collections from malpractice claims.
Reduced Variation in Practice Patterns
•
People who receive care in the Boston area get twice as much care - costing
$300 million more annually -- than residents in New Haven, Connecticut.
More spending does not lead to higher quality of care.
•
By bringing costs into line, the plan will eliminate the kind of situation that
leads to open-heart surgery costing $21,000 in one Pennsylvania hospital and
$84,000 in another hospital in the same state, with the lower-cost hospital
providing better outcomes.
•
Making patients aware of these differences will help them make cost
conscious choices that will produce savings but maintain quality.
Streamlining Administration
•
The Health Security plan will introduce standard claims forms,
comprehensive benefits packages, and standardized reimbursement rules,
procedures and regulations. No longer will a growing share of health care
dollars pay for processing paper and complying with regulations. Nor will
the health care industry be forced to continue hiring four new administrators
for every doctor simply to keep up with the flood of paperwork.
•
The Health Security plan will result in economies of scale that will lower
administrative burden for the system as a whole by consolidating
administrative and purchasing functions performed individually by small
businesses and families today. Under today's system, up to 30-40% of the
premiums paid by small firms support the overhead of brokers, insurance
agents and underwriters. Large firms pay significantly less for
administration - about 5-7% of premiums.
Rooting Out F r a u d and Abuse
•
The Health Security plan will reduce the estimated $80 billion spent on false
�Savings
Page 4
billing and other fraudulent practices by making health care fraud a
punishable crime with stiff penalties and recovering money from offenders.
Fail-safe Budget
•
While there is ample evidence that lower cost growth will be driven by
competition and increased efficiency, the Health Security plan will build in a
back-up measure to cost control: an enforceable budget.
•
The budget will be met by capping the growth in what individuals and
businesses pay for the comprehensive benefits package; this is similar to caps
proposed in other legislation and enacted in the State of Washington.
May 14, 1994
�The Health Security Act
SMALL BUSINESS
Small business is the nation's engine of economic growth. Yet this growth is
threatened by a health care system that is stacked against small business. Their
health care coverage costs more and offers less. Insurers often attract small
businesses by offering low premiums, but then raise them dramatically - as much as
50% in a single year. As a result, small businesses can face premiums that vary in
price by as much as 350% for similar benefits. Administrative costs eat up more than
40 cents of every dollar small businesses spend on health insurance premiums, eight
times as much as large companies.
Despite these problems, most small businesses want to provide health care
coverage to their employees -- and most do. Today 62% of American businesses with
less than 100 employees provide insurance. But these businesses that provide
insurance are paying for the ones that don't. On any Main Street, the health care
bills for the dry cleaner who insures their employees keep going up because the owner
of the car wash down the street does not cover their employees and they end up in the
emergency room when they are injured or fall ill.
The Health Security Act will end this unfair "cost-shifting," lowering costs for
most small businesses but ensuring that no one gets a free ride. The Act will give
small businesses a better deal by eliminating hassles and paperwork, giving low
wage employers substantial discounts, and reforming today's complex and inefficient
workers compensation system. Small businesses will be able to get the security of
rock solid coverage for their employees and their families, and the vast majority will
see lowered costs.
Controls Costs
•
The Health Security Act will put small businesses and consumers in the
driver's seat -- creating large purchasing pools that enable small businesses
to get the same deal from the insurance companies that large companies get
today. Health plans will be forced to compete for business, bringing down
prices and improving the quality of care.
•
Administrative costs will be drastically reduced because the regional health
alliance will assume the administrative burden for the small business -administering benefits, enrolling employees, negotiating and renewing
coverage, and bargaining for reasonable coverage.
�Small Business
Page 2
Helps Small Businesses Grow
•
The Health Security Act will help those firms that are creating the most jobs
and growing the fastest. The 62% of small businesses that provide insurance
today are the fastest growing small businesses in America. New, more
affordable coverage will help them expand even more, leading to more jobs
and higher wages. The Wall Street Journal wrote: "For many small
businesses, saddled with escalating health care costs, President
Clinton's health care package comes as an unexpected windfall."
•
Experience shows that the Health Security Act will create a better climate for
small businesses to grow and prosper. Since Hawaii asked all employers to
provide insurance for their employees in 1974, the unemployment rate has
dropped to one of the lowest in the nation (2.8% in 1991), and small business
creation rates have remained high (the number of employers grew almost
200% from 1970 to 1991).
•
When all small business employees are guaranteed a comprehensive package
of health benefits, employers will be able to retain a stable, high-quality
workforce.
Provides Discounted Coverage for Low-Wage Small Businesses
•
Small businesses of less than 75 employees with an average wage of less than
$24,000 will receive discounts o f 10% t o 56%, depending on their average
size and wage. These premiums replace what businesses pay today.
•
Contributions for health coverage will amount to only about 15 cents an hour
for the small employer whose average worker makes minimum wage. Added
to the minimum wage, that is still below the minimum wage during most of
the 1980s, when adjusted for inflation. And that buys a comprehensive
package of benefits.
•
Small businesses that currently provide health benefits will likely pay
substantially less under reform, due to falling administrative costs and lower
premium rates.
•
Small businesses who today are only able to provide bare bones insurance
will be able to provide a comprehensive package of benefits to their
employees and their own families at a reasonable price.
�Gives 100 Percent Tax Deduction to the Self-Employed
•
The self-employed and independent contractors will be able to deduct 100% of
the cost of the comprehensive benefits package from their taxes, just as all
other businesses do today. The self-employed are currently allowed to deduct
25% of health care costs.
Reforms Workers Compensation
•
Under the plan, injured workers will obtain treatment through their health
plans, just as they would for other injuries or illnesses. This will stop
duplication, help workers get back to work quickly, and reduce costs for small
businesses.
•
Workers' compensation insurers will continue to provide coverage and
reimburse the worker's health plan according to a fee schedule.
•
A Presidential Commission will be established to study the issues involved in
full financial integration and make detailed recommendations, advisable to
the President by July 1, 1995.
Ends Insurance Industry Abuses of Small Businesses
•
The Health Security Act makes it illegal for health plans to raise premiums if
an employee gets sick. I n today's system, small businesses often see their
premiums skyrocket when just one of their employees or someone in their
family gets sick.
•
Under the Health Security Act, health plans will charge small businesses the
same premium as big businesses in the same region (based on family
composition) for the uniform, comprehensive package of benefits. Low-wage
small businesses will receive a discount.
•
Insurance companies will have to accept all who apply for coverage. This will
end "occupational redlining," the practice where insurers refuse to cover
certain industries, such as hospitals, grocery stores, and barber shops.
May 4, 1994
�STATES- A NEW ROLE UNDER HEALTH REFORM
Both the federal and state governments lack sufficient authority today to
control costs. Many states, facing rising Medicaid budgets and diminishing private
insurance coverage, have tried to contain costs and expand access, only to run into
roadblocks in federal law. Although the states regulate private insurers, federal
barriers, such as the Employment Retirees Income Security Act (ERISA), have greatly
limited states' ability to initiate reform and control health costs.
While the federal government determines policy for Medicare and shares
authority with states over Medicaid, it has no way to keep private health costs under
control. Federal cost containment measures for public policy only shift costs to
private insurers and states.
The Health Security plan will establish a federal framework for comprehensive
health reform, with states having maximum authority and flexibility to design
systems that work for their residents. It establishes a new partnership between
states and their federal governments, with joint responsibility for assuring
comprehensive benefits high quality health care, universal coverage, and enforceable
cost control.
The Federal Framework
•
The Health Security plan provides a federal framework to guarantee
comprehensive benefits and ensure quahty standards are met.
•
States will use the same financing mechanism and adhere to
comprehensive benefits package.
•
Federal assistance will make i t possible for aU states, even those with low per
capita income and large numbers of part-time and unemployed workers, to
achieve universal coverage.
•
A reserve fund estabhshed under the program will help states cope w i t h
regional recessions.
The State Role
•
States w i l l be given maximum flexibility to adopt a system that will work
best for them, provided i t meets national quahty and benefits standards.
�States will have the primary responsibihty for assuring that all eligible
individuals have access to a health plan that dehvers the nationally
guaranteed comprehensive benefits package.
The new program will be phased in state by state. States that can quickly
adapt to the new system can join by 1995; all states will be in the system by
1997.
Health Alliances
•
States will assume responsibihty for the design, estabhshment, and control of
health alhances that best meet the needs of their citizens.
•
States will be able to specify the number, size, and geographic distribution of
alhances.
•
States will also appoint the members of the board of each regional alhance to
ensure that alhances represent area famihes and businesses.
Health Plans
•
States will have the flexibility to adapt the national framework to suit their
own needs. States will be able to certify health plans and hcense providers.
States will remain responsible for monitoring health plans and health care
providers.
•
States will be responsible for ensuring that health plans meet the federally
estabhshed health coverage standards, including the elimination of
preexisting conditions, admitting all enrollees at the same price, and
guaranteeing that all Americans will always be covered.
•
To protect providers and patients from insolvent plans, states will set capital
standards and estabhsh guaranty funds, consistent with federal law.
Single Payer Options
•
States may develop a single payer plan, as long as federal requirements for
benefits, quahty and cost containment are met.
•
Under the single payer option, the state or a designated agency will make
all payments to health care providers, with no intermediaries, health plans,
or other entities assuming financial risk.
�States may also choose a single payer alhance to serve a part of their state.
Rural areas that do not have sufficient numbers of competing providers, for
example, can have a single payer alhance tailored to their needs, while
remaining parts of the state could be served through regional and corporate
alhances.
Medicare and Medicaid
•
Once a state's system is successfully up and running, each state will have the
option of seeking permission to integrate Medicare beneficiaries, into
alhances or single payer systems.
•
States will continue to administer the Medicaid program for cash assistance
recipients and for supplemental services, including long-term care.
October 8, 1993
�The Health Security Act
TRANSITION
States may enter the new system as early as January 1, 1996 and all states
must enter the new system by January 1, 1998. States will be given start-up funds
and technical assistance in developing state plans and legislation. States entering
the new system on a fast track mil have some additional flexibility in complying u ith
federal regulations. To assure a rapid transition, the National Health Board, the
Department of Labor and the Department of Health and Human Services are
authorized to issue any regulations on an interim and final basis.
Incentives for States to Start Earlier
•
Earlier access to start-up funds;
•
Federal discounts for low-wage small businesses and low-income individualbegin as soon as the states have their programs up and running
•
Faster achievement of guaranteed, comprehensive benefits for state
residents.
Immediate Insurance Reform Measures
To reduce the potential for disruption in the health care system during the
transition, certain interim insurance reform measures will be enacted, and will t.i*.effect immediately upon passage of legislation. These measures will:
•
Prohibit insurers from dropping people or failing to renew their coveracr
with strictly defined exceptions.
•
Limit premium increases; increases that exceed a prescribed percentayr * ill
be subject to prior approval by state insurance commissioners.
•
Limit the application of exclusions for pre-existing medical conditions t.. n.-*»employees and their dependents.
•
Prohibit insurers and self-insured employer plans from imposing waitini;
periods for coverage on any employee otherwise eligible under terms nf t h.plan.
�Transition
Page 2
•
Authorize the Secretary of HHS to establish a national high-risk pool to
provide insurance coverage to individuals who get dropped by insurance
companies or who otherwise could not get coverage during the transition
The pool will be funded through premiums charged to enrollees and
assessments against health insurers, including self-funded plans.
L i m i t i n g Prices and Spending
While short-term cost controls will not be imposed. The President will urge ill
health care sectors to limit price and spending increases.
•
The Secretary of HHS will monitor prices and expenditures and periodn ilU
report on conformity with the President's request.
•
Confidentiality of data will be assured.
January 5.1994
�The Health Security Plan
UNDOCUMENTED PERSONS
TTie Immigration and Naturalization Service estimates that more than
3.2 million "unauthorized individuals" were living in the United States in
1992. Many of these undocumented workers and residents do not have access
to regular health care providers relying instead on community health centers,
migrant health centers, and, in too many cases, the emergency room.
As with other uninsured people, the uncompensated care that
undocumented workers and residents receive is passed on to employers and
employees who do have insurance. In addition, these costs have hit hard on
Medicaid budgets in states like California, Texas, and Florida. The federal
government has responded and is working with states facing unusual
financial
strains.
U n d o c u m e n t e d Persons Not Eligible f o r Guaranteed Benefits
•
Eligibility for the comprehensive benefits package is limited to
American citizens and legal residents. Undocumented persons are not
eligible to receive Health Security cards or the guaranteed health
benefits specified under the plan.
C o n t i n u e d Access t o Emergency and C o m m u n i t y H e a l t h Services:
•
Individuals living i n the United States without proper documentation
will have access to emergency and other health services as they do
today. Providers will receive funds to support these services.
•
The federal government will maintain funding for community health
centers and migrant health centers that serve a large number of
undocumented persons.
October 8, 1993
�The Health Security Act
UNION PLANS
Millions of Americans -- particularly union members -- have worked hard to
get the solid health benefits they enjoy today - - trading increases in wages in order
to maintain the same health benefits. In some cases, they have been willing to accept
reduced benefits to ensure that they still have some coverage. But even those with
excellent health benefits live in constant fear of losing that protection. Insurance can
disappear overnight as people are laid o f f , move, change jobs, or become ill.
The Health Security Act will protect hard-earned union benefit plans and
allow employers to continue providing 100 percent of health benefits. It will do right
by working Americans and labor unions who have long been in the forefront of the
fight to provide health security to every American.
Preserves Benefits
•
The Health Security Act will provide the comprehensive benefits all
Americans deserve. For those with coverage beyond the federally
guaranteed package, the included tax preference for those benefits will be
preserved for ten years. At that time, long-term care and mental health
benefits in the guaranteed benefits package will offer services far beyond
what all but a handful of plans provide today; benefits subject to taxation will
therefore be minimal.
•
Employers who currently pay 100% of the premium, or contribute to the
coinsurance and deductibles or pay for benefits over and above the
comprehensive benefits package can continue to do so indefinitely on a tax
preferred basis.
Helps Restore Lost Wage Increases
•
Millions of American workers will have their first real chance for wage
increases in years. For two decades, rising health care costs have robbed
American workers of wage increases they need and deserve. With
guaranteed, comprehensive benefits, unions will no longer have to negotiate
away wage increases in order to preserve benefits.
�Union Plans
Page 2
Increases Choices
•
Today, only one out of every three companies that employ fewer than 500
people offers employees a choice of health plans. The Health Security Act
will allow every individual the choice of at least three plans in every area: a
traditional fee-for-service plan like many people have today, a network of
doctors and hospitals, and an HMO-type plan. Individuals - - not their
employers or benefits managers - - will choose health plans and doctors.
Corporate alliances with over 5,000 employees will also have to offer a
minimum of three plans.
Simplifies Care
•
A l l families will receive health care from a single plan. Coordination of
benefits problems will be eliminated for all individuals.
Preserves Taft-Hartley Trusts
•
Taft-Hartley trusts will be able to continue to operate their own health plans,
subcontract with health plans, or join the health alliances.
May 14, 1994
�The Health Security Act
U R B A N COMMUNITIES
An inadequate supply of health care providers, combined with
extraordinarily
high rates of uninsurance have left 22 million inner city residents without access to
private primary care providers; 16 million have incomes under 200 percent of the
poverty level. Language barriers, and the lack of transportation and child care
services, pose additional problems for inner city residents seeking medical care.
The economic base of many urban areas is comprised largely of low wage
workers, unemployed or self-employed individuals and the elderly - providing less
insurance support for the development of local private health care systems.
Financially-strapped
community health centers and public hospitals are inundated
with victims of urban violence, drug-related health problems, HIV arid other
epidemics. Increasingly volatile urban climates compound the difficulty in
sufficiently staffing these high-volume care centers.
The Health Security plan will create a system that meets the unique needs of
urban communities. The plan will develop strategies for delivering and financing
health care in inner cities, making care more easily available, attracting doctors and
nurses to urban areas, and providing the incentives and support to keep them there.
Guarantees Comprehensive Benefits
•
The Health Security plan will guarantee every American a comprehensive
package of benefits with no lifetime limits. A l l Americans will have the
security of comprehensive coverage, no matter who they are or where they
live -- even i f they change or lose their jobs, move, start a small business, or
face a family crisis.
•
The comprehensive benefits package covers a wide range of preventive
services including prenatal care, well-baby care and nutritional counseling to
reduce infant mortality and get children off to a healthy start.
•
Current Medicaid recipients will be eligible for the same comprehensive
benefits and the same choice of health plans offered to the rest of the
population i n their area.
•
Health alliances will ensure that all Americans enroll in plans providing the
full comprehensive benefits package
�Urban
Page 2
Increases Access to Providers
•
By providing health insurance coverage for everyone, the Health Security
plan ensures a stable payment source to doctors and hospitals practicing in
underserved areas. I n addition, their payments will be higher to reflect the
cost of inner city care.
•
A comprehensive new workforce training strategy will increase the number of
primary care doctors, nurse practitioners and physician assistants, so
necessary to assuring care for urban underserved communities.
•
Additional workforce initiatives, such as tax incentives, payment bonuses,
and loan repayment programs, will encourage providers to practice i n
underserved areas. The plan will also expand the National Health Service
Corps, a current source of health professionals for many underserved areas.
Community Input
•
Each alliance will reflect the communities it serves. Alliances will
have a board of directors composed of equal numbers of consumers and
employers who purchase care in that area.
•
Health plans will conduct annual consumer surveys and be required to
seek out the opinions of those in communities that have historically
been denied access to high quality care.
•
Alliances will be prevented from creating two-tier systems of care;
grievance redress procedures will be required of all plans and
alliances.
Assures Participation of Essential Community Providers
•
The Health Security Act will certify certain providers and facilities that have
traditionally served the needs of underserved populations as "essential
community providers." This provision will assure the participation of these
providers for at least the first five years after implementation.
•
Health plans will be required to contract with and pay for services of all
essential community providers in their service areas.
�Urban
Page 3
Encourages Health Networks
•
Federal funding will become available to help physicians, nurses, physician
assistants, social workers, neighborhood clinics and urban public hospitals,
establish practice networks, school-related clinics, and community-based
health plans in medically underserved areas.
•
The Health Security ACt includes grants to support the development of
telecommunications capacity to link underserved providers with other
providers, health care centers, and institutions and provide continuing
education and professional support.
•
Investments in currently successful programs, such as community and
migrant health centers, will be increased to help them establish and enhance
contacts with other providers.
Expands Health Education and School and Community-Based Clinics
•
New programs will support the special needs of school-aged youth in
high risk settings. The Act will build on school-based or school-linked
health clinic demonstrations which have proven effective in delivering
health services to adolescents. These clinics will provide physical and
mental health services, and counseling in disease prevention, health
promotion and reduction in high-risk behavior.
•
A comprehensive health education program in grades K-12 in high-risk
schools will focus on behavior that results in the majority of health problems
among adolescents and adults, with an emphasis on specific local problems.
•
The Act will aim to establish several thousand new health care clinics
under the sponsorship of schools, community health programs, and
social service organizations.
•
The Health Security Act will support Ryan White programs for high
HIV-prevalence cities and states, and community-based clinics,
providing outpatient care, prevention, and substance abuse treatment.
Coordination of Programs
•
During the phase-in of the new system, current government funding will
continue to pay for clinical services for the uninsured as well as supplemental
services for all low-income individuals.
�Urban
Page 4
After universal coverage is achieved, funds which had been used to provide
health services to the uninsured will be redirected and combined with new
grants to pay for support services to ensure access to care. These services
include outreach, follow-up, home visits, transportation, and child care
during office visits.
January 5, 1994
�The Health Security Plan
VETERANS
Health care reform will honor the nation's commitment to continue
providing comprehensive health care to its veterans. Reform will give
veterans more choices about how and where they receive care. The Health
Security plan will preserve veteran benefits, increase veteran health care
system flexibility, and maintain specialized services.
Special Populations
•
Low income Veterans and those with service connected disabihties
currently served by the Department of Veteran Affairs will receive the
benefits they do today.
•
Congress will continue to fund speciahzed services, such as treatment
for post-traumatic stress disorder. Low-income veterans and those
with service-connected disabihties will have access to these speciahzed
services whether or not they enroll in a VA health plan.
New Eligibility
•
In areas where Veterans' plans exist, Veterans who are not currently
eligible for care through the VA will have the option of enrolling in
Veterans' plans to receive the comprehensive benefits package.
•
Veterans who enroll in a fee-for-service plan may obtain health care
through the VA system. Under that arrangement, they will be
responsible for any contributions required.
Competitiveness
•
The Department of Veteran Affairs will have the opportunity to
organize health plans to compete with other health plans for Veteran
enrollment in alhances.
•
VA hospitals and clinics also will be provided with broad authority to
enter into contract with other health plans to provide services to
veterans.
�Veterans
Page 2
Less Paperwork
•
Under health reform, unnecessary reporting requirements and
inspections that currently burden VA institutions and providers will
be reduced, freeing VA providers to concentrate on patients rather
than paperwork.
Funds
Under the plan, the VA will be permitted to retain funds recovered
from third-party payers.
VA managers will be allowed to control budgets without traditional
restrictions of line-items or earmarked funds, and delegate more
flexibility to VA clinics and hospitals .
October 8, 1993
�WOMEN'S HEALTH
*
Women are increasingly the victims of life-threatening illness, yet
still are at the bottom of our medical research agenda. Funding for
research into breast and ovarian cancers, osteoporosis and other
diseases remains inadequate. Although women are more likely to use
health care than men, they are less likely to have insuranceWomen make up a larger portion of the population holding part-time
jobs and clerical or sales jobs—jobs which usually don't offer health
insurance to employees.
Women tend to live longer and require more long-term and home health
services that are often not available or affordable.
Many women must rely on their spouses for health insurance, and risk
of being dropped if they divorce or if they are widowed.
From the beginning of the health reform process, women's health and
preventive care concerns were at the core of the program. The Health
Security plan will emphasize the kinds of care and research that protect
women's health and guarantee comprehensive care.
Comprehensive Benefits
•
Under the Health Security plan, all women will be guaranteed
coverage regardless of health status, marital status, employment
status, or abihty to pay.
•
Women will be guaranteed a comprehensive package of benefits that
will include unprecedented free coverage of a wide range of preventive
services, including mammograms, Pap smears, diagnostic services, and
prenatal care.
•
The plan includes coverage for health services that help prevent
unwanted pregnancies.
Preventive Health
•
The Health Security plan will cover a schedule of preventive
screenings, tests, and checkups covered in only a few of today's health
insurance pohcies. These include regular mammograms for women
�Women's Health
Page 2
with a close family history of breast cancer and will be covered under
the regular cost sharing provisions, like other medical procedures.
The nationally guaranteed comprehensive benefits package will also
include free coverage for mammograms every two years for women
over age 50 free-of-charge--no matter which plan someone chooses, as
an extra incentive for those most at risk.
Preventive services included in the comprehensive benefits package
are provided at ages specified by the report of the U.S. Preventative
Services Task Force. These recommendations can be modified by the
National Health Board as new information becomes available.
Supports Women's Health Research
•
New research initiatives will concentrate on child health (including
birth defects, prenatal care, and adolescent health), and illnesses that
primarily strike women -- including breast cancer, ovarian cancer, and
osteoporosis.
•
Medical research initiatives will be expanded to include efforts to
isolate and cure diseases such as breast cancer and cervical cancer.
Expansion of Home and Community-Based Long-Term Care Services
•
The addition of a new home and community-based long-term care
program and the expansion of nursing home coverage will help reduce
the undue burden born by many women caregivers.
October 8, 1993
�The Health Security Act
W O R K E R S ' COMPENSATION I N T E G R A T I O N
The Health Security Act will integrate workers' compensation
into the new health care system in two steps.
medical
benefits
In the short term, delivery systems will be integrated. Injured workers will
receive health services through their health plans, which must demonstrate their
capacity to treat work-related injuries and meet new standards for quality and
efficiency. Current workers' compensation carriers will retain financial
responsibility and reimburse health plans for the services they provide to injured
workers.
In the long run, a federal commission will study the feasibility and
appropriateness of transferring financial responsibility for all medical benefits to
health plans as well. This will result in even greater cost savings and higher quality
care.
Advantages for Workers
•
Workers will have the opportunity to see the same doctors and nurses whom
they trust for all of their medical care because they will receive their care
through their regular health plans.
•
Medical services provided to injured workers will be subject to the same
standards of quality care as other medical services delivered by health
providers.
Advantages for Firms and Providers
Money can be saved with a consolidated system through economies of scale
and streamlining.
Use of fee schedules will reduce price discrimination and costs.
Integration will reduce fraud and abuse. Monitoring will be easier in a closely
integrated system.
It is expected that firms will experience a reduction in premiums as a result
of cost savings.
�Worker's Compensation Integration
Page 2
•
Departments of Labor and Health and Human Services will develop and test
treatment guidelines for the most common work-related illnesses and
injuries.
•
Case managers will encourage rapid return-to-work treatments.
Possible Financial Integration
•
A Commission on Integration of Health Benefits will be established to study
the feasibility and appropriateness of transferring financial responsibility for
all medical benefits, including those now covered by workers' compensation,
to the new health care system. The Commission will study the most difficult
issues involved in integration and will submit a report to the President by
July 1, 1995. I f the report recommends integrating financial responsibility
for all medical benfits in health plans, then it must also provide a detailed
plan for doing so.
•
Integration of financing may further reduce costs of workers' compensation.
By making health plans fully responsible for providing medical benefits to
injured workers, new incentives to control costs will be applied to the
treatment of work-related injuries and illnesses.
Auto Insurance
•
Medical benefits covered by auto insurance would be delivered in the same
way as injuries covered by Worker's Compensation,with an integrated
delivery system. Those injured in auto accidents will receive health services
through their health plans; auto insurance carriers will reimburse health
plans.
�
Dublin Core
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Title
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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
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William J. Clinton Presidential Library & Museum
Identifier
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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.
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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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One Pagers [binder] [2]
Creator
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White House Health Care Task Force
Health Care Task Force
Christine Heenan
Identifier
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2006-0885-F Segment 3
Is Part Of
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Box 13
<a href="http://clinton.presidentiallibraries.us/items/show/36148" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12091530" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
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Adobe Acrobat Document
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Reproduction-Reference
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3/16/2015
Source
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42-t-12091530-20060885F-Seg3-013-011-2015
12091530