-
https://clinton.presidentiallibraries.us/files/original/72cec2e9a9322311d1f5ad6e1aac0c80.pdf
135835e09a0917bef718311c83cd1318
PDF Text
Text
FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Heenan
Subseries:
OA/ID Number:
3535
FolderlD:
Folder Title:
Rump Group
Stack:
Row:
Section:
Shelf:
Position:
S
53
1
3
1
�6/27/94
12:15 p.m.
MAINSTREAM COALITION PROPOSED AGREEMENT
PART ONE - COVERAGE
I.
INSURANCE COVERAGE
This section guarantees access to Qualified Health Plans for all U.S. citizens and
lawful residents not covered under other public programs such as Medicare,
Medicaid, CHAMPUS and DVA. This section details the establishment of Health
Care Coverage Areas (HCCAs), institutes insurance market reforms, establishes
standardized benefits packages, creates Qualified Health Plans (QHP), establishes
eligibility for low-income assistance vouchers and expands tax deductibility of
health insurance premiums.
A.
Assurance of Universal Coverage
1.
A National Health Commission (as described in Section XIV.) must
report to Congress biennially on the status of health insurance
coverage in the nation. The report must include, but is not limited to,
the structure and performance measures of every market area,
including the following:
a.
b.
Demographics of the uninsured, and findings on why those
individuals are uninsured;
Structure of deUvery system;
c.
Number, organizational form of health plans;
d.
Level of enrollment in health plans;
e.
State implementation of responsibilities, including
establishment of coverage areas;
f.
Status of insurance reforms;
g.
Development of purchasing groups and other buyer reforms;
h.
Success of market and other mechanisms of controlling health
expenditures and premium costs in the market area and
nationally;
�i.
j.
Adequacy of subsidies for low income individuals;
k.
Status of Medicare beneficiaries, transition into Medicare
managed care and QHPs;
1.
Coverage progress among those who are employed, including
status and level of voluntary employer contributions and
participation rates in pools and among large employers;
m.
Percentage of individuals who are enrolled in Qualified Health
Plans, separated into categories of Medicare, Medicaid, employed
individuals and individuals eligible for low-income subsidies;
n.
Informal recommendations, specific to each market area, on
how the area might increase coverage among the residents and
further moderate growth in premiums; and,
o.
B.
Status of transition of Medicaid toward managed care and
integration into AHPs;
Evaluation of adequacy of benefit packages.
Coverage Trigger
1.
Establishes a national goal that 95% of all Americans will have health
care coverage by 2002.
2.
If this goal is not met, the Commission must submit formal and
specific recommendations to Congress by January 1, 2002 as draft
legislation. The recommendations shall include methods to reach 95%
coverage in market areas that have failed to meet that target. They
must address all relevant parties, including states, employers,
employees, unemployed and low income individuals, public program
beneficiaries, etc.
3.
In addition to any other recommendations it submits, the Commission
must make separate recommendations on the following:
a.
A schedule of assessments or contributions to encourage
employers who are not doing so to purchase coverage for their
employees;
b.
A method of encouraging full coverage which does not require
any assessments on or contributions from employers;
�c.
d.
Possible adjustments to subsidies; and,
e.
4.
Possible adjustments to the benefits package;
Possible adjustments to tax treatment of benefits.
Congressional Consideration of the National Health Care Commission
Report. This proposed process is being reviewed by the Senate and
House Parliamentarians.
A.
Rules for the Senate
1.
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and legislative language. If the Majority Leader
has not introduced the bill within five days of session, any
Senator may do so.
2.
The bill will be referred to the appropriate Senate
Committee.
3.
If the Committee fails to report the legislation by July 1,
2002 (or if the Senate is not in session on this date, by the
first day of session after this date), it shall be automatically
discharged from further consideration of the bill; and the
bill shall be placed on the appropriate Senate calendar.
4.
Within 5 session days after the bill is placed on the
calendar, the Majority Leader, at a time to be determined
by the Majority Leader in consultation with the Minority
Leader, shall proceed to the consideration of the bill.
If on the sixth day of session, the Senate has not proceeded
to consideration of the bill, then the presiding officer must
automatically put the bill before the Senate for
consideration.
5.
30 Hours of consideration
a.
Two hours for first degree relevant amendments
b.
One hour for each relevant second degree
amendment.
c.
30 minutes on each debatable motion, appeal, or
point of order submitted by the presiding officer to
�the Senate and no motion to recommit shall be in
order.
6.
B.
There shall be five hours of consideration of motions and
amendment appropriate to resolve the differences
between the Houses, at any particular stage of the
proceedings.
Rules for the House of Representatives
1.
The Majority Leader must introduce the Report as a bill
on the first day of session following the submission of the
Report and legislative language. If the Majority Leader
has not introduced the bill within five days of session, any
Member may do so.
2.
The bill will be referred to the appropriate House
Committee or Committees.
3.
If the committee or committees fails to report the
legislation by July 1, 2002 (or if the House is not in session
on this date, by the first day of session after this date), they
shall be automatically discharged from further
consideration of the bill.
4.
On the sixth legislative day (the day on which the House
is in session) after the date on which the bill has been
placed on the appropriate calendar, it shall be privileged
for any Member to move that the House resolve itself into
the Committee of the Whole House on the State of the
Union, for the consideration of the bill, and the first
reading of the bill shall be dispensed with.
5.
After general debate, which shall be confined to the bill
and which shall not exceed four hours, to be equally
divided and controlled by the Chairman and Ranking
Minority Member of the Committee or Committees to
which the bill had been referred, the bill shall be
considered as read for amendment under the five-minute
rule. The total time for considering all amendments shall
be limited to 26 hours of which the total time for debating
each amendment under the five minute rule shall not
exceed one hour.
6.
At the conclusion of the consideration of the bill for
amendment, the Committee shall rise and report the bill
�to the House with such amendments as may have been
adopted, and the previous question shall be considered as
ordered on the bill and the amendments thereto to final
passage without intervening motion except one motion to
recommit.
Health Care Coverage Area
The major vehicle for reorganizing the health care marketplace would be the
establishment of geographic areas called Health Care Coverage Areas
(HCCAs). Employees of employers with fewer than 100 employees and
individuals residing or working in the HCCA would be pooled together and
would be eligible for insurance at an age-adjusted community rate. HCCAs
are established by each state and a minimum number of 250,000 lives must be
included in the HCCA rating pool. States may enter into cooperative
agreements to establish interstate HCCAs. States may decrease the number of
covered lives included in a rating pool.
Within each HCCA, consumers will have several different options available
to purchase health insurance. Employers and individuals may purchase
coverage directly from an insurer or agent, they may enroll at designated
state enrollment sites or they may chose to join a purchasing cooperative.
Accountable Health Plans may charge different administrative (or
enrollment) fees depending upon how the plan is purchased. If a Point of
Service (POS) Option plan is not available in the HCCA in which an
individual lives or works, the individual may purchase such a plan in an
adjacent HCCA.
D.
Insurance Market Reforms
The Secretary of HHS shall, within six months of enactment, and in
consultation with private expert entities such as the National Association of
Insurance Commissioners (NAIC), develop federal standards with which
Qualified Health Plans must comply in order to be deductible by an employer
or an individual. While these federal standards will be established by the
Secretary of Health and Human Services, the enforcement will be by the state
or the Department of Labor depending on the nature of the Qualified Health
Plan. All Qualified Health Plans must:
1.
Guarantee issue to all qualified applicants.
2.
Guarantee availability throughout the entire area in which it is offered.
�3.
4.
Not deny, limit, or condition coverage based on health status, claims
experience, or medical history during the annual open enrollment
period. The bill includes a first-time enrollment amnesty extended for
a certain period after the date of enactment. Individuals are
encouraged to maintain continuous coverage. Continuous coverage
means that the period between the date of enrollment in a health plan
and the last date of coverage may be no longer than three months. If
an individual has not maintained continuous coverage or is enrolling
in a plan for the first time after the initial open enrollment period,
coverage may be subject to a pre-existing condition limitation of no
more than six months. Pregnancy and pre-natal care are exempted
from this limitation.
5.
Comply with all rating requirements, including age and family size
adjustments, within the coverage area. ( Special rules will be
established to apply to Employer Sponsored Heatlh Plans and
Qualified Association Plans).
6.
Comply with enrollment process.
7.
E.
Guarantee renewal to all qualified enrollees, except in instances of nonpayment of premiums or fraud or misrepresentation.
Comply with financial solvency requirements, premium and collection
criteria. (Special solvency rules are established for certain types of plans
for large employers).
Benefit Packages
1.
Within six months of enactment, the Commission (described in
Section XIV.) shall develop and submit to the Congress clarification of
the initial standard and basic benefits packages. These packages must
adhere to the following:
a.
The actuarial value of the Standard Benefit Package can not
exceed the actuarial value of the Blue Cross/Blue Shield
Standard Option under the Federal Employees Health Benefits
program.
b.
The Basic Benefit Package must contain higher cost sharing
and/or fewer categories of benefits.
c.
Both benefit packages must include a full range of medically
appropriate treatments and preventive services.
�2.
Categories:
The following categories of benefits are to be included in the benefits
package:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
1.
3.
Inpatient and outpatient care.
Emergency, including appropriate transport services.
Clinical preventive services, including services for high risk
populations, immunizations, tests or clinician visits.
Mental Illness and Substance Abuse.
Family planning and services for pregnant women.
Prescription drugs and biologicals.
Hospice Care.
Home health care.
Outpatient laboratory, radiology and diagnostic,
Outpatient rehabilitation services.
Vision care, hearing aids and dental care for individuals under
22 years of age.
Patient care costs associated with investigational treatments that
are part of approved clinical trial.
Priorities:
Within the constraints of the actuarial limits set in this act. Congress
directs the Commission to adhere to the following priorities:
a.
b.
Consideration for needs of children and vulnerable populations,
including rural and underserved persons.
c.
4.
Parity for mental health and substance abuse services, which
shall consist of a broad array of mental health and rehabilitation
services managed to ensure access to medically necessary, and
psychologically necessary treatment and to encourage the use of
outpatient treatments to the greatest extent feasible.
Improving the health of Americans through prevention.
Medically Necessary or Appropriate
A Qualified Health Plan shall provide for coverage of the categories of
benefits described in this section for treatment and diagnostic
procedures that are medically necessary or appropriate.
An item or service is "medically necessary or appropriate" if, consistent
with prevailing medical standards, it is;
�a.
For treatment of a medical condition.
b.
Safe and effective (i.e., there is sufficient evidence to
demonstrate that the item can reasonably be expected to produce
the intended health outcome or provide the intended
information).
c.
Medically appropriate for a specific patient (i.e., it can reasonably
be expected to provide a clinically meaningful benefit if
furnished in a setting commensurate with the patient's needs).
Criteria for determination of medically necessary or appropriate are set
forth. QHPs shall make all coverage decisions under these criteria.
The Commission can, in limited circumstances, issue interim coverage
recommendations.
5.
Cost-Sharing
The Commission shall also develop multiple cost sharing schedules
which vary by delivery system organization. In making these
determinations, the Commission will consult with expert groups for
appropriate schedules for covered services. This clarification is subject
to approval by Congress under expedited procedures.
6.
Limitations
The Commission is prohibited from specifying provider types or
specific procedures in the benefit packages.
7.
Additional Commission duties related to defining the basic and
standard benefits packages:
a.
Develop interim coverage decisions in limited circumstances.
b.
Design the basic and standard benefits packages to prevent
adverse risk selection when combined with the risk adjustments
called for in the bill.
c.
May not specify provider types when clarifying covered benefits.
d.
May not specify particular procedures or treatments or classes
thereof.
�8.
Consideration of Commission Recommendations
The Commission will have the authority to propose modifications to
the benefits package (within the actuarial value ceiling described above)
that would not go into effect unless approved by Congress under baseclosing procedures. The Commission is responsible for any updates to
the benefits packages after the first year and these updates are also
subject to Congressional approval under expedited procedures.
II.
Qualified Health Plans
A.
Accountable Health Plans (AHPs)
1.
Definition: a health plan that may be operated as a variety of delivery
systems such as indemnity plans, preferred provider organizations,
health maintenance organizations, or other delivery systems. An AHP
is a health plan that is certified by the state as meeting insurance
market reform standards, health plan standards, quality, reporting
standards, and other standards.
2.
Standards
The National Health Care Commission (described in Section XIV.) will
establish standards for AHPs. In addition, AHPs:
a.
Must meet insurance reforms described in (I., C ) .
b.
May not engage in marketing or other practices intended to
discourage and /or limit the issuance to eligible individuals on
the basis of health condition, industry, geographic area or other
risk factors.
c.
Must make a health plan available throughout the entire HCCA
area in which it is offered.
d.
Must demonstrate its ability to make available and accessible to
each potential enrolle in the area the full range of benefits
required under the standard and basic benefit packages, when
medically necessary and promptly.
e.
Must provide for the application of coverage standards (for
�benefits) which are consistent with the coverage standards issued
by the Commission and disclosed to plan enrollees.
f.
g.
Must make available to nonparticipating providers the criteria
used in selecting those providers that are permitted to participate
in the plan.
h.
Must comply with federal information requirements.
i.
Must offer the standard and basic benefit packages, but may also
offer benefits in addition to these packages, if such additional
benefits are offered and priced separately from the standard and
basic benefit packages.
j.
B.
Must not accept enrollment of an individual who is currently
enrolled in another AHP.
Must comply with a system of binding arbitration for coverage
disputes.
Employer-Sponsored (risk-bearing) Plans
1.
Definition: a group health plan that may be operated as a network plan
or an indemnity plan for which the employer retains all or a portion of
the insurance risk, commonly referred to as self-insured.
2.
Standards:
a.
Employer sponsored plans must meet all the standards for AHPs
and insurance market reforms, except they are not required to
take all applicants, and the population served and area covered
is defined by such an employer's employee population.
b.
Financial solvency, reserve, and guarantee fund standards will
be established by the Secretary of the Department of Labor (DoL)
consistent with the applicable rules under Part 4 of Title I of
ERISA.
c.
The Secretary of DoL may take corrective actions to terminate or
disqualify an employer-sponsored plan that does not meet the
above standards.
d.
The Secretary of DoL is appointed as trustee for insolvent
employer-sponsored health plans.
10
�C
Qualified Association Plans (QAPs)
1.
Definition: Association health plans that have been in existence for
three years prior to the date of enactment.
2.
Standards:
a.
Must meet all standards for AHPs with the following exceptions:
i.
ii.
3.
Special solvency requirements will be established by DoL
for QAPs.
Must only take any member in their designated
association.
Requirements for Sponsoring Entity (Association)
a.
b.
Must have appropriate by-laws that specifically state the purpose,
as a trade association, industry association, professional
association, chamber of commerce, religious organization, or
public entity association.
c.
Must have been established and maintained for substantial
purposes other than to provide the health care required under
this section.
d.
Must be, and have been, in operation (together with its
immediate predecessor, if any) for a continuous period of not
less than 3 years.
e.
4.
Must be organized and maintained in good faith.
Must receive the active support of its membership.
Treatment of Multiple Employer Welfare Arrangements (MEWAs)
a.
In general, upon enactment, a MEWA will meet the standards to
become either a QAP or a certified purchasing group.
b.
Any MEWA that has been in effect for not less than 18 months
upon enactment and with respect to which there is application
with the domicile state for certification as a QAP, shall be treated
for purposes of this subtitle as a Qualified Health Plan (if such
11
�plan otherwise meets the requirements of this Act);
c.
However, MEW As will not be able to continue to operate if the
domicile state can demonstrate that -i.
ii.
the plan that is the subject of the application, on its face,
fails to meet the requirements for a complete application;
or
iii.
5.
the sponsor has made fraudulent or material
misrepresentation(s) in the application;
a financial impairment exists with respect to the applicant
that is sufficient to demonstrate the applicant's inabihty to
continue its operations.
Treatment of Rural Electric Cooperatives (RECs) and Rural Telephone
Cooperative Associations (RTCs)
RECs and RTCs can continue to exist if they meet the same standards as
QAPs; or if they are certified by the state as a purchasing group.
D.
Multi-Employer (Taft-Hartley) Plans
Taft-Hartley plans must meet the same requirements as large employers. (See
Section III.B. below)
E.
Public Programs
Existing public programs like Medicare, Medicaid, Department of Defense
health programs. Department of Veterans Affairs health programs and Indian
Health Service programs are considered to be Qualified Health Plans for the
purposes of this section.
F.
Pre-emption of Certain State Laws regulating Insurance Plans
The following state laws relating to health plans are preempted for any QHP:
1.
State laws that restrict plans from:
a.
limiting the number and type of providers who participate in a
plan;
b.
requiring enrollees to obtain health services from participating
providers;
12
�c.
d.
3.
G.
establishing different payment rates for participating providers;
e.
2.
requiring enrollees to obtain referral for treatment by a specialist
or health institution;
creating incentives to encourage the use of participating
providers;
State corporate practice of medicine laws;
State mandated benefit laws.
Advance Directives
1.
Right to Self-Determination
a.
b.
Plans must provide for educational activities for patients and
providers and must have a functioning process to provide for
communication between the patient and the appropriate health
care provider regarding all aspects of the patient's care, including
obtaining informed consent, patient prognosis and treatment
decisions, and the formulation of advance directives.
Discussions of prognosis and treatment alternatives should
occur at the time of diagnosis, prior to treatment and whenever
there is a significant change of status which affects diagnosis,
prognosis and treatment.
c.
2.
Each Qualified Health Plan must notify enrollees of their rights
to self-determination in health care decision-making and of the
plan's policy regarding advance directives. Plans must
maintain procedures to require that the existence and content of
an advance directive is recorded in the patient's chart (written or
electronic) and provide for a mechanism to notify all appropriate
health care providers of the information.
In order to receive Medicare or Medicaid reimbursement for
particular procedure codes to be determined by the Secretary of
HHS, claims forms (written or electronic) must include the
physician's certification indicating that the patient discussed
with the physician the diagnosis, prognosis and treatment
options and that the patient's questions were answered.
Decisions by Surrogates
13
�In the event that a state does not have a law on surrogate decisionmaker for health care decisions, a federal health care surrogate standard
shall apply. This standard is:
a.
A surrogate may make a health-care decision for a patient who is
an adult or emancipated minor if the patient has been
determined by the primary physician to lack capacity and no
agent or guardian has been appointed or the agent or guardian is
not reasonably available.
b.
An adult or emancipated minor may designate any individual to
act as surrogate by personally informing the supervising healthcare provider or specifying it in a health care power of attorney.
In the absence of a designation, or if the designee is not
reasonably available, any member of the following classes of the
patient's family who is reasonably available, in descending order
of priority, may act as surrogate:
i.
the spouse, unless legally separated;
ii.
an adult child;
iii.
a parent; or
iv.
an adult brother or sister.
c.
d.
III.
If none of these individuals are reasonably available, an adult
who has exhibited special care and concern for the patient, who
is familiar with the patient's personal values, and who is
reasonably available may act as surrogate.
A surrogate shall communicate his or her assumption of
authority as promptly as practicable to the specified members of
the patient's family who can be readily contacted.
Large and Small Employer Responsibilities and Purchasing Groups
A.
Small Employer Purchasers
1.
Definition: employers with 100 or fewer full-time employees.
2.
Responsibilities:
a.
May not be the sponsor of a risk-bearing plan, but if a member of
14
�an eligible Association may join a QAP.
b.
c.
If an employee resides in another HCCA, the employer must
provide information regarding how to obtain information
regarding AHPs available in that HCCA.
d.
Small employers must make available to their employees a
choice of at least three Qualified Health Plans either by joining a
purchasing group or through independent brokers or insurance
agents.
e.
Small employers who contribute toward coverage must pay to
any Qualified Health Plan selected by the employee an amount
equal to the contribution they would make on the employee's
behalf to the health plan selected by the employer.
f.
B.
Must provide all employees (including part-time and seasonal)
with information regarding all AHPs offered in the HCCA in
which the employer is located.
Payroll Deduction. If an employee requests, employer must
arrange for payroll deduction to pay the premium amount due,
less any employer contribution, to the plan or purchasing group
of the employee's choice. However, if the employee selects a
plan other than those offered by the employer, the
administrative cost of making such a payroll deduction may be
charged to the employee.
Large Employer Purchasers
1.
Definition:
employers with more than 100 full-time employees.
2.
Responsibilities:
a.
All large employers must offer their employees a choice of at
least three QHPs, one of which must be a point-of-service option
and one of which must offer a basic benefits package. A large
employer may comply with this subsection by offering QHPs
provided by a single entity. Large employers may also meet this
obligation, in part, by making available to their employees the
choice of a Qualified Association Plan (see below).
b.
Large employers are ineligible to join the small employer and
individual purchasing groups or to purchase insurance at the
community rate either through a broker, independent agent.
15
�purchasing cooperative, or public enrollment office.
c.
d.
All large employer purchasers are regulated by the DoL and
remain subject to ERISA.
e.
If an employer contributes to its employee's health coverage, it
must provide coverage as of the first day of the month in which
an employee becomes eligible. Once terminated, coverage
continues through the end of the month of termination.
f.
COBRA. An individual whose employment has been
terminated by a large employer must elect within 30 days of the
termination to either remain in the plan provided by the
employer for a period not to exceed 12 months, or until the
individual is reemployed, whichever is less.
g.
C
Employees of large employers are also ineligible to purchase
insurance at the community rate either through a broker,
independent agent, purchasing cooperative, or public
enrollment office.
Selection of Plan by Majority of employees. Each employer shall
make selection of health plans on an annual basis. Employers,
who are not contributing to coverage, shall comply with a
selection made by more than 50% of employees.
Individual and Small Employer Purchasing Groups
1.
These purchasing groups shall be chartered under state law.
2.
Membership in these purchasing groups will be voluntary and limited
to employers and employees of businesses with 100 or fewer
employees, and to all other non-Medicaid U.S. citizens or legal
residents not employed by a large employer who live in the HCCA
area.
3.
Nothing in the Act shall be construed to require any individual or
small employer to purchase exclusively through a purchasing group.
4.
Nothing in the Act requires the establishment of a purchasing group
nor prohibits the establishment of a purchasing group in an area.
5.
Nothing in the Act shall be construed from preventing a purchasing
group from being the purchasing group for more than one HCCA.
16
�6.
7.
D.
Nothing shall be construed to prevent a state from estabhshing or
designating more than one purchasing group in a HCCA.
Purchasing groups are permitted to contract selectively with Qualified
Health Plans. Purchasing groups are permitted to negotiate a price
lower than the community rate, if so, that price becomes the plan's
new community rate. Nothing in this act shall be construed to prevent
a purchasing group from negotiating prices on administrative fees or
items outside the basic and standard benefits packages which may be
unique to the purchasing group.
Allowing Access to Federal Employee Health Benefit Program
Any plan under the Federal Employee Health Benefit plan offered to federal
employees in a HCCA must be available for purchase by individual and small
group purchasers in that area. Non-federal employee purchasers shall pay a
premium amount based on the local community rate for that plan, and shall
not be a part of the FEHB insurance pool. Plans offered nationally through
FEHB shall not be required to be open to non-federal employee enrollment.
IV.
Nondiscrimination provisions that apply to all employers:
A.
General Rules
Employers that contribute to the purchase of any employee's health care coverage may not discriminate against any employee based on the employee's
income. Employers that contribute to the purchase of any full-time
employee's health care coverage must make an equal dollar contribution to
all full-time employees choosing to purchase health care coverage offered by
such employer. In addition, employers that contribute to the purchase of any
part-time employee's health care coverage must make a proratated equal
dollar contribution to all part-time employees choosing to purchase health
care coverage offered by such employer.
1.
A large employer that otherwise contributes shall not be required to
offer an equal dollar contribution to an employee or "cash out" an
employee that does not choose to purchase health care coverage offered
by such employer.
2.
For purposes of part-time employees, a dollar contribution will
constitute an equal dollar contribution if the employer makes a dollar
contribution proportionate to the number of hours worked by the parttime employee.
17
�B.
Special Rule for Small Employers
1.
To the extent a small employer contributes to an employee's health
care coverage, the employer cannot discriminate against an employee
that chooses to purchase health care coverage from other than such
small employer.
2.
In no event shall a small employer be required to "cash out" an
employee who does not choose to purchase health care coverage
through the employer. For example, if a small employer makes a
contribution on behalf of a full-time employee that chooses a plan the
employer offers, it must also make a contribution to a full-time
employee that chooses a Qualified Health Plan not offered by the
employer.
3.
Small employers may charge a reasonable fee to cover their
administrative costs associated with withholding and remitting
employee health insurance premiums of employees not opting for the
health care coverage offered by the small employer.
Penalties
To the extent an employer does not comply with these nondiscrimination
rules, a penalty will be assessed for the period of time the employer is in
noncompliance. Such penalty will be equal to $100 for each day, or part
thereof, of such period. (See Section 4980B of the Internal Revenue Code for
analogous rules).
D.
Definitions
1.
A full-time employee is defined as an individual who is employed for
an average of 30 or more hours per week.
2.
A part-time employee is defined as an individual who is employed for
an average of at least 10 hours per week, but less than 30 hours per
week.
3.
An individual does not qualify as a full-time or part-time employee
until the individual has been employed for six months (i.e., seasonal
employees are not treated as part-time employees).
18
�Exemption for Collectively Bargained Plans
Single-employer and multi-employer bona fide collectively bargained plans
are exempt from these nondiscrimination rules.
V.
Assistance to Individuals and Families for the General Purchase of Insurance
A.
Eligibility:
Individuals and/or families not otherwise eligible for Medicare or Medicaid,
whose income is less than 240% of the federal poverty level will be eligible for
a Voucher for the purchase of a Qualified Health Plan.
B.
Amount of Voucher
1.
2.
G
For individuals and families with incomes less than 100% of poverty
the voucher will be equal to 100% of the average premium of the
lowest 2/3 of Qualified Health Plans offered in the HCCA in which
they reside or work.
For individuals and families with income above 100% of the federal
poverty level, the Voucher amount will be decreased on a sliding scale
basis to 240% of the federal poverty level.
Phase-in Schedule for Vouchers
Vouchers will be phased-in at the beginning of each year under the
following schedule:
Calendar Year
Percentage of Poverty
1997
1998
1999
2000
2001
D.
90%
120%
150%
180%
240%
Administration of Vouchers
1.
The Secretary of HHS will establish a mechanism for
determining eligibility for vouchers, for distributing application
forms, and to the extent practicable, for allowing enrollment in a
19
�Qualified Health Plan at the time of appUcation for subsidy.
2.
The Secretary may provide for administration of Vouchers through an
appropriate State agency.
VI.
Assistance to Individuals and Families — Expanded Tax Deductibility
(Described in Section XIII.,B.)
VII.
Expanding Access for Underserved Populations
A.
Community-Based Primary Care Grant Program
1.
Three grant programs would be established to promote community
health plans and practice networks.
a.
The HHS Secretary will establish a program to administer grants
to the states for the purpose of creating or enhancing communitybased primary care entities that provide services to low-income
or medically underserved populations. This provision is
designed to complement the existing federal Community and
Migrant Health Center programs by making flexible funding
available to local public health departments, rural hospitals, and
other public and private community care entities.
b.
The Secretary of HHS may make grants to and enter into
contracts with consortia of public and private health care
providers for the development of qualified community health
plans and practice networks. The Secretary will give preference
to plans and networks with three or more categories of providers
such as EACH/RPCHs, MAFs and other rural hospitals, migrant
health centers, community health centers, homeless health
services providers, public housing providers, family planning
clinics, Indian health programs, maternal and child health
providers, federally qualified health centers and rural health
clinics, state and local health department programs and health
professionals and institutions providing services in one or more
Health Professional Shortage Areas (HPSAs) or to medically
underserved populations.
c.
Loans and loan guarantees for capital costs would be authorized
20
�for the development of qualified community health plans or
practice networks.
B.
Enhanced Assistance for Federally Qualified Health Centers
1.
Expanded resources will be provided for the Federally Qualified Health
Centers;
2.
This provision is intended to complement the state-based community
primary care grant program described above. Both provisions are
aimed at addressing the shrinking availability of primary health care
services in the country's rural and inner-city communities.
C
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
(As described in Section XIII., D.)
D.
Development of Networks of Care in Rural and Frontier Areas
1.
2.
E.
The HHS Secretary is authorized to waive certain Medicare and
Medicaid requirements for demonstration projects to operate rural
health networks. Public and private entities may apply for such
waivers. The Secretary may award grants to assist organizations in
rural networks planning.
The Secretary will conduct a study on the benefits of developing a
supplemental benefit package and making available premiums that
will improve access to health services in rural areas.
Grant Program for Low Interest loans for Capital Improvement in Rural and
Underserved Areas
Loans and loan guarantees for capital costs would be authorized for the
development of qualified community health plans or practice networks.
F.
Office of the Assistant Secretary for Rural Health
Under this provision, the position of Director of the Office of Rural Health
would be elevated to the position of the Assistant Secretary for Rural Health.
The mission of the office would be expanded to include advising on how
health care reform could impact rural areas.
21
�G.
Rural and Frontier Emergency Care
A rural emergency medical services program is established to improve
emergency medical services (EMS) operating in rural and frontier
communities. This program will:
1.
2.
Provide federal grants to states for telecommunications demonstration
projects linking rural and urban health care facilities;
3.
Establish an Office of Emergency Medical Services to provide technical
assistance to state EMS programs;
4.
H.
Offer a matching grant program for improving state EMS services.
These grants will encourage better training for health professionals and
provide necessary technical assistance to public and private entities
which provide emergency medical services;
Federal grant support will also be provided to the states for the
development of air transport systems to enhance access to emergency
medical services.
Medicare Dependent Hospitals
1.
Modify Payments to Medicare Dependent Hospitals in the following
manner:
a.
b.
clarify of updates; and,
d.
L
conform target amounts to extension of additional payments;
c.
2.
base payments on a 36 month period beginning with the first day
of the cost reporting period that begins on or after April 1, 1990;
would extend Medicare-dependent hospital classification
through 1998.
Would establish a demonstration project regarding payment to larger
Medicare dependent hospitals.
EACH/RPCH Program Improvements and Extension to all States
1.
Expands the EACH/RPCh program to all states.
2.
Rural community hospitals meeting eligibility criteria may qualify as
22
�Rural Emergency Access Community Hospitals (REACHs).
3.
Current special reimbursement to small rural Medicare—dependent
hospitals enacted in Omnibus Budget Reconciliation Act of 1989 is
extended.
4.
Modify provisions that relate to hospital inpatient services in a Rural
Primary Care Hospital so that:
a.
a RPCH cannot have more than 6 beds;
b.
c.
the Secretary can terminate the RPCH designation if the average
length of stay for the previous year exceeded 72 hours. In
determining the average length of stay, cases which exceed 72
hours due to inclement weather or other emergency conditions
are not included in the calculations;
d.
5.
the RPCH cannot perform surgery or any service requiring
general anesthesia (unless the risk of transferring the patient
outweigh the benefits);
the GAO must submit a report determining if the revised RPCH
criteria have resulted in RPCHs providing patient care beyond
their abilities or have limited RPCHs" abilities to provide needed
services.
Designates EACH hospitals so that:
a.
urban hospitals can be designated as EACHs and do not need to
meet the 35 mile criteria, but do have to meet all the remaining
criteria. Urban EACHs would still be subject to the Medicare
Protective Payment System; and,
b.
hospitals located in adjoining states and otherwise eligible as
EACHs and RPCHs can participate in a state's rural health
network and these hospitals or facilities are permitted to receive
grants.
6.
Permit RPCHs to maintain swing beds in a Skilled Nursing Facility
except that the number of swing beds may not exceed the total number
of swing beds established at the time the facility applied for its RPCH
designation. Beds in a distinct-part SNF do not count towards the total
number of swing beds.
7.
Extend the deadline for the development of prospective payment
system for inpatient RPCH services to January 1, 1996.
23
�8.
9.
Adopt technical amendments relating to Part A deductible, coinsurance
and spell of illness.
10.
The Department of Justice and Federal Trade Commission would be
instructed to issue formal guidelines for EACH/RPCHs.
11.
The Secretary would be permitted to designate an unlimited number of
RPCHs in non-EACH states. The RPCHs must establish relationships
with a full-service rural hospital that meet the same criteria as EACHs
with the exception of the criteria that the EACH have 75 beds.
12.
HHS would be required to conduct a pilot program that would allow
RPCHs to admit patients on a limited DRG basis instead of using the
72-hour average length of stay criteria.
13.
Codify the MAF requirements into Medicare, allowing Medicare to
reimburse on a cost basis those facilities which meet the MAF
requirements.
14.
J.
Clarify that physician staffing criteria only apply to doctors of medicine
and osteopathy.
Develop a grant program for states that operate MAFs. The grant
program would be modeled after the EACH/RPCH program.
Extends the Rural Health Transition Grant Program
Extends the program through FY 1998 with authorized appropriations of $30
million annually, FY 1993 - 1998. Reports from grantees would be required
every 12 months. As of October 1,1994, RPCHs are eligible for rural health
transition grants.
K.
Increases reimbursement to PAs and NPs under Medicare
1.
Certified Nurse Practitioners and Physicians Assistants would be
reimbursed at 85% of the RBRVS rate for services performed in all
outpatient settings.
2.
Under Medicare, certified Nurse Practitioners would be reimbursed at
65% of the RBRVS rate for assisting at surgery in urban areas.
3.
States would be required to directly reimburse all certified Nurse
Practitioners in a rural area under Medicaid. This expands the current
24
�requirement that all states directly reimburse pediatric and family
Nurse Practitioners, which gives states the option of directly
reimbursing other types of NPs.
L.
Telemedicine and Related Telecommunications Technology
1.
2.
M.
Coordinates various federal grant programs which fund telemedicine
and related telecommunications demonstrations and grant programs.
This provision establishes a federal interagency task force, coordinated
and chaired by the Department of Health and Human Services, would
be established to oversee telemedicine and other telecommunications
demonstration projects already underway.
A grant program would be established to fund telemedicine and related
telecommunications technology in rural areas. The program would be
administered through the Assistant Secretary for Rural Health.
Applicants for the grant would be rural health care providers such as
rural referral centers, rural health clinics, community health centers,
migrant health centers, area health and education centers, local health
departments and public hospitals.
National Health Service Corps
1.
2.
N.
Fully funds the National Health Service Corps program and require
that at least 20% of those in the Scholarship and Loan Repayment
Program be nurses and physicians assistants
Reauthorize the Community Scholarship Program. In addition, the
criteria for selecting students should be modified and a 15%
administration fee for those agencies administering the scholarships
should be established.
Indian Health Reform Amendments
1.
Indian Health Service remains as a provider of health care for the
Indian population.
2.
Reaffirms current federal policy of guaranteeing that Indian Tribes
should be eligible to apply for all appropriated funds and grants created
under health reform legislation, at levels not less than any other
qualified entities. This provision is simply a reaffirmation of current
Federal policy.
25
�3.
4.
O.
Requires the Assistant Secretary for Indian Health to establish a new
formula for the distribution to tribes of all new funds that become
available for health care initiatives and programs under health reform.
This formula would consider differences in local resources, status of
health, socioeconomic status of Tribal people, and
facilities/equipment/staff that are available.
Retains Indian eligibility under current law for additional benefits.
Under this provision, whatever comprehensive benefits one accrues
through health reform legislation, Indians would not lose any current
benefits. Such benefits include all supplemental benefits, such as
environmental health, mental health benefits, and alcohol abuse
treatment.
Transitional Requirements for Plans Serving Special Needs Populations
1.
Nondiscrimination Service Area Standards
Health plans must not discriminate in the drawing of services area
boundaries on the basis of race, ethnicity, socioeconomic status, age, or
anticipated need for health services.
2.
Special Access Standards
Plans must meet special access standards that take into account the
special needs and circumstances of urban and rural underserved areas.
The Secretary would be required to establish access standards for
enrollees living in medically underserved areas that take into account
the following indicators:
a.
b.
c.
Accessibility of primary care services based on measures such as
the ratio of primary care providers to expected enrollees;
Accessibility of other services, based on measures such as travel
time;
Accessibility of health plans services for individuals with
limited ability to speak the English language, and for population
with similar needs.
3.
Reporting Requirements
Health plans must report on key indicators of access, quality and
service in a manner that provides separate information and
monitoring for those in medically underserved areas.
4.
Designation of Underserved Communities and Populations
The Secretary would annually designate underserved areas and
populations as either of the following areas:
a.
Areas with a shortage of personal health services as designated
26
�b.
c.
d.
5.
under section 332(a)(3) or 1302(7) of the Public Health Service
Act;
Health Professional Shortage Areas as described in section
332(a)(1)(a) of the PHS Act;
High impact areas as described in section 329(a)(3) of the PHS
Act; or
an area which includes a population group which the Secretary
determines as a health manpower shortage area under Section
332(a)(1)(B) of the PHS Act.
Certification of Essential Community Providers
Any public or non-profit private entity furnishing services in a
designated medically underserved community or population may
apply to the Secretary for certification as an essential community
provider. In order to be certified, the entity:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Must be a public or non profit private entity;
Must be capable of providing for a full range of primary health
care services that are available and accessible promptly, as
appropriate and in a manner which assures continuity;
Have organization arrangements for quality assurance programs
and maintaining patient record confidentiality;
Demonstrate financial responsibility;
Accept all patients notwithstanding their ability to pay;
Make every effort to collect appropriate reimbursement from
Medicare, Medicaid and third party payers;
Estabhsh a sliding-scale fee schedule based on ability to pay for
services;
Reviews annually its catchment area;
Where appropriate, provides access to patients with limited
english-speaking ability;
Meets the requirements of section 1861 (z) of the Social Security
Act, compiles appropriate statistical and other information.
6.
Obligation to Offer Contracts for Primary Care Services
All health plans, including self-insured plans, would be required to
offer a contract with a reasonable number as determined by the
Secretary of certified essential community providers. Mandatory
contracting would be in effect for the first five years after enactment.
7.
Scope of Contracts
The contract between health plans shall:
a.
Provide for primary health services that are included in the
uniform benefit package, furnished on an outpatient basis and
provided directly by the essential community provider.
27
�b.
Terms and conditions applied to the agreements shall be
comparable to terms and conditions that apply to other
providers furnishing comparable services to the health plan.
c.
Payment will be based on Section 1876 of the Social Security Act.
8.
Health Plan Obligation for Non-primary Care
Health plans must meet general access standards for non-primary care
services to insure accessibihty and availability of all covered and noncovered primary care services for all enrolled members. (Needs more
definition.)
9.
Access in Underserved Areas
The Office of Technology Assessment (OTA) will conduct a study on
improving access in underserved areas.
P.
Urban " Safety-Net" Hospitals
EstabUshes a revolving loan fund and grant program to fund capital
improvements for publicly owned and operated "safety-net" hospitals.
Other Urban Hospitals
Demonstration for inaccessible other urban Hospitals to qualify as Sole
Community Hospitals.
VIII. New Home and Community Based Long Term Care Program
A.
General
Establishes a new capped program in the Social Security Act to provide
home-and community-based services for older Americans and
individuals with disabilities. The program is administered by the
States with federal matching payments for services provided. Total
funding is capped, and there is no individual entitlement to services
under this program.
B.
Eligibility
The Secretary will issue regulation establishing uniform eligibility
criteria and assessment protocols. In order to receive benefits under
the program, an individual must be determined eligible, must undergo
28
�a standardized assessment and have a individualized plan of care
developed. To be eligible, an individual must be in one of the
following categories. The first three categories apply to individuals of
all ages; the final category applies only to children under age six.
1.
2.
Presents evidence of severe cognitive or mental impairment.
3.
Has severe or profound mental retardation.
4.
C
Requires hands-on or stand-by personal assistance supervision
or cues in three or more of five activities of daily living: eating
dressing bathing, toileting, and transferring in and out of bed.
Is under age six and would otherwise require hospital or
institutional care for a severe disability or chronic medical
condition.
Covered Services
1.
2.
D.
At a minimum, a state's array of services must include personal
assistance (both agency administered and consumer directed) for
every eligible category of participant. Services may include, but
are not limited to: case management, homemaker and chore
assistance, home modifications, respite services, assistive
technology, adult day services, habilitation and rehabilitation,
supported employment, and home health services.
Services may be delivered in a home, a range of community
residential arrangements, or outside the home. Services may
not be provided in licensed nursing homes or intermediate care
facilities for the mentally retarded.
Cost Sharing
Eligible individuals with incomes over 150% of the federal poverty
level pay co-insurance to cover a portion of the cost of all services they
receive according to a sliding scale. Persons with incomes between
150% and 200% of the federal poverty level pay 10% of the cost of care;
between 200% and 250% of poverty 20% co-insurance, and persons with
income over 250% of poverty pay a 25% co-insurance.
State Administration
29
�Each state must have an approved plan, which specifies: administering
agency or agencies; services to be covered, and how the needs of all
types of eligible individuals will be met; provide a plan for making
eligibility determinations: provide information on how the state will
develop care plans, coordinate services, reimburse providers and plans,
administer vouchers or cash payments, license or certify providers. In
addition, the state must develop a system of determining allocation of
resources and how the new program with be integrated with existing
long-term care programs, and must assure that low-income persons in
the program is at least equal to the proportion of low-income persons
in the state's population.
F.
Quality Assurance
States are responsible for developing comprehensive quality assurance
programs that monitor health and safety of participants as well as
assure that services are of the highest quality. States must develop, for
federal approval, quality assurance systems that include consumer
satisfaction surveys. In addition, consumer advisory groups are
expected to play a strong role in assuring and enhancing quality.
Federal Matching Payments to States
A federal matching payment will be made to states based on the current
Medicaid match rate plus 28 percentage points. Federal matching
percentages can be no less than 78 percent and no more than 95 percent.
No federal matching payments will be made once the cap is reached.
H.
Funding, Allotments to States
For federal Fiscal years 1996-2002 - No federal funds allocated.
PART TWO - COST CONTAINMENT & CONSUMER PROTECTION
A.
High Cost Plan Assessment
(described in Section XIII., A.)
B.
Medical Liability Reform
1.
Alternative Dispute Resolution
a.
No health care malpractice action may be brought in court until final
30
�resolution of the claim under an alternative dispute resolution (ADR)
method adopted by the state from models developed by the Secretary of
HHS, or developed by the state and approved by the Secretary of HHS.
b.
2.
If the party initiating court action following the ADR receives a worse
result with respect to liability or a level of damages 33 1/3% below that
awarded in the ADR, that party must pay the costs and attorneys fees of
the other party incurred subsequent to the ADR.
Damages
Non-economic damages awarded to a plaintiff in a health care malpractice
claim or action may not exceed $250,000, indexed for inflation.
3.
Several Liability
The liability of each defendant in a health care malpractice action for noneconomic and punitive damages will be based on each defendant's proportion
of responsibility for the claimant's harm.
4.
Punitive Damages
Seventy-five percent of punitive damage awards will be paid to the state in
which the action is brought and such funds will be used for provider
licensing, disciplinary activities and quality assurance programs.
5.
Statute of Repose
A twenty year statute of repose will be applied to health care malpractice
actions.
6.
Fee Reform
Lawyers may not charge contingency fees greater than 33 1/3% of the first
$150,000 of the award in a health care malpractice action and 25% of amounts
in excess of $150,000. Calculation of permissible contingency fees is based on
after tax amounts.
7.
Limited Preemption
State laws that have higher limits on attorneys fees and non-economic
damages are preempted. State laws that provide for longer statutes of repose
are preempted. Does not preempt those laws with lower limits on attorneys
fees and non-economic damages are preempted. Does not preempt state laws
with shorter statutes of repose.
31
�Administrative Simplification and Paperwork Reduction
Implements a national health information network to reduce the burden of
administrative complexity, paper work, and cost on the health care system; to
provide the information on cost and quality necessary for competition in
health care; and to provide information tools that allow improved fraud
detection, outcomes research, and quality of care.
1.
National Health Information Network
Requires the Secretary of HHS to implement a national health
information network by adopting standards for:
a.
b.
transmitting information electronically,
c.
conducting transactions using this information,
d.
certifying public or private entities to perform the intermediary
functions which implement the network,
e.
monitoring performance to assure compliance,
f.
establishing procedures for adding codes to previously adopted
standards,
g.
making changes to previously adopted standards, and
h.
2.
representing the content and format of health information in
both paper and electronic forms,
developing, testing, and adopting new standards.
Health Information Advisory Commission
In carrying out duties under this part, the Secretary would consult with
an Advisory Commission consisting of 15 members from the private
sector with expertise and practical experience in developing and
applying health information and networking standards. The members
would be appointed by the President and serve staggered 5 year terms,
and would include providers and consumers.
3.
Requirements for Qualified Health Plans and Health Care Providers
32
�All Qualified Health Plans, including Federal and State plans, and all
health care providers would be required to comply with federal
standards for formatting information and electronic transactions.
The Secretary may require transactions to be consistent with the goal of
reducing administrative costs. In addition, certain standard data must
be made available electronically on the health information network to
authorized inquiries. Other requirements for electronic information,
such as quality related information, may be specified in other parts of
the law and would be put through the same standards setting
procedure before becoming required.
4.
Accessing Health Information
a.
b.
5.
The Secretary would establish technical standards for requesting
standard health information from participants in the health
information network which assure that a request for health
information is authorized under federal privacy provisions.
The Secretary would establish standards for the appropriate
release of health information to researchers and government
agencies, including public health agencies. The Secretary would
establish standards for the electronic identification of a request as
one which comes from a person authorized to receive health
information under federal privacy provisions.
Effective Date
A timetable of effective dates would be included which would specify
when each requirement would take effect relative to the date of
enactment. In general, the Secretary would adopt existing standards
within 9 months of enactment and more time is given for standards
which must be developed. At least 12 months grace period is allowed
after any standard is adopted before use of that standard becomes
required.
D.
Quality Assurance
The goal of health reform is to ensure that Americans have access to health
care plans that compete on the basis of price and quality. Assessing quahty
requires reliable and comparable information on the outcomes and
effectiveness of services provided by plans. Under this subtitle. Qualified
Health Plans are required to annually report data on the quality of their
services to the Secretary of HHS in a format prescribed under the National
Health Information Network. The Secretary may determine the manner in
33
�which these data are provided to certifying authorities in states. This title also
provides direction to the Secretary to improve and expand the capability of
HHS to support and encourage research and evaluation of medical outcomes.
Standards and Measurements of Quality
The Secretary, in consultation with relevant private entities, will develop
quality standards with which all Qualified Health Plans must comply. These
standards are designed to improve the data available upon which to assess
quality and the processes by which quality care is continuously improved.
The Secretary will study the capabilities of entities within its jurisdiction to
accomplish these goals including:
1.
2.
supporting research and evaluation on medical effectiveness through
technology assessment, consensus development, outcomes research
and the use of practice guidelines;
3.
conducting effectiveness trials in collaboration with medical specialty
societies, medical educators and qualified health plans;
4.
maintaining a clearinghouse and other registries on clinical trials and
outcomes research data;
5.
assuring the systematic evaluation of existing and new treatments, and
diagnostic technologies in an effort to upgrade the knowledge base for
clinical decision making and policy choice;
6.
E.
setting priorities for strengthening the medical research base;
designing an interactive, computerized dissemination system of
information on outcomes research, practice guidelines, and other
information for providers.
Anti-fraud and Abuse Control Program
This subtitle establishes a stronger, better coordinated federal effort to combat
fraud and abuse in our health care system. It expands criminal and civil
penalties for health care fraud to provide a stronger deterrent to the billing of
fraudulent claims and to eliminate waste in our health care system resulting
from such practices. It also seeks to deter fraudulent utilization of health care
services. It would:
1.
Require the HHS Secretary and Attorney General to jointly establish
and coordinate a national health care fraud program to combat fraud
34
�and abuse in government and Qualified Health Plans;
2.
Finance the anti-fraud efforts by setting up an Anti-Fraud and Abuse
Trust Fund. Monies from penalties, fines, and damages assessed for
health care fraud are dedicated to the Trust Fund to pay for the antifraud efforts;
3.
Increase and extend Medicare and Medicaid civil money and criminal
penalties for fraud to all health care programs;
4.
Bar providers convicted of health care fraud felonies from participating
in the Medicare program;
5.
Require HHS to publish the names of providers and suppliers who
have had final adverse actions taken against them for health care
fraud; and,
6.
Establish a new health care fraud statute patterned after existing mail
and wire fraud statutes under Title XXIII of the Criminal Code and
allows for criminal forfeiture of proceeds.
X. REFORM OF EXISTING PUBLIC PROGRAMS
A.
Medicaid (Some would like to integrate Medicaid faster if it did not adversely
affect the cost of health care reform.)
1.
Integration of Medicaid beneficiaries into Qualified Health Plans
a.
The Secretary shall make recommendations on the integration
of AFDC and non-cash recipients into the community-rated pool
and into Qualified Health Plans. The Secretary's
recommendations shall address:
i.
ii.
the administration of subsidies,
iii.
2.
the impact on private health insurance premiums,
the adequacy of services for Medicaid recipients and the
need for and structure of wrap around services.
New State Option for Medicaid Coverage in Qualified Health Plans
States may give their AFDC and non-cash eligible beneficiaries
35
�(excluding medically needy) the option to receive medical assistance
through enrollment in a Qualified Health Plan offered in a local HCCA
instead of through the Medicaid plan.
a.
b.
3.
The state may not restrict an individual's choice of plan and is
not required to pay more than the applicable dollar limit for the
HCCA area.
The number of individuals electing to enroll in a Qualified
Health Plan is limited to a fifteen percent of the eligible
population in each of the first three years, and ten percent in
each year thereafter.
Limitation on Certain Federal Medicaid Payments
Federal financial participation for acute medical services, including
expenditures for payments to Qualified Health Plans, is subject to an
annual federal payment cap.
a.
b.
The per-capita limit for fiscal year 1996 is equal to 118% of the
base per capita funding amount (determined by dividing the
total expenditures made for medical assistance furnished in 1994
by the average total number of Medicaid categorical individuals
for that year).
c.
After 1996, the per-capita limit is equal to the per-capita funding
amount determined for the previous fiscal year increased by 6
percent for fiscal years 1997 through 2000, and 5 percent for fiscal
year 2001 and beyond.
d.
Expenditures for which no federal financial participation was
provided and disproportionate share payments are excluded
from this calculation.
e.
4.
The cap is determined by multiplying a per capita limit (defined
below) by the average number of Medicaid categorical
individuals entitled to receive medical assistance in the state
plan.
States are required to continue to make eligible for medical
assistance any class category of individuals that were eligible for
assistance in fiscal year 1994.
State Flexibility to Contract for Coordinated Care Services
a.
States have the option, to establish a program under Medicaid
36
�program to allow states to enter into contracts with at-risk
primary care case management (PCCM) providers.
b.
An at-risk PCCM provider must be a physician, group of
physicians, a federally qualified health center, a rural health
clinic or other entity having other arrangements with physicians
operating under contract with a state to provide services under a
primary care case management program.
c.
Qualified risk contracting entities must:
i.
meet federal organizational requirements;
ii.
guarantee enrolled access; and,
iii.
have a written contract with the state agency that includes:
(a) .
an experienced-based payment methodology;
(b) .
premiums that do not discriminate among eligible
individuals based on health status;
(c) .
requirements for health care services; and,
(d) .
detailed specification of the responsibilities of the
contracting entity and the state for providing for, or
arranging for, health care services.
d.
Meet federal standards for internal quality assurance.
e.
Enter into written provider participation agreements with
essential community providers;
1.
2.
States are required to contract directly with essential
community providers, or at the election of the ECP, each
risk contracting entity may enter into agreement to make
payments to the essential community provider for
services.
Essential community providers include:
a.
Federally Qualified Health Centers,
b.
Public Housing Providers,
c.
Family Planning Clinics,
37
�d.
AIDS providers under the Ryan White Act,
e.
Maternal and Child Health Providers, and
f.
B.
Rural Health Clinics.
Medicare
1.
Medicare remains a separate program and continues to be federally
administered. Beneficiaries enrolled in Part B continue to pay a
monthly premium. The statutorily defined Medicare benefits continue
to be the Medicare benefit package in both fee-for-service and managed
care.
2.
Beneficiary opt-in to private qualified health plans.
a.
b.
For individuals choosing an AHP, Medicare will pay the federal
contribution calculated for Medicare risk contracts. Individuals
are responsible for paying the difference between the premium
charged and the federal contribution.
c.
3.
Medicare beneficiaries may opt into a qualified health plan in
their HCCA.
During the annual enrollment period, Medicare-eligibles may
choose a new plan through their employer/purchasing
cooperative or they may return to the traditional Medicare
program.
Medicare Select
a.
b.
Medicare Select policies will be offered during Medicare's
coordinated open enrollment period.
c.
4.
The Medicare Select program would become a permanent option
in all States.
Plans may not discriminate based on health status.
Medicare Risk Contract Program
a.
Medicare health plans must meet Qualified Health Plan
standards and cover all Medicare benefits under a risk contract
for a uniform monthly premium for a year.
38
�b.
Employers may sponsor Medicare health plans for former or
current employees.
c.
Cost contracts, SHMOs, etc. would continue as under current
law. The 50/50 requirement is terminated at the point at which
the Secretary determines that health plans have alternative
quality assurance mechanisms in place that effectively provide
sufficient quality safeguards. In the interim, the Secretary may
grant waivers of the 50/50 requirement.
e.
Medicare health plans will offer a standard benefit package
comprised of the current Medicare benefits defined in statute or
an alternative package, defined by the Secretary, covering
identical services but with cost-sharing consistent with typical
managed care practice and not to exceed the actuarial value of
FFS.
f.
Standardize supplemental benefits that risk contractors may
offer in addition to Medicare benefits. In addition to the
standardized policies, health plans may offer other supplemental
policies. However, Medicare health plans must at least offer two
supplements to be defined by the Secretary: one which would
cover catastrophic costs (out-of-pocket limit) and other items
traditionally covered in employer-sponsored plans, and one
covering outpatient prescription drugs.
g.
The current standardized Medigap plans would be changed so
that Medigap may only pay up to one-half of the 20% part B
coinsurance. Beneficiaries currently holding Medigap plans
covering the entire 20% coinsurance would be exempt from this
change as long as they renew their current insurance.
h.
The Secretary shall define Medicare market areas which shall be
consistent with the health care coverage areas defined by the
non-Medicare population. For the Medicare program, the MSAs
may cross state lines if the Secretary determines it is necessary to
increase choices to Medicare beneficiaries. The federal
contribution for a Medicare health plan will be the same
throughout the Medicare market area.
i.
The Secretary will administer a coordinated annual open
enrollment period during which Medicare beneficiaries will
choose from all plans (including Medigap insurers) offering
products to Medicare beneficiaries. The Secretary may authorize
any variations of participation in the enrollment process.
39
�j.
The Secretary of HHS will provide to all Medicare benefidaries
in a market area uniform materials for enrolling in health plans.
k.
The federal contribution is calculated as the weighted average of
fee-for-service per capita cost in the market area and the
premiums submitted by Medicare health plans to the Secretary
to provide Medicare benefits. The Secretary is authorized to
adjust for heart disease, cancer, or stroke.
1.
Beneficiaries pay the difference between the federal contribution
and the total premium charged by the health plan they select. If
the health plan's premium is less than the federal contribution,
the beneficiary is entitied to a rebate that the plan may provide
in cash or apply to supplementary coverage. The rebate would
be treated as non-taxable income.
i.
ii.
5.
Beneficiaries eligible for Medicare prior to 1999 are
grandfathered under these provisions and may
always enroll in Medicare FFS (regardless of local
costs) for the regular part B premium only.
If the federal contribution is less than the FFS per
capita cost in the market area and the beneficiary
selects Medicare FFS, the beneficiary pays an
additional premium to the Federal Government
equal to the difference between the federal
contribution and FFSPCC.
Administrative Simplification
The Secretary has authority to consolidate the functions of fiscal
intermediaries and carriers. Provides for coordination of Medicare and
supplemental insurance claims processing. Permits standardized,
paperless process.
6.
Study and Demonstration for Medicare Cost Containment
a.
Requires ProPAC to study and make recommendations to
Congress regarding ways to slow the rate of Medicare growth at
the local market level. The study should include ways to set
local expenditure targets and monitor success in controlling
costs. Updates for payment rates under Parts A and B should be
set to achieve local targeted expenditure levels, while rewarding
efficient providers and/or markets.
b.
A demonstration is authorized to evaluate Part A expenditures
for hospital service and/or Part B expenditures in fee for service
using provider-group or State-level volume performance
40
�standards.
GRADUATE MEDICAL EDUCATION
[Under Discussion]
41
�I.
FINANCING
A.
Financing Totals (Estimated Over 5 years; $ in Billions)
Savings
Medicare Savings
Medicaid Savings
Postal Service Retirement
$70.1
$55.8
$13.0
SUBTOTAL SPENDING REDUCTIONS
$138.9
Revenues
High Cost Plan Premium Assessment
Tobacco Tax ($1.00 increase)
HI State/Local
Income Relating Medicare Part B Premiums
$30.0*
$62.3
$ 7.6
$ 8.0
SUBTOTAL REVENUES
$107.9
TOTAL FINANCING
* Preliminary estimate based on available information
$246.8
B.
Descriptions of Medicare Savings
1.
Adjust Inpatient Capital Payments. This proposal combines three
inpatient payment adjustments to reflect more accurate base year data
and cost projections. The first would reduce inpatient capital payments
to hospitals excluded from Medicare's prospective payment system by
15%. The second would reduce PPS Federal capital payments by 7.31%
and hospital-specific amount by 10.41% to reflect new data on the FY 89
capital cost per discharge and the increase in Medicare inpatient costs.
The third piece would reduce payments for hospital inpatient capital
with a 22.1% reduction to the updates of the capital rates.
2.
Revise Disproportionate Share Hospital Adjustment. ThisAct
eliminates the current disproportionate share hospital adjustment
with a new voucher program to cover health care provided to those
with out health insurance.
3.
Extend OBRA 93 Provision to Catch-up after the SNF Freeze Expires
Included in OBRA 93. OBRA 93 established a two-year freeze on
update to the cost limits for skilled nursing facilities. A catch-up is
allowed after the freeze expires on October 1, 1995. This Act eliminates
the catch-up.
4.
Change the Medicare Volume Performance Standard to Real Growth
GDP. This Act substitutes the five-year average growth in real GDP
42
�per-capita for this volume and intensity factor and the performance
standard factor for physician's services.
5.
Establish Cumulative Growth Targets for Physician Services. Under
this Act, the Medical Volume Performance Standard for each category
of physician services would be built on a designated base-year and
updated annually for changes in beneficiary enrollment and inflation,
but not for actual outlay growth above and below the target.
6.
Reduce the Medicare Fee Schedule Conversion Factor by 3% in 1995,
Except Primary Care Services. The conversion factor is a dollar amount
that converts the fee schedule's relative value units into a payment
amount for each physician service. This Act reduces the factor by 3% to
account for excessively high targets.
7.
Extend OBRA-93 Provisions on Part B Premium Collections. OBRA 93
established the Part B premium collections at 25% of program costs.
This Act extends the collection of these premiums.
8.
Extend OBRA 93 Catch-up After the Home Health Freeze Expires.
OBRA 93 eliminated the inflation adjustment to the home health
limits for two years. This Act eliminates the inflation catch-up
currently allowed after the freeze expires on July 1, 1996.
9.
Extend OBRA 93 Medicare Secondary Payor Data Match with SSA and
IRS. OBRA 93 included an extension of the data match between HCFA,
IRS and SSA to identify the primary payers for Medicare enrollees with
health coverage in addition to Medicare.
10.
Increase Part B Deductible for Enrollees. Increase the amount that
enrollees must pay for services each year before the government shares
responsibility for physician services. The deductible would be
increased to $150 and indexed to the rate of growth.
11.
Reduce Hospital Market basket Index Update. This proposal reduces
the Hospital Market Basket Index Update by 2%. Currendy Medicare
changes the inpatient per-discharge standardized amount by a certain
amount every year to reflect input costs changes in Congressional
direction. OBRA 1993 reduced the Index in Fiscal Years 1994 through
1997. This proposal would reduce the updates by 2% for Fiscal Years
1997 through 2000.
Medicaid Savings
1.
Revise Disproportionate Share Hospital Adjustment. This proposal
eliminates the current disproportionate share hospital adjustment
with the new voucher program to cover health care provided to those
with out health insurance. Medicaid DSH payments are to be
43
�eliminated in FY 1996 - 15%, FY 1997 - 25%, FY 1998 - 60% and 1999 100%
2.
D.
Capitate the Federal Payments Made for Medicaid Acute Care Medical
Services under Medicaid Program. The per-capita federal financial
participation growth rate for acute medical services under the Medicaid
program would be capped at 6% for fiscal years 1997 through 2000 and
at 5% for fiscal year 2001 and beyond.
Revenues
1.
2.
Tobacco Tax. The proposal increases the tax on tobacco by
per
thousand pounds ($1 per pack of 20 cigarettes). Described in Section
XIII.,G.)
3.
H I State and Local. State and local jurisdictions can opt to pay the H I
payroll tax for State and local workers hired before April 1, 1986. The
proposal would extend the payroll tax to all remaining exempt State
and local workers.
4.
XII.
Postal Service Retirement. Require the U.S.P.S. to fund the U.S.P.S.
Retirement System in the U.S.P.S. budget rather than the Federal
Budget. This would free funds from the Federal budget.
Income Related Part B Premiums. This proposal would charge highincome enrollees a premium up to 75% of program costs based on an
enrolle's modified adjusted gross income.
Fiscal Responsibility
Fail-Safe Mechanism
The bill establishes a Fail-Safe mechanism to ensure health care reform does
not increase the deficit. Details are described below:
1.
A Current Health Spending Baseline (CHSB) is established. The CHSB
includes:
a.
Medicare Expenditures
b.
Medicaid Expenditures
c.
Health Related Tax Expenditures
i.
The employee exclusion of employer-provided health
insurance premiums.
44
�ii.
iii.
2.
Employer deduction for health insurance premiums.
7.5% floor for deduction of medical expenses.
A Health Reform Spending Estimate (HRSE) is established. The HRSE
includes:
a.
b.
Deduction for purchase of Qualified Health Plans by all
individuals.
c.
Cigarette excise tax.
d.
Vouchers for purchase of a Qualified Health Plan.
e.
3.
Everything included in the CHSB.
High-Cost Plan Assessment
In any year that the Director of OMB notifies Congress that HRSE will
exceed the CHSB, the following automatic actions will occur to prevent
deficit spending:
a.
b.
The assessment on high cost insurance plans is increased.
c.
The expanded tax deduction phase-in is slowed down.
d.
Out-of-pocket limits in the standard and basic benefit packages
are increased.
e.
4.
The voucher phase-in is delayed.
Starting in the year 2004, an employer may no longer deduct and
an employer may no longer exclude supplemental benefits
provided to employees and contributed to by employers.
Congress may act on alternative recommendations made by the
National Health Commission to avoid the actions listed above.
XIII. Tax Provisions
A.
High Cost Plan Assessment
1.
Beginning in 1996, an annual assessment will be imposed on High Cost
Plans. High Cost Plans are those health care packages whose premiums
(not including supplemental benefits, if any) exceed a certain dollar
amount.
a.
To determine whether a plan is a High Cost Plan, an insurer
divides its plans into two categories:
45
�i.
those based on the basic package (Primary Basics), and
ii.
those based on the standard package (Primary Standards).
b.
c.
Plans that fall within the lowest 25% of the geographically adjusted plan premiums nationally are exempt. For purposes of
determining whether a plan is exempt, the Primary Basic and
Primary Standard plans are considered separately.
d.
2.
It then determines which, if any, of either the Primary Basics or
Primary Standards are priced such that they are in the top 40
percent of all such plans in the health care coverage area
(HCCA).
The geographically adjusted premium is calculated by adjusting
each accountable health plan's premium for regional variations.
Such adjustments shall include, but not be limited to, variations
in the cost of living and demographics.
The assessment on a High Cost Plan is equal to 25% of the difference
between the premium charged for the Primary Basic plus
supplementals, if any, and the Primary Standard plus supplementals, if
any, and a reference premium.
a.
b.
3.
B.
For purposes of determining the assessment on the Primary
Basic plus supplementals, if any, the reference premium is the
average of all Primary Basics in the HCCA.
For purposes of determining the assessment on the Primary
Standard plus supplementals, if any, the reference premium is
the average of all Primary Standards in the area.
The High Cost Plan Assessment also applies to self-insured plans. The
tax will apply to the difference between the self-insured High Cost
Plan's premium (including any supplementals) and the applicable
reference premium for the HCCA. In calculating this tax, the high cost
self-insured plan's premium will be the premium used for meeting the
COBRA requirement. The Department of Treasury will be given
authority to develop regulations implementing this provision.
Assistance to Individuals and Families -- Expanded Tax Deductibility
1.
Self-employed individuals purchasing health insurance may take an
above-the-line deduction for 100% of the cost of such insurance (i.e.,
not subject to the 7.5% floor), subject to a phase-in period. However,
the deduction is limited to the cost of either a basic or standard benefits
package. To the extent self-employed individuals purchase benefits
46
�supplementing such packages, the cost of such supplemental benefits
will be deductible as medical expenses under current law (i.e., subject to
the 7.5% floor).
2.
Individuals (other than self-employed) that purchase health insurance
will be allowed an above-the-line deduction (i.e., not subject to the
7.5% floor) for 100% of the cost of either a basic or standard benefit
package. To the extent an individual purchases benefits
supplementing the packages, the cost of such supplemental benefits
will be deductible as medical expenses under current law (i.e., subject to
the 7.5% floor).
Employer-Provided Health Insurance
1.
2.
Employers may take a deduction for amounts contributed towards a
standard benefits package, as well as all benefits supplementing such
package, if any.
3.
Employers may take a deduction for amounts contributed towards a
basic benefits package. However, no deduction is permitted for any
contributions made towards benefits supplementing the basic benefits
package.
4.
D.
Employees may continue to exclude from gross income all employerprovided health insurance.
Fail-Safe option includes possible employer and employee cap on
supplementals after 2004.
Tax Incentives for Practice in Rural, Frontier, and Urban Underserved Areas
1.
Physicians practicing full-time and either newly certified or newly
relocated to a rural, frontier, or urban Health Professional Shortage
Areas (HPSA) are allowed a tax credit equal to $1,000 a month up to a
total of $36,000. Tax credits will be prorated in direct relation to the
time worked in the HPSA, up to a total of $36,000;
2.
Nurse practitioners and physician assistants would be eligible for a
similar credit equal to $500 per month;
3.
In order to retain the full value of the credit, the physician, nurse
practitioner or physician's assistant must practice continuously in the
area for five years.
4.
Loan repayments made on behalf on an individual as part of the
National Health Service Corps Loan Repayment Program are excluded
from taxable income of the individual;
47
�5.
The cost of annually purchased medical equipment, owned directly or
indirectiy, and used by a physician in a rural or frontier Health
Professional Shortage Area (HPSA) can be immediately expensed, up to
$32,500;
6.
Interest, up to $5,000 annually, paid on professional medical education
loans of a physician, registered nurse, nurse practitioner, or physician's
assistant will be allowed as an itemized deduction if the individual
agrees to practice in a rural, frontier or urban Health Professional
Shortage Area (HPSA).
Long Term Care Tax Provisions
1.
2.
Employer provided qualified long-term care coverage which meets
certain consumer protection standards promulgated by the National
Association of Insurance Commissioners, is excluded from an
employee's taxable income. Premiums paid by an individual for
qualified long-term care coverage are deductible as a medical expense
(i.e. subject to the 7.5% floor);
3.
F.
Expenditures for qualified long-term care services are deductible as
medical expenses (i.e. subject to the 7.5% floor). Such services include
diagnostic, preventive, therapeutic, rehabilitative, maintenance and
personal care. Provision of such services must be contingent upon
certification of impairment in three or more activities of daily living by
a licensed health care practitioner;
NAIC is directed to promulgate standards for the use of uniform
language and definitions in qualified long-term care coverage
insurance policies, with permissible variations to take into account
differences in state licensing requirements for long-term care
providers.
Accelerated Death Benefits
Clarifies the income tax treatment of accelerated death benefits paid to
terminally ill persons. Payments made under a qualified terminal illness
rider can be received tax-free as if they were paid after the insured's death.
G.
Tobacco Tax
The proposal increases the tax on tobacco by approximately $16.67 per pound
of tobacco products, and would extend the tax to tobacco to be used in "rollyour-own" cigarettes. The new tax rates would be:
48
�1.
Cigarettes:
small cigarettes
$62 per thousand (i.e., $1.24 per pack of
20 cigarettes)
large cigarettes
2.
$130.20 per thousand
Cigars:
small cigars
large cigars
3.
$5.82 per thousand
65.875 percent of manufacturers price
(not more than $155 per thousand)
Cigarette papers and tubes:
cigarette papers
cigarette tubes
4.
3.88 cents per 50 papers
7.75 cents per 50 tubes
Snuff, chewing tobacco, pipe tobacco, "roll-your-own" tobacco:
snuff
$1.86 per pound
chewing tobacco
62 cents per pound
pipe tobacco
$3.49 per pound
"roll-your-own" tobacco
$3.49 per pound
5.
The proposal would repeal the present-law exemptions for tobacco
products provided to employees of the manufacturer and for use by the
United States.
6.
The proposal also includes several administrative and compliance
provisions designed to improve the collection of the excise tax.
XIV. National Health Commission
An independent National Health Commission is established to oversee the
health market much like the Securities and Exchange Commission oversees
the financial markets.
A.
Operation
1.
The Commission shall be composed of 7 members appointed by
the President with the advice and consent of the Senate. The
Commission members will serve 6 year overlapping terms. No
more than four members of the Commission may be from the
49
�same political party. The members shall be compensated at level
IV of the Executive Schedule. One member of the Commission
shall be designated as the Chairman by the President.
2.
3.
The Commission shall appoint an Executive Director and such
additional officers and employees it deems necessary to carry out
its responsibilities under this act.
4.
B.
The Commission members will have gained national
recognition for their expertise in health markets.
The Commission will be advised by expert private sector boards
which focus on health benefits and health plan standards.
Responsibilities
1.
Clarify the standard and basic benefits packages.
2.
Develop and clarify the quality standards set in this act for
Qualified Health Plans and provide for this information to be
distributed to consumers in a standardized format. This
information will include reporting prices, evaluating health
outcomes and measuring consumer satisfaction.
3.
Report to Congress on a biannual basis (described in Section
I.,A.).
d.
Develop risk adjustment factors for Accountable Health Plans.
e.
Monitor the Fail-Safe Mechanism to prevent deficit spending
(described in Section XI.,B,4.).
f.
Recommend methods to achieve universal coverage if trigger
mechanism is engaged in the year 2002 (described in Section
I.,B.).
50
�
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
A name given to the resource
Rump Group
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Health Care Task Force
Christine Heenan
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 3
Is Part Of
A related resource in which the described resource is physically or logically included.
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
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
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
3/16/2015
Source
A related resource from which the described resource is derived
42-t-12091530-20060885F-Seg3-013-012-2015
12091530