G. Cost Estimates Estimate by Social Security Administration: $66.4 billion in fiscal 1975. H. Other Major Provisions Individuals can "elect out" of program by securing coverage from private insurers offering comparable or better protection and thereby exempt themselves from payroll taxation for Federal health insurance. Employer plans may qualify in lieu of Federal program if they pay 75% of the cost and the protection is better than the Government plan. Provides incentives for growth of comprehensive health service systems which would benefit from cost-savings for efficient operation. 6 Health Care Insurance Assistance Act-S. 987 (SENATOR CLIFFORD P. HANSEN) A. General Approach A voluntary health insurance program called "medicredit," under which the Federal Government would pay health insurance premiums for the poor, and allow income tax credits for all others toward the purchase of private health insurance plans. The amount of tax credit would include 1) 100% of premium charges for catastrophic insurance plans and 2) an income-related percentage of premium charges for other health insurance providing certain basic benefits approved by the Government. Medicare would continue as at present. B. People Covered The total population under age 65 would be eligible. Those with no Federal income tax liability would receive full payment of their health insurance premium costs. For all others, the Federal share of health insurance premiums gradually decreases from 100% until those with a tax liability of $891 or more would get a tax credit of 10% of premium cost. C. Scope of Benefits A health care policy, in order to qualify under this program for purposes of a tax credit, would have to provide, at a minimum, the following benefits: (1) 60 days hospitalization (with extended care days counting as1⁄2 hospital day or 2 days of extended care for each hospital day, including nursing services, drugs, blood, appliances, maternity and psychiatric care, physical therapy-subject to a $50 deductible. (2) Emergency or outpatient services including diagnostic services, x-rays, lab tests, etc.-subject to 20% coinsurance on 1st $500 of expense. (3) Medical care by physician, in hospital or office, including diagnosis and treatment, psychiatric care, immunizations, physical exams, lab services, radiation therapy, maternal and well-babycare subject to 20% coinsurance. (4) Dental or oral surgery, ambulance service subject to 20% coinsurance. (5) Catastrophic illness provisions beyond basic coverage, including hospital services, extended care services (limited to 30 additional days), outpatient blood, prosthetic aids-subject to graduated corridor of deductible expense based on a family's or individual's taxable income, on the following scale: 10% on 1st $4,000, 15% on next $3,000, 20% thereafter. D. Payment to Providers Usual and customary charges for all services, including hospital and extended care. (7) E. Administration Establishes Health Insurance "Advisory" Board to write policy and regulations. Private insurance companies would each administer their own approved policies. F. Financing Costs of health insurance for the poor would be met by Federal general revenue expenditures and by reductions in Federal income tax collections for those receiving tax credits. G. Cost Estimates American Medical Association estimate: $14.5 billion. 8 Catastrophic Health Insurance Program-S. 1376 (SENATOR RUSSELL B. LONG) A. General Approach A national program of catastrophic health insurance for people under 65, covered under Social Security Program would be administered by Social Security and would supplement existing private health insurance. Medicare would continue for those age 65 or over. Medicaid would continue as is, except that the benefits provided to eligible individuals under the new program would no longer need to be paid for through the medicaid program. B. People Covered All persons under 65 fully or currently insured under Social Security, plus their spouses and dependents. "Buy-in" agreements for State and local governmental employees not covered by Social Security. C. Scope of Benefits Same as currently provided under medicare parts A and B, without limitations on the number of hospital days, extended care facility days, or home health visits, and benefits would be subject to following deductibles and coinsurance: (1) Hospital deductible of 60 days hospitalization per year per individual, plus $15 a day coinsurance after 60th day. Post hospital extended care services provided after the 60-day hospital deductible was met would be covered subject to $7.50 a day coinsurance. (2) Supplemental medical deductible initially established at $2,000 per year per family, with coinsurance of 20% of medical expenses exceeding the deductible. Benefits would become effective January 1, 1972. D. Payment to Providers Payments made to patients, providers, and practitioners under this program would be subject to the same reimbursement controls as under medicare. Quality, health and safety standards and utilization controls used in the medicare program would apply also. E. Administration Same as medicare. F. Financing Financed through payroll contributions from employees, employers, and self-employed (0.3% in 1972-74, 0.35% in 1975-79, 0.4% in 1980 and thereafter). Wage base would be $9,000 initially, rising subsequently. Trust fund for Federal Catastrophic Health Insurance would be completely separate from other trust funds operating under Social Security programs. G. Cost Estimates H.E.W. estimate: $2.5 billion on an incurred basis and $2.2 billion on a cash basis for 1st year of operation. National Health Care Act-S. 1490 (SENATOR THOMAS J. MCINTYRE) A. General Approach A program which would provide financial assistance for State health care insurance plans for the poor and uninsurable and set a Federal Minimum Standard Health-care Benefits Program as a condition of eligibility for increased Federal income tax deductions for the costs of private health insurance coverage. Individuals who itemize deductions would be allowed an unlimited tax deduction from income equal to all premiums paid under health plans meeting the minimum standards. An employer would be eligible for a tax deduction equal to 100% of his costs in providing a qualified health plan to his employees. Only 50% of the cost of a nonqualified policy could be deducted. It would supplement medicare and medicaid. B. People Covered Persons on public assistance would be covered through qualified State health-care plans at no expense to themselves. Uninsurable individuals and those with low-incomes could enroll at a modest cost in the State plan. All other individuals participating in a qualified health care plan who itemize deductions would be entitled to receive increased tax deductions for insurance premium expenses. C. Scope of Benefits Different levels of minimum benefits would be required for private group and individual plans and for State pool plans for the poor, near poor, and previously uninsurable, with the State pool plans initially being more comprehensive. Effective January 1, 1973, the private group and individual plans would include the following subject to (a) in qualified employer plans, deductibles of up to $100 per family and coinsurance payments of up to $1,000 per family; (b) in qualified individual plans, unlimited deductible amounts and coinsurance ranging up to 20% of covered expenses and; (c) a ceiling on copayments for participants in the State pools: (1) 30 days hospitalization-subject to $10 deductible for 1st day, $5 for each additional covered day. (2) 60 days extended care services subject to $2.50 per day deductible. (3) 90 days home health services subject to $2.50 per day deductible. (4) All diagnostic, x-ray, and lab exams on an ambulatory basis-no limit and no deductible. (5) 3 visits per year to physician in office or ambulatory center-$2 deductible per visit. (6) Unlimited visits for outpatient surgery and radiation therapy-$2 deductible per visit. (7) 6 exams for well-baby care-no deductible. (8) Unlimited inpatient physician services-$3 deductible per day, for 1st 30 days, $5 per day thereafter. (11) |