National Health Insurance and Health Improvements ActS. 915 (SENATOR JACOB K. JAVITS) A. General Approach A national health insurance plan established through a gradual expansion of the medicare program to cover the general population. Benefits would be broadened to include certain services not presently covered under medicare. The medicare Part B premium would be eliminated. Medicaid would be continued. B. People Covered Medicare would be extended to all those over 65, the disabled, widows over 60, and widowers over 62 effective July 1974. Effective July 1976, the program would be extended to all citizens and aliens admitted for permanent residence. C. Scope of Benefits Same benefits as under medicare at the beginning: (1) 90 days of hospital care with $60 deductible and coinsurance of $15 per day after 60th day. (2) 100 days post-hospital extended care with coinsurance of $7.50 per day after 20th day. (3) Physician and related services including outpatient diagnostic services, home health services, and physical therapy. Additional benefits would be phased in, as follows: (1) Maintenance drugs for chronic conditions, effective July 1976. (2) Annual physical examinations, effective July 1977. D. Payment to Providers Until July 1, 1976, reasonable cost for hospitals and institutions and reasonable charges for physicians (as under medicare). Thereafter, new methods, developed in interim, may be employed. E. Administration Essentially the same as medicare. Federal administration using private carriers, intermediaries, and State health agencies for appropriate roles. New public insurance corporations could be set up to administer the program if private carriers and intermediaries could not do so properly. F. Financing Financed by taxes on employers, employees, and self-employed (3.3% each in 1976 and thereafter) with Federal general revenue contributions equal to 1⁄2 of the amount collected through payroll taxes. Annual taxable wages for workers would be $15,000; for employers, no taxable wage base would apply. G. Cost Estimates HEW estimate of additional cost to Federal taxpayer, fiscal year 1974 $41.6 billion. 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. 8 National Health Care Act-S. 1100/H.R. 5200 (SENATOR THOMAS J. MCINTYRE/REPRESENTATIVE OMAR BURLESON) 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. However, if an employer failed to establish and maintain a qualified health plan for his employees, no tax deduction would be allowed for premium expense of plans in non-compliance with the requirements of the bill. The program 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, 1975, the private group and individual plans would include the following: (1) 30 days hospitalization-subject to $5 copayment. (2) 60 days skilled nursing home services-subject to $2.50 per day copayment. (3) 90 days home health services-subject to $2.50 per day copayment. (4) All diagnostic, X-ray, and lab exams on an ambulatory basis-no limit and no copayment. (5) 3 visits per year to physician in office or ambulatory center-$2 copayment per visit. (6) Unlimited visits for outpatient surgery and radiation therapy-$2 copayment per visit. (7) 6 exams for well-baby care-no copayment. (8) Unlimited inpatient physician services-$2 copayment per day, for 1st 30 days, $5 per day thereafter. (9) Catastrophic coverage-any individual who incurs $5,000 in medical expenses (including expenses reimbursed by in 34-500 - 74-34 surance) within 12 consecutive months would immediately become entitled to the maximum level of benefits outlined in the bill, irrespective of the phasing-in period, and up to $250,000. Effective July 1, 1974, State pool plans would be identical to the above but also include the following benefits: (1) Physician visits-6 per year. (2) Hospitalization-120 days. (3) Skilled nursing facility-120 days. (4) Well-baby care-12 visits during 1st two years. (6) Additional benefits-dental care for children under 19 (1 annual oral exam-no copayment; fillings, extractions, dentures20% coinsurance), prescription drugs ($1 per prescription), physical therapy (20% coinsurance); family planning services, prosthetic aids (20% coinsurance), maternity care (20% coinsurance). By January 1, 1980, private group coverage would be expanded to cover the initial State pool plan level of coverage. Subsequent benefit improvements are provided for in future years. For the private group and individual plans, coinsurance up to 20% could be substituted for the copayments applicable to covered benefits, and an additional annual deductible could be imposed. However, in the case of employees and their dependents, covered by a qualified employee health care plan, the sum of these copayments and deductibles could not exceed $1,000 for a calendar year. Aggregate copayments for the low-income under a State pool plan would be income-related; for uninsurable individuals under a State plan, a $1,000 ceiling would be placed on aggregate copayments. D. Payment to Providers Payments would be limited to the 75th percentile of prevailing charges for professional services and for institutions, to rates approved by a State Health Care Institutions Cost Commission. E. Administration Private insurers would each administer their own policy for qualified group and individual plans. For the qualified State health-care plans, each State would set up a health insurance pool, a portion of the risks of which private insurers would be required to underwrite. One or more private companies would be designated to administer the State plan. Premium rates for the State plans would be determined within each State, subject to review by HEW. F. Financing Costs of protection for all people not insured through a State pool would be borne by employers, employees and the self-employed through premium payments to private insurance companies, and indirectly by the Federal Government through tax deductions for these premium expenses. A State pool would be financed with premium payments from the uninsurable, partial premium payments from the near-poor, and Federal-State contributions to subsidize, in part, costs of protection for the near-poor, and in full, the costs of protection for welfare recipients. Contributions of the near-poor would vary with income. The Federal matching payments would vary with a State's per capita income and range from 70% to 90%. Federal matching payments would come from general revenue funds. G. Cost Estimates Sponsor estimates cost of program to taxpayers to be $8.1 billion in new taxes for first full year of operation (fiscal year 1976). H. Other Major Provisions Includes provisions intended to 1) increase and redistribute supply of health manpower; 2) promote ambulatory care; 3) strengthen health planning; 4) improve cost and quality controls for health services. 11 |