President Clinton will offer all Americans a broad, guaranteed package of health benefits covering everything from eyeglasses and dental visits for children to prescription drugs for young and old alike, officials said Saturday.
The plan, still being finalized by Clinton and his advisers, would be paid for primarily by requiring all employers to pay up to 8.5 percent of their payroll to buy health policies for their workers, senior administration officials said.The hope is that Congress will enact the plan by next spring and states would begin moving into the new health system in 1995, with a firm deadline of Dec. 31, 1997, for all states to guarantee the benefits package to all citizens and legal residents.
In tandem with the benefits would come restrictions on the growth of spending for the benefit package, as well as for Medicare and Medicaid. Employers who offer more generous benefits and employees who receive them would be taxed on the difference.
The package would stress preventive services (see box).
Clinton met three times last week with his top health and economic advisers in an effort to come to closure on his long-promised health reform plan, and top aides were still huddling over the holiday weekend to fill in the remaining blanks.
Clinton plans to begin a round of closed-door briefings Tuesday with lawmakers and interest groups and to make last-minute revisions right up until he addresses a joint session of Congress on or about Sept. 22. The actual legislation and a detailed policy book running several hundred pages may be unveiled two weeks later.
Senior officials, who insisted on anonymity, said still to be decided was exactly how fast the cost of the basic benefit package would be allowed to grow. Medical costs have been rising twice as fast as inflation for years.
One source said they are trying to decide whether to slow the growth rate to 1 percentage point above the inflation rate plus a factor for population growth by 1998 or 1999 or to keep it strictly to the inflation rate plus population growth.
The Clinton plan envisions an 80-20 split between employers and employees of the cost of health insurance, with a typical plan expected to cost $1,800 a year for individuals, $3,700 for a single adult with children and $4,200 for families.
The employer's share for a family policy would work out to $3,360. But if more than one person in the family worked, the employers would pay a lower share, possibly $2,300 each.
Businesses would never pay more than 7.5 percent to 8.5 percent of payroll for health insurance, and firms with low wages and fewer than 50 workers would pay as little as 3.5 percent, officials said. But no longer could one working spouse pay nothing for health insurance while the other spouse's employer picked up the family's bill.
The Clinton administration hopes to encourage most Americans to sign up for prepaid health plans, where they could pay as little as $10 to visit a health maintenance organization.
But they would have the option of paying more for fee-for-service plans that do not restrict their choice of doctor or hospitals.
If they chose fee-for-service plans, they would pay deductibles of $200 a person and $400 per family and 20 percent co-payments up to limits of $1,500 a person and $3,000 per family each year, the sources said.
What the plan would and wouldn't cover
Coverage is expected to include:
- Doctor and hospital visits, prescription drugs, hospice and home care, emergency treatment, physical therapy, medical equipment, laboratory fees, ambulance services and other services typically included in insurance policies.
- 70 to 75 specified tests to screen for disease such as mammograms, cholesterol tests and pelvic exams and prescription drugs.
- Routine preventive care for children, well-baby exams, immunizations, eyeglasses and preventive dental care.
- Eye and ear exams for adults.
- Dental care for adults by the year 2000.
- Before 2000, when broad coverage takes effect, mental health and drug and alcohol abuse treatment would be limited to 60 days in the hospital; psychotherapy treatment limited to 30 days per year; and no initial limit on outpatient drug and alcohol treatment.
Services not expected to be covered:
- Cosmetic surgery that is not medically necessary
- Infertility treatments
- Eyeglasses for adults
- Dental care for adults before the year 2000