The legislation is the culmination of almost two years of work by the Senate Finance and Labor Committees with input from health care providers, insurers, and consumer groups. The bill was introduced June 5th by Senate Majority Leader George J. Mitchell (D-Maine), Senators Edward M. Kennedy (D-Mass.), Donald W. Riegle, Jr. (D-Mich.), and Jay Rockefeller (D-W.Va.).
Health America is the latest bill (See the April 12, 1991 article on the Russo bill in "DC") that seeks a solution to the 37 million Americans with no health coverage and the phenomenal rise in health care cost. The United States spent $676 billion on health care in 1990, approximately 12 percent of GNP; as a comparison, 6 percent of GNP went to health care in 1965.
The United States spends more per person on health care than any country in the world: 40 percent more than Canada (Canada has national health insurance); 90 percent more than West Germany; and more than twice as much as Japan. Large American businesses last year saw their health care expenditures rise by 22 percent.
The Four-Pronged Problem of Health Care Costs
- Those who buy health insurance pay 10-15 percent too much because the cost of care for the uninsured results in higher premiums and charges to those who can pay.
- RAND Corporation studies show that 15-30 percent of medical procedures are unnecessary.
- Excessive administrative costs in dealing with 1,200 separate insurance companies with different forms and procedures leads to billions of dollars of waste a year.
- Lack of incentives to keep charges down due to "open-ended" reimbursement to providers.
The Bill's Proposed Solutions
- Universal coverage: Employers would be required to either provide coverage for their workers and families or contribute a percentage (7.5 to 8 percent) of the employer's payroll to a public insurance program called AmeriCare. AmeriCare, administered by the states, would replace Medicaid except for long-term care. The employer-provided health insurance policies would cost an average of about $1,680 per employee. Those with low incomes would not pay premiums for enrollment in AmeriCare.
- Research to determine necessary/unnecessary care; practice guidelines; technology assessment; private and public managed care programs.
- Standardized billing forms; requiring small insurers to work together at the state level for paying bills; and reforming the small business insurance system to cut the overhead costs paid to insurance companies.
- Create an independent Federal Health Expenditure Board to encourage cost containment at the state level. The board will establish rate negotiations between purchasers and providers of health care.
The consulting firm of Lewin, ICF, has "conservatively" estimated that the program would save the U.S. $80 billion in health expenditures over the next five years. The cost to the government in the first year of the plan would be approximately $6 billion.
Richard Miller, director of government relations for the ACA says the ACA has maintained close contact with Senator Mitchell's office and the other sponsors of the bill, providing input on a variety of issues concerning chiropractic.
Paul Kelly, ACA assistant director of governmental relations said, "We have been assured for a number of weeks that chiropractic would be included -- but to avoid undue pressure from special interests, details of the bill have been kept tightly under wraps."
The bill faces opposition from Senate Republicans, President Bush, and small business interest groups. Richard Miller said of the bill's chances: "This is a sweeping reform bill. The full implications are not yet known, but it is sure to provoke controversy. Majority Leader Mitchell wants to advance this legislation this Congress -- there will be plenty of supporters, but all sorts of special interest groups will be attempting to modify or detail this proposal."
Paul Kelly added, "... we do not view chiropractic's inclusion in the bill as secure -- someone is bound to try and rip the profession out of the legislation as it advances."
Senator Mitchell emphasizes the underlying foundation of the bill must be cost containment. He offered this ominous prediction: "I believe the time to act is now. If we do not work together to control the soaring cost of health care and to provide care for millions of Americans now uncovered, or at risk of losing their coverage, we will fall victim to the collapse of the system."
Steve Kelly
Assistant Editor