Congressional leaders and President Bill Clinton attempted to strike a deal in mid-June on controversial health insurance legislation. At press time, the question remained: Could congressional leaders and the president compromise and give the nation a measure of insurance reform?
In early March, the Academy endorsed a health insurance bill as it was originally introduced by Sens. Nancy Kassebaum, R-KS, and Edward Kennedy, D-MA. Its key provisions were portability of insurance for people who lose or change jobs, and restrictions on the denial of coverage because of pre-existing conditions.
The Senate tacked additions onto the Kassebaum-Kennedy bill before passing it, and the House passed its own legislation. Last month, negotiators wrestled with the differences and drafted legislation that Congress and the president might approve.
The Kassebaum-Kennedy bill's central tenets remained intact. However, negotiators hammered away at points of contention such as:
Medical savings accounts. MSAs combine high-deductible catastrophic insurance policies with tax-free accounts from which people pay their own routine health care bills. The House had pressed for MSAs, but the Senate and the president objected, fearing that healthier, wealthier people would use MSAs as tax shelters and that premiums for traditional insurance would skyrocket. The Academy favors MSAs as one of many options for expanding access to care.
The compromise proposed in mid-June would allow MSAs for the self-employed and businesses with up to 50 employees. After two years, a study would confirm whether MSAs lower costs and draw healthier people out of traditional insurance plans. After another year, large employers and the unemployed could use MSAs unless Congress intervened.
Fraud and abuse provisions. Congress had approved provisions to strengthen federal authority to penalize fraud and abuse in health care. The legislation could have subjected physicians to criminal penalties for activities they didn't know were illegal and could have punished them for unintentional actions.
Medical groups contested the provisions. FPs used AAFP's legislative hotline to congressional offices in Washington to protest the fraud and abuse proposals. By mid-June, the deal-makers modified the proposals in response to physicians' concerns.
At press time, there were no guarantees either that Congress would pass the compromise legislation or that the president would sign it. However, it did seem likely that many provisions in the compromise will resurface next year--unencumbered by the distractions of election-year politics--if they fail to become law this summer.
FP Report, July 1996 headlines
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