Clinton Aides Detail Health Care Plan : Transition: Officials are told to expect a gradual phase-in. One provision would allow workers to take insurance with them when they change jobs.

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The health care reform plan being prepared by President-elect Bill Clinton is so broad and complex that many of its elements will need to be phased in, probably state by state, to avoid widespread confusion and breakdowns in the delivery of medical services, Clinton’s health policy advisers have concluded.

Clinton may also eventually impose government price controls on the private sector--capping physician fees and hospital charges--if a national health care budget, a centerpiece of his agenda, fails to control medical spending.

These and other details of Clinton’s largest and most ambitious initiative emerged here Friday as Judy Feder, Clinton’s top health policy adviser, briefed congressional staff members on the new system now being devised.


The briefing was held behind closed doors to allow candid discussion of facets of the initiative that have not been made public, but a Times reporter was able to attend with about 100 key congressional staffers who were invited.

The goal of the Clinton plan is to lower health care costs while providing at least a basic health insurance package for all Americans, including the estimated 35 million people in this country who are without coverage.

The plan would lean heavily on employers to provide the coverage and to move into large purchasing networks, which would have sufficient economic clout to seek out low-cost, high-quality care.

One of the key features would be a provision allowing workers to take their insurance with them when they change jobs. Another would prevent companies from denying coverage based on pre-existing medical conditions.

Feder indicated that in addition to coming up with the right benefits and safeguards for a plan that could change the lives of millions of people, the incoming Administration is concerned about merging it into the immensely complicated and varied state health care bureaucracies.

Great delicacy may be needed to avert chaos. Calling the system “an $800-billion gorilla,” Feder said: “We intend simultaneously to move deliberately and carefully while dealing with the fact that it’s urgent and we’ve got to get this sucker moving.”


She asserted, without elaborating, that Clinton intends to force “a major restructuring of the insurance market” and expects to have his legislative proposals completed “within roughly 100 days,” after forging a congressional coalition with “a lot of support behind it.”

When pressed by one Capitol Hill staffer for a more specific timetable, Feder looked around the room and said: “That has as much to do with you as with us.”

In her comments about forced “restructuring” of the insurance industry, Feder virtually confirmed that Clinton will seek to ban insurers from refusing to cover those with pre-existing diseases and to allow individuals to take their insurance from job to job.

Feder underscored that the new President will take his health care reform campaign directly to the American people to prepare the ground for a favorable reception.

As Feder’s appearance suggested, the first stage of that campaign is already under way.

Feder was joined Thursday and Friday by several top Clinton aides, including Atul Gwande and Bruce Fried, who circulated among the congressional aides. Earlier this week, Fried told a District of Columbia Bar Assn. group that Clinton’s health policy advisers have concluded that the concept of “managed competition”--in which large networks of businesses and employees seek the most cost-competitive care--may not appreciably slow health care spending for as much as five years.

The growing conviction that the savings may not be enough comes at a time when runaway health care costs reached a new high for 1992--accounting for more than 14% of the gross national product, or $838.5 billion annually--while the federal budget deficit also worsened, with the national debt projected to increase by more than $1 trillion over the next four years.


These developments have imbued the Clinton camp with a deep sense of urgency and resolve to undertake health care reform quickly.

For all of the new insights on Clinton’s initiative that Feder’s talk revealed, just as striking was how much remains undecided.

Aside from the question of whether to tax workers for health benefits their employers provide, there are also decisions pending on what specific services would be contained in a bare-bones package of benefits.

Another major component of Clinton’s plan is a national health standards board, which would be empowered to establish an annual national health care budget.

Feder conceded that how the board would set a budget, how it would enforce its decisions and how to disperse funds are some of the questions that have not been resolved.

Other major details that soon need to be thrashed out include how to incorporate Medicare and Medicaid into a managed competition system, and how long-term care fits into the new scheme, Feder said.


Times staff writer Marlene Cimons contributed to this story.