As a part of national health care reform, President Clinton next month will propose creating a permanent regulatory agency with broad powers to set levels of coverage, establish guidelines for doctors and hospitals and monitor spending, Administration sources said Monday.
Under the proposal, being evaluated by an independent group of attorneys, the agency would have power to alter the elements of the standard package of benefits expected to be provided under the new health care plan. The agency also would draw up guidelines for physicians and hospitals and review spending patterns among states in an effort to instill budget discipline, the sources said.
Walter Zelman, a senior official of the White House Task Force on National Health Care Reform, stressed Monday that no final decisions have been made. He said the current thinking about a national health care board--which has been communicated to some members of Congress--represents only "preliminary thinking."
But health policy analysts said Monday that some national governance mechanism clearly is needed under the blend of government regulation and free enterprise that the Clinton Administration is designing, popularly known as managed competition.
One independent analyst said the proposal "sounds like they are setting up a mechanism for national wage and price controls--to nationally monitor health spending, develop budgets and have enforcement mechanism for states that can't stay within budget."
The group evaluating the proposal is also looking at other legal and constitutional issues raised by the President's emerging overhaul agenda, from tort reform to granting medical providers exemptions to antitrust laws so they can discuss voluntary price restraints among themselves.
Another issue undergoing legal review is a proposal to combat possible discrimination by health providers. Under the proposal, if a discrimination complaint was made against a health provider, the provider--not the accuser--would bear the burden of proof, White House sources said.
The goal is to ensure that insurers do not subtly discriminate against customers on the basis of age, race, gender or medical condition, particularly during the phase-in period, which could last four years or more, they said.
Many details surrounding a national health care board have not been set. Among the pending issues before the President are: how many seats the board will contain, what consumer or industry groups will be represented and who appoints the members--Congress or the President.
But in a tentative decision that could ruffle some congressional feathers, the current White House thinking is that board members should be appointed by the President, as are board members at existing independent federal agencies, Administration sources said.
During the presidential campaign last year, Clinton proposed creating a "health standards board" that would establish annual health budgets to limit public and private medical expenditures, saying that its members should include consumers, providers, business, labor and government.
The 12-member independent legal review group that is studying health agency proposals is one of four panels of outside experts--all working free--now scrutinizing the Administration's emerging health care reform agenda, looking for potential pitfalls.
A second review group of 12 experts is focusing on issues of administrative simplicity and quality control. The President wants to streamline insurance reimbursement, in part by issuing all citizens and legal residents a plastic "health security card," also containing each holder's medical history, that can be used by doctors and hospitals for instant electronic billing.
A third review group consists of nearly 47 doctors, nurses and other providers who have been looking at how the plan will affect the work of front-line medical providers.
The fourth panel, six actuaries and one economist, is examining the Administration's cost estimates associated with restructuring a health care system, ranging from projected savings to the cost of providing coverage to the 37 million uninsured Americans.
Administration analysts have privately put the reform price tag at between $30 billion and $90 billion annually.