First Lady Assails Health Care ‘Free Lunch’ : Reforms: She vows that firms that do not offer insurance and young people who forgo coverage will be required to pay their ‘fair share.’

In a blunt message to those who will be hard hit financially by health care reform, First Lady Hillary Rodham Clinton said Friday that President Clinton’s agenda will require every business and individual to pay a “fair share” for insurance coverage.

In return, all Americans will get a lifetime of “health security,” at affordable rates, she said.

“It is time finally for everybody in America to take responsibility,” the First Lady said, referring to young people who have chosen to forgo coverage and to companies that do not offer health insurance to workers.

“There can’t be any more free lunch,” she said during a town hall speech to several hundred people here. “There cannot be any more people who take advantage of the system and basically take a free ride.”

The speech seemed to be another exercise in fine-tuning the Administration’s message in its campaign to sell health care reform. That campaign is already under way, even though the President has yet to make the final decisions on his health care reform agenda.

Appearing alongside 11 Democratic governors who are meeting here, the First Lady also proclaimed a new “national partnership” in which states will be granted broad latitude in implementing health care reforms under a federal framework.

She also said the Administration’s ability to control health care costs will determine how quickly coverage can be extended to the nation’s 37 million uninsured.

“If we do not control costs, we cannot reach universal coverage and we cannot provide the kind of broad-based benefits packages that Americans deserve to have,” she said.

She said the Administration’s reform agenda can be deemed a success only if all Americans can say one day: “We can rest assured we will have it (insurance) next year and the year after and the year after that. And no matter who we work for, no matter how sick we might become, no matter who we marry or the state of the health of the child that we bear, we will all be secure.”

She indirectly confirmed that universal coverage will exclude immigrants who are here illegally by saying that a health security card will be issued to “every American citizen and those who are permanent residents in this country.”

The cards, she said, will guarantee holders “a comprehensive package of benefits no matter where they work, where they live, how old they are or whether they have ever been sick.”

The First Lady, who had spoken Sunday to the American Medical Assn., was accompanied here by White House pollster Stanley B. Greenberg, media adviser Mandy Grunwald, political adviser Paul Begala and Ira Magaziner, who directs the White House Task Force on National Health Care Reform that the First Lady chairs.

During her 35-minute speech, the First Lady emphatically linked health care reform to the nation’s long-term economic competitiveness.

“One cannot proceed without the other,” she said. “If left unchecked, health care costs will continue to hurt our families, bankrupt our businesses and our state budgets and drive the federal deficit ever and ever higher,” she said.

She did not provide details on how businesses and individuals will be required to pay their “fair share,” but Administration planners are focusing on a payroll deduction of about 10%--split between employer and employee--that would replace the premiums companies and workers now pay for health insurance.

To ease the burden on small businesses and low-wage workers, certain base incomes will be exempted, and the poor will be exempted altogether.

The First Lady also confirmed that the reform agenda will use a national budget as a cost-containment mechanism, possibly to be enforced by each state. “We all must learn to live within a budget. We can no longer write a blank check for health care,” she said.

She became the most animated when she cited companies that do not cover their workers and young people who opt to go without insurance coverage, blaming them in part for driving up costs for everyone.

“We’re going to tell individuals who think they can get by without coverage--because they are 25 and believe they are immortal--that when they have that terrible (car) accident or unpredicted illness and end up in the emergency room or in the ICU (intensive care unit) and stick us with the bill, that we’re not going to let that go on any longer,” she said. Her remarks drew strong applause.