Non-Traditional Medicine OKd by Health Plan

The health care package being designed by the Clinton Administration would allow for treatments by chiropractors, podiatrists, acupuncturists and other less-traditional healers, senior Administration officials said Saturday.

The decision, one of many details revealed by White House planners in a briefing for reporters, gives new hope to those practicing outside the medical mainstream who feared that their livelihoods were threatened because they would be barred from the new government-imposed health care system.

Under the emerging health care proposal, medical networks would be free to include such treatments--but they would also be equally free to leave them out.

“Essentially what we are doing is specifying what services are provided; we’re not specifying who provides them,” one official said.

For instance, the new system would cover treatment for lower back pain, but it would give health networks the freedom to decide the type of practitioners who are eligible to offer the treatment. A patient who chose to join a health network that includes chiropractors would therefore have access to that service.

Clinton intends to unveil his reform plan on or about Sept. 22 in a speech to a joint session of Congress. He will submit the necessary legislation about two weeks later. Because the President plans to consult widely between now and then, officials stressed that he is likely to alter his proposals in the next three weeks.

While major revisions are unlikely, “we’re not going to pretend that we’ve just come down from the mountain with the tablets,” one senior official said. “If people have better ideas than what we’ve had, we’ll be flexible and try to accept them.”

Clinton’s reforms call for organizing consumers into large insurance-purchasing alliances that shop among provider networks for the best price and quality. Each alliance will be required to offer a variety of insurance plans from which members can choose, ranging from a traditional fee-for-service plan to a health maintenance organization.

Whether any of these insurance plans include alternative medicine practitioners will largely be a function of state licensing requirements and the preferences of individual alliances and their plans, officials said.

That the services of non-traditional healers will not be excluded under national health reform will come as good news to tens of thousands of chiropractors, podiatrists, optometrists and psychologists--and also to the millions of Americans who, polls show, are increasingly opting for their services.

“Essentially what we’re doing is creating a level playing field,” one Administration official said.

Administration officials also reiterated that if the President’s plan is enacted, most Americans would be guaranteed coverage by 1996, with the rest by the end of 1997. They said they expect as many as 10 states to be able to carry out the Washington-dictated reforms by 1995.

As the foundation for universal coverage, Clinton intends to require all businesses to pay at least 80% of every full-time worker’s insurance premiums, with the employee paying the rest. The government would subsidize discounts, on a sliding scale, for low-wage-earners and the businesses that hire them, as well as for the unemployed.

Most self-employed people would have to pay the full 100% of premiums, but that entire amount would be tax-deductible.

Until recently, the Administration had hoped to limit the amount that companies and workers must pay in premium contributions--to about 7% of payroll for large firms, 3.5% of payroll for small businesses and 1.9% of wages for individuals.

But senior officials suggested Saturday that such limits have already risen during the current calculations, with the cap for big companies now calibrated at between 7.5% and 8.5% of payroll. It was unclear what the final caps will be for small businesses and individuals.

The officials, speaking on the condition of anonymity, emphasized that no numbers are cast in stone.

In the briefing, Administration officials said they also believe that they have found a solution for one of the most baffling questions involved in the employer contributions: In the case of two-income families, how much should each employer pay?

In most two-income families today, one employer--typically the one offering the best health plan--is saddled with the entire premium for a family’s health insurance.

But that would change under Clinton’s plan. Instead, both employers would be required to pay a portion, based on an intricate formula that officials had great difficulty articulating.

To illustrate, the nationwide average cost for the government-defined standard health care package is now set at $1,800 for an individual and $4,200 for a family. Assuming the employer pays 80% of the cost and the employee 20%, the payments for an individual policy would be $1,440 by the employer and $360 by the worker. For a family policy, the employer would pay $3,360 and the worker $840.

But for the two-worker family, each employer would pay about $2,300 in premiums.

“What you’re actually going to pay as an employer for each worker is somewhat lower ($2,300) than would have been the case if you had been paying full family premium ($3,360),” one senior policy analyst said.

This policy should discourage discriminatory hiring practices based on a prospective employee’s marital or family status, officials said.

On the other hand, the total employer contribution for a two-income family will be greater than for a one-employee household. Officials were unable to explain the rationale behind that decision Saturday.

Administration officials also confirmed that companies that continue to provide workers with health care packages richer than the government-designed plan would not be able to take a tax deduction on the extra elements after several years.

Similarly, such additional benefits will count as taxable income to the individual recipients.

Existing and future labor contracts, however, will be exempt from the new tax for as long as eight to 10 years, officials said. The reason, they explained, is that over the years many contracts have provided workers with greater health benefits instead of higher wages. The extension period will provide an adjustment period.

Although the guaranteed health care package contains an array of services, some will not be phased in until the year 2000, including adult dental coverage and unlimited mental health coverage, officials said.

Among the benefits that would start immediately is coverage for prescription drugs, with a $250 annual deductible and 20% co-payments.

Included in the Clinton Plan . . .

Besides payroll deductions, President Clinton’s package would come with a fee schedule. Patients will be required to pay annual deductibles and co-payments, the White House says.

What it would cost: Standard benefits package (national average of cost shared by employers, employees and government)

Individual: $1,800

Family: $4,200

*

Out of Your Pocket: Managed care (modeled after HMOs)

Individual: $10 per visit

Family: NA

Out of Your Pocket: Traditional care

Individual: $200 deductible; 20% thereafter with $1,500 maximum

Family: $400 deductible; 20% thereafter with $3,000 maximum

*

Benefit: Hospital

Limits: No private room unless medically necessary

Co-payment: 20%

*

Benefit: Doctor services, outpatient hospital, including emergency

Limits: NA

Co-payment: 20%

*

Benefit: Preventive care, including well-baby and prenatal

Limits: For adults, pelvic exams, mammograms every 2.5 years and cholesterol screenings

Co-payment: 20%

*

Benefit: Prescription drugs

Limits: NA

Co-payment: $250 annual deductible, 20%

*

Benefit: Hospice

Limits: Hospital alternative only

Co-payment: 20%

*

Benefit: Home health care

Limits: As hospital alternative only; 60-day limit unless patient would have to return to an institution

Co-payment: 20%

*

Benefit: Extended care facilities (skilled nursing, rehabilitation)

Limits: Hospital alternative only; 100 days maximum

Co-payment: 20%

*

Benefit: Routine eye, ear exams

Limits: Glasses for children only

Co-payment: 20%

*

Benefit: Preventive dental care

Limits: Under 18 only; age limit would end in year 2000

Co-payment: 20%

*

Benefit: Mental health/drug or alcohol abuse inpatient services

Limits: 30 days per episode, 60 days per year; these limits would end after year 2000

Co-payment: One day deductible; 20%

*

Benefit: Psychotherapy

Limits: 30 visits

Co-payment: Share half the cost

NA means not available

Sources: White House, Times staff