Plan Evokes Hopes, Fears in Orange County

With guarded hope and considerable anxiety, the people who provide health care in Orange County--from emergency room doctors to visiting nurses--are braced for change.

When President Clinton addresses a joint session of Congress Wednesday night to spell out his health-care reform plan for all Americans, his message will also get close scrutiny from Orange County biotech firms, insurance companies and even neighborhood pharmacists.

“We really don’t know what is going to emerge. And that uncertainty is really bothering people,” said Gregory Bishop, an Irvine-based health care consultant. “It is unnerving.”

Most worried are those with a major financial stake in what happens:

* Physicians, psychologists and hospital administrators expect the plan to quicken Orange County’s move toward health maintenance organizations and other managed-care plans, forcing some hospitals to close and perhaps rendering the independent practitioner something of an endangered species.

* Large employers fear they will lose some of their authority to decide which medical plans are best for their employees, and small employers who currently do not offer medical coverage worry that they may be forced to buy insurance they can’t afford.

* Insurance companies are concerned that limits will be placed on how much they can charge for minimum health benefits required under the plan, and that such limits could force some of them out of business.

* Nurses and providers of home health care are eager to know if the plan secures their roles in providing preventive medicine and cheaper at-home care. And labor unions are alarmed that employee health benefits might be taxed.

* Individuals with generous medical insurance question whether the plan’s expected guarantee of a minimum medical insurance plan for everyone will somehow reduce the quality or limit choices of their coverage.

Despite some serious misgivings, there is general acknowledgment that the major goals of reform--universal access to health insurance and cost control--are vitally important.

The prospect of reform raises guarded hope that the uninsured working poor in Orange County will get access to primary-care physicians and no longer rely on expensive hospital emergency rooms.

“We expect . . . if people have something wrong with them, they will go to a primary-care provider rather than wait until their condition is so severe they need to rush to a hospital emergency room,” said Ed Foley, vice president of the Orange County office of the Hospital Council of Southern California.

Dr. Melvyn Sterling, president of the Orange County Medical Assn., desires a reform plan that will make employers provide medical insurance for their workers, allow employees to take their medical insurance with them from job to job, and forbid the insurance industry to deny anyone coverage for pre-existing medical conditions, all part of the Clinton plan.

“I think the dominant problem in American health care is the health care insurance industry,” Sterling said. “I think Clinton understands that and is addressing that problem.”

Other than emergency room care, Clinton’s plan includes no basic health care coverage for undocumented immigrants.

“If there is no coverage for these people at all and their only recourse is the emergency room or community clinics, we are back to step one,” said Dick Ruiz, fiscal officer for the South County Community Clinic, a nonprofit organization serving the poor and medically uninsured.

On another front, Bruce Webster, chairman of the Orange County Psychological Assn. insurance task force, said his organization is most concerned that mental health benefits, which are included in Clinton’s draft plan, remain part of the final health package. But he also hoped it would offer some protection for the independent practitioner who doesn’t want to join an HMO.

“I am not optimistic this reform will bring much relief to the average independent practitioner,” he said.

Dan Korpolinsky, president of the Orange County Biomedical Industry Council, representing firms that produce drugs and medical devices, said he fears more stringent cost controls will reduce industry profits, with a resulting drop in funding for new product research.

A major question in the medical community is the potential effect of “managed competition,” an innovation that is a cornerstone of the Clinton proposal.

Under Clinton’s version of managed competition, regional or corporate alliances would purchase a variety of insurance plans from which consumers could choose.

Jeff Stark, president of La Habra Moving & Storage Inc., said he is “truly excited” by the prospect of providing his 10 employees with medical insurance, a benefit that until now has been financially “out of reach” for his small company.

He acknowledged, however, that the federal government’s possible requirement for him to provide such insurance is also “scary,” because he isn’t certain how much it will cost and whether that cost may be offset by some new tax incentive.

Judee Slack, a Westminster financial consultant who specializes in small businesses, said: “Unless the federal government puts a cap on how much the small employer has to pay, using a very low percentage of his payroll as a guideline, it would be devastating.”

Meanwhile, Orange County’s large employers fret because Clinton’s plan allows each state to determine what benefits employers must offer, beyond minimum federal standards.

Dorothy Sherman, manager of health plans for Hunt-Wesson in Fullerton, said that because Hunt-Wesson has operations in 28 states, “if (Clinton) goes to state-mandated programs, it could be a mess.”

Especially wary of the plan are labor unions such as United Food and Commercial Workers International Local 324, representing 22,000 retail clerks in Orange County and Long Beach.

UFCW officials said they would oppose any proposal to tax employees for their health benefits that exceed a basic standard. They also want to protect the income tax write-offs that corporations now take on their contributions to employee health premiums, which give firms an incentive to make the benefits more generous.

“We need to bring everybody in the country up to what we have and not bring us down to the minimum standard,” said John Sperry, president of the local.