Obstacles loom, but Americans need this first step

The bill unanimously passed by the Senate Tuesday is certainly not the major health care reform that President Clinton championed in 1994. Neither the Senate bill nor its companion measure, passed by the House last month, would provide basic health care insurance to the 41 million uninsured Americans. And neither would require any employer not currently offering health insurance to make it available to employees.

Nonetheless, the Senate bill represents a step of enormous substantive and political significance. It could help ease expansion in the ranks of the uninsured and alleviate insured Americans’ gnawing fear of losing coverage. These would be major accomplishments any time, and all the more so in an election year.

The Senate and House bills guarantee that the millions of workers who lose or switch jobs every year would be able to retain uninterrupted health insurance. Workers would not have to wait, uninsured, for months or years before coverage under their new employer’s policy became effective. Nor would employees be excluded from coverage for preexisting medical conditions, such as diabetes, hypertension or cancer. Eighty million Americans have medical conditions that have made it difficult for them to maintain health coverage or to secure coverage in a new job.

The reforms in the legislation would also be welcomed by those who moved to an employer not offering health insurance and those who lost their jobs. Both the Senate and the House versions require the employee’s former health insurer to extend an individual policy. That probably would be more expensive and restrictive than a group policy, and the displaced employee would have to pay for it. But for the estimated 1 million workers who lost their health insurance in the last two years alone, this change would be a major advance.

Congress’ move to make health insurance portable enjoys deep, bipartisan support. But the differences that exist between the House and Senate versions threaten to derail progress in the considerable areas of agreement. The House bill includes a cap on malpractice awards; Clinton has already strongly objected to this provision, which indeed more logically belongs in legislation addressing the tort system.

House members also seek creation of medical savings accounts, allowing individuals to invest in their own tax-exempt accounts, often for catastrophic coverage. The Senate defeated a similar provision; opponents fear that these accounts would undermine the affordability of more comprehensive group policies covering routine as well as catastrophic care. We do too.

Senate approval of an amendment, not in the House version, requiring insurers to treat mental illness the same as physical diseases could also present problems. This provision is intelligent and compassionate public policy but may be a deal-breaker for some fiscal conservatives in the House.

Conference action could begin this week, but partisan posturing and special-interest provisions threaten to kill both bills.

Few dispute the need for insurance portability and an end to exclusions for preexisting medical conditions. Congress must focus on taking the first steps toward health insurance reform and thus begin to quell the rising worry that Americans have over their uncertain access to medical care.