U.S. Deserves This Health Reform

That the Kennedy-Kassebaum Health Insurance Reform Bill passed 100 to 0 in the U.S. Senate on April 23 was no fluke. Both Republicans and Democrats knew it incorporated the best and most pragmatic elements of the ambitious Clinton health reforms that crashed in 1994, reforms that would limit exclusions still existing in more than half of all Americans’ health insurance policies and that would make health coverage portable so workers would not lose their insurance if they changed or left their jobs.

The bill enjoys the support of both President Clinton, who applauded it in his State of the Union address in January, and Senate Majority Leader Bob Dole, who as recently as Tuesday said he would like a reasonable facsimile of it passed before he retires from office next week.

Nevertheless, many on Capitol Hill say the bill is doomed because of the failure of House and Senate members to nail down a workable compromise. Progress has been made in recent days on two key provisions, dubbed MEWAs and parity. House members have informally agreed to drop their insistence on exempting small insurance pools called MEWAs (multiple employer welfare arrangements) from state regulation. This is good news for consumers, because otherwise MEWAs would not have to comply with state mandates that require plans to offer such essential procedures as mammography screenings and newborn infant care.

The other compromise has been on so-called parity, the Senate bill’s requirement that mental illnesses be covered as fully as physical health conditions. The new language instead simply calls for more study. Given the Senate bill’s fuzzy definition of what constitutes “mental illness,” there is certainly a need to look at studies before drafting further legislation.

The real stickler is medical savings accounts, or MSAs. These would allow Americans covered by high-deductible “catastrophic” insurance (a deductible of $1,500 for individuals, $3,000 for families) to make tax-free contributions to private accounts and either use that money to pay medical expenses or roll it over into IRAs or pension plans.

The basic idea behind the MSAs is sound: to encourage ordinary citizens to assume some of the responsibility for the country’s spiraling health care costs (expected to reach $1 trillion by the end of this year). But large, national consumer groups like Citizen Action have argued reasonably that the MSA provision, being pushed primarily by House Republicans with the backing of the American Medical Assn., would encourage the wealthy, who could afford to pay high deductibles, to opt out of low-deductible or comprehensive plans, thus raising the costs for everyone else, and could tempt the presumably healthy to avoid wellness checkups that might save them money in the short term but could raise their medical costs down the line.

The only politician on the Hill powerful enough to persuade the Republicans to accept a compromise on MSAs--such as Sen. Edward Kennedy’s notion of testing them in key states--is Dole. The presumptive Republican presidential candidate has much to gain from marshaling his formidable negotiating skills, for he insisted on a workable compromise when it became clear that Clinton’s health care bill was doomed. The president stands to gain as well, for in his State of the Union address he declared passage of a compromise health bill a top priority. Both have much to lose if they don’t get behind this bill in the coming week, but given the bill’s indispensable provisions, the sorest loser may be the average American.