Clinton to Seek Broader Access to Medicare

Pushing ahead with a brick-by-brick renovation of Medicare, President Clinton on Tuesday proposed health care benefits for a new assortment of older workers and retirees, including layoff victims and those who lose benefits when they retire.

The White House also provided new details on its plan to allow retirees aged 62 through 64 to buy Medicare coverage for the first time, at a monthly cost of about $300. This measure is aimed particularly at those with “preexisting conditions” that can make their private health care insurance prohibitively expensive.

In addition, administration officials were preparing to announce today a $20-billion initiative in child-care benefits, reflecting the White House’s new, selective focus on enhancing social programs at a time when the federal budget deficit, shrinking more rapidly than virtually anyone expected, is also losing its status as a defining political issue.

The administration’s proposed child-care initiatives will include new tax breaks for working parents, officials confirmed late Tuesday. Other expected proposals include higher federal tax credits to help parents cover child-care costs, tax credits to employers who sponsor child-care centers and increased federal support to states that offer child-care subsidies.

The proposals fulfill a promise Clinton made last October, at a White House conference on child care, to seek more money to help working parents cope with child-care expenses.

On the subject of his new health care initiatives, Clinton said Tuesday they “are designed to address the problems of some of our most vulnerable older Americans” and would provide “more American families with the health care they need to thrive . . . “

The proposed broadening of the giant health care program for the elderly would be financed by premiums and other budget savings, White House aides said. Still, some Republican critics were extremely wary of what they saw as an expansion of an already huge and financially shaky program. Sen. Phil Gramm (R-Texas), who helped torpedo Clinton’s much more sweeping attempt at health care reform in 1994, derided the new plan and predicted a “tough fight” in Congress.

Under the White House proposals, the government would--for a price--extend health insurance to groups of Americans who slip through the cracks of the current system:

* Displaced workers 55 and older would be allowed to purchase Medicare coverage at an estimated cost of $400 per month. In this age group, only half of laid-off workers are able to find new jobs, compared to more than 70% of younger layoff victims, according to the administration.

* Americans aged 62 through 64 would be able to buy Medicare coverage for an estimated $300 a month. At age 65, however, these early enrollees would have to pay a higher premium for doctor’s services than those who didn’t join the program until age 65. The amount of the higher premium would vary, depending on how early the recipient began purchasing Medicare, but would not exceed about $50 a month for those who sign up at 62. Currently, the monthly Medicare premium for doctors’ services is about $44.

* A key subset of this age group would be women who lost their health insurance when their husbands retired.

* Retirees 55 and older whose companies cut off their health benefits would be able to buy into their former employers’ health plans at the same cost as others in the plans. While details have not been finalized, the out-of-pocket cost to pensioners could be less than $300 a month in many cases, according to one White House official, although employer plans--and charges--vary significantly.

Administration officials estimate that 300,000 Americans might take advantage of the proposed new benefits. The White House proposal, which follows a 1996 law meant to guarantee insurance coverage for those with costly health conditions, reflects Clinton’s ongoing bid to overhaul the health care system. But in contrast to the debacle of 1994, when Clinton’s sweeping reform bid collapsed amid widespread criticism, he is now approaching questions of coverage in a much more modest, piece-by-piece manner.

“This is Strategy Two,” said Health and Human Services Secretary Donna Shalala in a briefing for reporters. “We are taking deliberate, strategic steps to fill in the gaps of where the health care system . . . is weak.”

At the same time, Republican critics on Capitol Hill were skeptical that an expansion of benefits could be accomplished without budgetary fallout, and they quickly warned that further burdening the troubled health care system would cause problems in the future. The Medicare trust fund, burdened by growing costs and an increase in the elderly population, is projected to go broke in 2008; a national commission is scheduled to make recommendations by March 1, 1999, on how to keep it solvent for the long term.

“If your mother is on the Titanic, and the Titanic is sinking, the last thing on Earth you want to be preoccupied with is getting more passengers on the Titanic,” Gramm said.

Gramm said he feared Clinton’s proposal would encourage more people to retire earlier, thus leaving not only Medicare but also Social Security even more underfunded due to the loss of tax revenues from their paychecks.

“I don’t believe the Congress is going to go along with this,” the senator added, even as he conceded that the president’s proposal was probably “very good politics” and would be “very, very popular.”

Rep. William M. Thomas (R-Bakersfield), chairman of the House Ways and Means subcommittee on health, had an only slightly less skeptical reaction. “We’ll look at any detailed proposal the president finally offers,” he said, “but if the era of big government is over, why is the president proposing all these government expansions?”

Clinton’s announcement Monday that he would submit a balanced budget for fiscal 1999 has only underscored the changing budgetary and political landscape in Washington. In recent days, the administration has leaked word of several new initiatives, including an effort to restore food stamp benefits cut off by the welfare reform law to some legal immigrants.

The administration also is planning to propose an expansion of the Head Start program, which promotes early childhood development for needy children.

But there were early indications Tuesday that lobbying groups were preparing a vigorous bid to resist any expansion of the expensive health care program.

“I still wonder why in the world we would expand Medicare at the same time the program is in crisis,” said Neil Trautwein, manager of health care policy at the U.S. Chamber of Commerce.

By contrast, advocates of social welfare spending, including sometime critics of the administration, embraced the Medicare expansion plan.

Rep. Richard A. Gephardt (D-Mo.), the House minority leader who has disagreed with the administration on many key issues this year, said he was “pleased” with the proposal and would “look forward to working with President Clinton to extend [Medicare] benefits to people in this vulnerable age group.”

AFL-CIO President John J. Sweeney was more effusive, saying the proposal “could well be the most significant step we’ve taken yet toward reducing the number of American families without health insurance coverage.” He called it “a lifeline to workers who have been forced into early retirement by layoffs, corporate downsizing or illness.”

To dramatize the needs, White House officials Tuesday highlighted the problems of a 64-year-old Missouri housewife who lost her health care coverage after her husband retired.

“If I incur more hospital bills between now and September, it’s a possibility we may have to sell the farm,” said Ruth Kain, who has run up more than $24,000 in medical bills for treatment of a heart condition.

Clinton’s plan to allow retirees younger than 65 to purchase Medicare coverage “would help thousands and thousands of people like me,” she said.

Said an approving president: “I think she has made clearer than I could ever hope to that for many Americans access to quality health care can mean the difference between a secure, healthy and productive life and the enormous burden of illness and worry and enormous financial strain.”

Times staff writers Edwin Chen and Robert Rosenblatt contributed to this story.