Health Care for the Unemployed

...President Reagan and Republicans on Capitol Hill (as well as some Democrats) are sure to oppose passage of another Federal health care "entitlement " Many conservative politicians see the health programs already on the books as responsible for curving the government into "insolvency," as Office of Management and Budget Director David Stockman recently put it Thus chances are that the entitlement banner will eventually fall by the wayside Waxman raised it in the first place to guarantee the solid support of organized labor and other interested lobbies, an objective that has by now been achieved The Administration, meanwhile, has been issuing words of caution and attempting to minimize the urgency of the situation Testifying before the Senate Finance Committee in late April, Stockman asserted that the number of uninsured jobless and dependents was not nearly so great as the CBO had suggested "The problem of lack of health insurance among the unemployed," he said, "is one of selective gaps and discontinuities—and not a pervasive or general problem " Those "wholly without access to health care services [are] really a limited subset of the unemployed " He went on to claim that they total about 2 1 million, and that most of them could be safeguarded by the sorts of extra obligations Dole and Waxman propose to place on employers "Whatever gaps m coverage" were left could be filled in by lettmg the states use funds from the social services block grants created in 1981, he said, eliminating the need for new Federal allocations It could be a "costly mistake," Stockman warned, to adopt anything beyond this minimal solution, for otherwise pressure would develop to embrace a variety of nonmsurance holders, not simply the unemployed In any case, the question of financing poses a major hurdle The President may ultimately approve some Federal appropriations Waxman or Dole schemes, yet he is virtually certain to insist that these be matched by new revenues—and most Republicans involved with health care issues will agree with him One idea Stockman outlined to the Finance Committee would place a cap on the amount of tax-free health insurance an employee can receive from an employer, making anything beyond the limit taxable income At present, approximately $25 billion a year in health coverage is beyond the Treasury's reach Reagan has long wanted to institute a cap, and now it could prove doubly useful Because workers would have to pay taxes on the value of health benefits they received above a certain figure, they would begin to think more carefully about the scope of their pohcies, and national health costs would be bound to drop On the other hand, since not everyone would forgo their broad coverage, the government would derive additional funds—which could defray the cost of health insurance for the unemployed But the plan involves definite political risks Many Americans have come to view top quality health care at little or no direct cost as their inalienable nght Should they lose part of their employer-supplied protection, they might want Washington to take up the slack That is what Senator Robert Packwood (R -Ore ) is worried about Responding to Stockman's testimony, he cautioned that if the cap did indeed result in workers scaling back their insurance, they would "turn and snap at us We will be pushed toward developing a national health insurance program " In other words, m seeking a painless way to cover the unemployed, Reagan could very well open a Pandora's box he thought he had firmly closed And this time Congi ess might not be able to let the chance for initiating a national health program slip by...

...LIMITED PROPOSALS Health Care for the Unemployed by JONAS MORRIS ROBERT DOLE Washington Congress has put enactment of a health insurance program for the unemployed on the legislative fast track Democrats and Republicans agree that something should be done to ease the hardship of the millions who have lost their medical coverage along with their jobs in the current recession Before either of the two major bills under consideration becomes law, however, abig slippery spot has to be circumvented The drafters must convince their colleagues that their schemes are temporary arrangements designed to help today's jobless, and will head off the demand for a broader, more comprehensive Federal system of health care financing The path is a narrow one, and in both houses members of every ideological stripe feel uncertain about finally being able to negotiate it Capitol Hill's concern owes its origins, largely, to President Reagan's policies They have so undermined the economy that we are experiencing the highest unemployment rate since the Depression, with over 11 million Americans at present looking for work Roughly 2 million more, it is believed, have given up the search How many of these people are without health insurance for themselves and their families is impossible to determine exactly, because some are still receiving benefits from their former employers or through a spouse The Congressional Budget Office (CBO) estimates that, counting dependents, this group of uninsured numbers 10 million Exacerbating the situation are the changes the Administration has made in the Federal health care system They have resulted in an appreciable decline of the widespread satisfaction that in recent years has insulated the government from agitation for some form of national health insurance (NHI) Following the enactment of Medicare and Medicaid in 1965, an increasing proportion of the U S population came to feel it was well enough taken care of, either by the existing programs or private insurance Accordingly, the constituency pressing for still more extensive Federal involvement steadily dwindled Until unemployment began to swell the number, there were only about 20 million American citizens who held no health insurance, and they were for the most part unorganized The cost-cutting initiatives of Reagan's first two budgets, most of which Congress endorsed, were the first steps toward upsetting the consensus Besides curtailments in Medicare and Medicaid, funding was reduced for services ranging from community health centers to Health Maintenance Organizations In the wake of these disruptions, the loss of health care coverage due to rising unemployment created another discontented group—this one a well-organized block whose interests are represented by labor spokesmen Jonas Morris, a new contributor, is a freelance journalist in Washington Even the Administration recognized that failure to take some immediate remedial action could produce a ground-swell for the very sort of reform it philosophically opposes And so, of course, did the members of Congress, who have over the years shied away from instituting national health insurance or a similar guarantee of universal health coverage The most recent rejection came in 1979-80 when several proposals, including President Carter's national health plan, were debated by the Senate Finance Committee As the Presidential election campaign heated up and the economy deteriorated, the committee simply abandoned the measures In the light of today's fiscal situation, there is no chance for a change of heart, rather, liberals and conservatives are conspiring to quell the cries of the unemployed by adding another strand to the existing "safety net " Generally, access to health care in the United States is gained through one's job The safety net has been set up to meet the needs of those who are outside the employment picture, and although its fibers are of different sizes and each one has its own inequities, it does afford some security The retired and the disabled are covered by Medicare, welfare recipients—or most of them, at any rate—by Medicaid But up to now no provision has been made for the j ob-less who are still receiving unemployment compensation and as a rule therefore do not qualify for welfare The problem is that the net has other holes as well, and patching only this one is a delicate business Millions of people lack health insurance because they are self-employed, their employers don't provide coverage, or their incomes are not quite low enough to qualify for Medicaid Uncounted others carry policies that are grossly inadequate Yet unless such groups were excluded from the legislation to aid the unemployed, passage would be very unlikely and the White House would almost certainly balk In the past, the unprotected have been the sticking point of every Congressional debate on national health, since covering them would represent (he largest additional cost The two options before Congress are similar despite being advertised as quite different One was drawn up by Representative Henry Waxman(D -Cal), chairman of the House Commerce Committee's Subcommittee on Health and the Environment It has subsequently been co-sponsored by Edward Madigan of Illinois, the subcommittee's ranking Republican, and was approved by the full Commerce Committee in early June It remains to clear several other committees before reaching the floor The other measure has been introduced in the Senate Finance Committee by its chairman, Robert Dole (R -Kan ) Both bills would distribute Federal funds to state governments for the purpose of either purchasing health insurance for the unemployed or paying their medical bills directly Coverage would be about the same as that offered under Medicaid Anyone whose unemployment benefits have expired would be eligible if they were not insured through another channel The states' participation would be voluntary, and they could require the unemployed to bear a portion of their own expenses, whether for premiums or actual treatment Waxman's proposal is slightly more far-reaching, in that it would give grants to public hospitals—the city or county institutions that have found their resources for tending to the indigent increasingly strained as more and more workers lose their health insurance To an extent, the two bills are at odds with the tacit understanding that has emerged in Washington over the years that most of the burden of any Federally mandated expansion of health care services should be borne by the nation's employers Nevertheless, they would require employers to carry an employee's health insurance for a few months after he is let go, and to open their programs to employees' unemployed spouses Whether private industry or the Federal treasury ends up supplying the bulk of the funding would thus depend in considerable measure on how long the average unemployed person is without a job The perceived variance between the Waxman and Dole plans stems from the fact that, even though both would be in effect for a limited period, Wax-man has described his measure as an "entitlement" while Dole calls his a "block grant Whate\er their practical insignificance, these terms can be important m the legislative bargaining process Entitlements are the mechanism Congressional liberals prefer for redistributing wealth and financing social services, conservatives like block grants better In the current circumstances, if Waxman refuses to relinquish the label he has chosen, his plan will probably be crushed by the weight of heavy political rhetoric...