An Ounce of Cure
the weekly Standard An Ounce of Cure Not long ago, health-care reform was almost fatally wounded by association with one of the greatest domestic-policy bellyflops in American political history:...
...And nothing, on balance, that violates conservative principle...
...Maybe so...
...the weekly Standard An Ounce of Cure Not long ago, health-care reform was almost fatally wounded by association with one of the greatest domestic-policy bellyflops in American political history: the Clinton "Health Security Act" of 1994...
...This legislation, also known as Kassebaum-Kennedy, was approved by a key Senate committee in a unanimous vote last August...
...It is a delicate animal, and its political fortunes are impossible to predict this far in advance...
...Can this be true...
...the bill allows insurance companies to charge anything they want...
...And you must be able to afford individual coverage...
...It's anyone's bet...
...health care, for the president, will always be an embarrassing issue...
...Kassebaum-Kennedy will be debated by the full Senate sometime between mid-April and early May...
...Surprise...
...And a variety of important business organizations-the National Association of Manufacturers and the Chamber of Commerce, for example-have offered conditional support...
...He wanted the whole, terrifying ball of "universal coverage" wax...
...Amazingly enough, the answer, for the most part, is yes...
...Republicans should get the credit they deserve for incremental insurance-market reform...
...In 1994, remember, most congressional Republicans promised to fill that gap...
...And the addition to the individual insurance market of a new group of such higher-risk policyholders will probably produce rate increases of some degree...
...States can't enact all these insurance reforms, after all...
...In order to secure insurance coverage for people who lose their jobs, join businesses without group plans, or enter self-employment, the act guarantees their access to an individual policy if they choose to buy one...
...federal law prevents state regulation of certain insurance plans that now cover a huge number of Americans...
...Not to worry: Clinton won't get the bulk of credit, no matter what...
...You must also be ineligible for group coverage under an employer's plan-your own or your spouse's...
...What now, barely a year after that particular question was resolved to the president's indelible partisan disadvantage...
...Can Senators Kassebaum and Kennedy hold the line on such amendments from their respective party caucuses, and thus keep the bill clean and passable...
...In his recent speeches and campaign appearances, Clinton promises to sign bipartisan insurance-market reforms in free-standing form-reforms significantly less ambitious than even the most conservative GOP proposals of two years ago...
...And President Clinton famously threatened to veto such reform in his 1994 State of the Union address...
...The bill in question is the Health Insurance Reform Act of 1995...
...David Tell, for the Editors...
...And he complains that Republicans won't let him have those reforms...
...Insurance companies in the "group policy" market are mostly okay with it...
...For most of that year, incremental health-care reform was a Republican standard...
...HIAA worries that this "no refusal" requirement will force rate increases that render individual coverage unaffordable and prompt some current policyholders to drop coverage...
...But that risk can only be avoided by doing nothing...
...Some probably fear that Democrats will attempt to leverage Kassebaum-Kennedy into something genuinely terrible in future sessions of Congress...
...The Health Insurance Association of America (HIAA) does strenuously object to one further part of the Kassebaum-Kennedy proposal...
...If the bill gets larded up with the pet health-care amendments of various individual senators, business groups have sworn they will (justifiably) revolt-and probably kill the measure...
...But Democrats rejected and mocked such incremental reform as inadequate to the "crisis"-and even counterproductive in the absence of a system-wide federal makeover...
...It wasn't enough, he said...
...And will the House, which has a large freshman class with no experience of 1994's health-care debate, be willing to move on comparable legislation, now still in its infancy...
...The legislation also guarantees access to group-plan insurance for most employers, bans the exclusion from such plans of any employee on the basis of health status alone, and requires that paid-up insurance policies be offered for renewal except in cases of policyholder fraud or misrepresentation...
...No one much objects to any of these provisions...
...Most significantly, the bill limits the ability of insurance companies to restrict coverage for recently diagnosed or treated "pre-existing conditions" to 12 months, after which those conditions must be covered, even if a patient changes jobs or health plans...
...And it would be nice if this Republican Congress could enter the fall campaign having done a little bit more than it already has for average American voters...
...And their application will be much more limited...
...Policyholders pay premium costs entirely out of their own pockets...
...Individual insurance is an unusually rate-sensitive market niche...
...It's not a preposterous complaint...
...In order to take advantage of this "group-to-individual portability" provision, you must (in most cases) have maintained uninterrupted, paid-up coverage in an employer-based insurance plan for three full years...
...In any case, insurance companies in states that adopt other means to expand coverage opportunities to newly uninsured individuals-and many states already have-are exempted from the bill's relevant requirements...
...So the decision to take such relatively expensive insurance tends to make marginally more sense if you're sicker, not healthier...
...Virtually every congressional Republican supported changes designed to ease the concerns millions of Americans have about continued access to medical coverage when they switch or lose their jobs...
...Can any health-care bill esteemed by William Jefferson Clinton really be worthwhile...
...The experience of 1994 cannot be expunged from popular memory...
...Kassebaum-Kennedy is almost, almost, entirely uncontroversial...
...Republicans may be forgiven any instinctive resistance they might have to a Clinton call for incremental health-care reform...
...It is endorsed by the National Governors Association, the state insurance commissioners, and the American Medical Association...
...And it's still an idea worth pursuing with the Kassebaum-Kennedy bill...
...Nothing that should frighten the vast majority of Americans, in other words, and much that should satisfy them...
...However the specialized dispute over individual insurance coverage is ultimately settled, the bottom line on Kassebaum-Kennedy will remain essentially the same: no new taxes, no new spending, no new federal bureaucracy, no state mandates, no rate restrictions, and no Hillary-style mandatory purchasing alliances and national expenditure caps...
...It was their idea...
...But even here, the options extended by Kasse-baum-Kennedy are markedly narrower than those contained in legislation every Republican senator endorsed in 1994...
Vol. 1 • February 1996 • No. 22
