FOIA Number: 2006-0885-F (Segment 7) FOIA MARKER This is not a textual record. This is used as an administrative marker by the William J. Clinton Presidential Library Staff.
Collection/Record Group: Clinton Presidential Records
Subgroup/Office of Origin: Health Care Task Force
Series/Staff Member: Steven Edelstein Subseries:
OA/ID Number: 3672 FolderlD:
Folder Title: Hoagland, Peter (D-NE)
Stack: Row: Section: Shelf: Position: S 52 3 5 2 Withdrawal/Redaction Sheet Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE
001a. letter From: Congressman Peter Hoagland, To: Mrs. Hillary Rodham 03/31/1993 b(6) Clinton, Re: Constituent letter [partial] (1 page) 001b. letter From: Constituent, To: Congresman Peter Hoagland [partial] (2 pages) 03/16/1993 b(6)
002. memo From: Bernard Craighead; To: Steve Edelstein; Re: Field Updates 02/16/1994 b(6) [partial] (1 page)
COLLECTION: Clinton Presidential Records Health Care Task Force Edelstein, Steve (House) OA/Box Number: 3672 FOLDER TITLE: Hoagland, Peter (D-NE)
2006-0885-F sb668 RESTRICTION CODES Presidential Records Act -144 U.S.C. 2204(a)| Freedom of Information Act -15 II.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA] bfl) National security classified information [(b)(1) of the F01A| P2 Relating to the appointment to Federal office [(a)(2) of the PRA) b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute [(a)(3) ofthe PRA) an agency [(b)(2) ofthe FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA| financial information 1(a)(4) of the PRA) b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information 1(b)(4) ofthe FOIA] and his advisors, or between such advisors [a)(5) ofthe PRA| b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) ofthe FOIA] personal privacy 1(a)(6) of the PRA| b(7) Release would disclose information compiled for law enforcement purposes 1(b)(7) ofthe FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions 1(b)(8) ofthe FOIA] PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells 1(b)(9) ofthe FOIA| RR. Document will be reviewed upon request. TC
AAUW CONFERENCE OF STATE PRESIDENTS LOBBY REPORTS - JUNE 28, 1994 1 sePO^f • Member of Universal Coverage Defined Comprehensive Congress Benefits Package vfcramer (D-AL; wants phascd-in UC, reservations on EM concerned about cost of benefits package V^oung (R-AVO opposes EM, especially for 5m business, wants opposes "more coverage'' vkoibe (R-AZ) opposes opposes Schenk (D-CA) wants UC, not sure of be^t way to get there OK Lehman (D-CA) concerned about EM for sm business, wants UC OK Franks (R-CT) wants UC, opposes EM OK ^Castle (R-DE) concemed about cost of achieving UC opposes 4liller (R-FL) opposes EM & LM. wants universal access opposes Rowland (D-GA) opposes EM. littJe support for UC miisimal suppcrt V^awdJ (R-IL) opposes EM, doesn't wart UC, just subsidies opposes for low-income Xcobs IN) opposes EM, any mandati opposes iilauerv- (D-KS) opposes EM, wants to acliieve UC gradually OK [Jefferson (D-LA) wants UC, some concemi re: EM OK
Wrcrkildsen (R-MA) wants UC, opposes EM supports, worried about cost URamstad (R-MN) wants universal access favors flexible benefits package Montgomery (D-MS) opposes EM opposes
banner (D-MO) supports concept of UC, worried about cost Aoagland (D-NE) supports UC, EM, but expects phase-in suppons j/fwett (D-NH) wants UC, seems to support EM >>• suppens /Zeiiff (R-NH) opposes EM suppons •ykoukema (R-NJ) supports IM thinks defined pkg. will not pass v/feichardson (D-NM) supports L'C, unclear on EM OK iHoughton (R-NY) suppons UC, undecided on EM waiting to see bills ! / suppons UC, EM not sure j ^itt (D-NC) TEL No. Apr 5,94 >
NHCC Field Reporting Form Name: Richard A. Lombard 1 State: Nebraska
Member Name: Hoagland and Kerrey and EXon District: Date: April 3, 1994
I. Intelligence Update
A) New Infonaatkm on Members* Position on Health Care: HoaglajKirs posrtion paper will be forthcoming and the insurance reforfn taskforci report to Kerrey has already been faxed last week. Hoagland/continues to support some kine of employer mandate wirth a( phas^/ln for small employers vith a cap on percent of paybiiMrC Kerrey particpating in a number of all day or half day health care work/visits .Today he is working in the physcian referral program in the Lancaster County Health Department and last week he was in the emergency room at St. Joseph's in Omaha late at night. Hoagland office concerned about thjthpe KKGG Town Hall Meeting cutting into their Gore Event. B) New Information on Allied Organizations' Activities Labor, Choice,Psychologists, and Rehab Advocates are meeting this week with Hoagland.
C.) NHW Inftimuitlun on Opporitlnn OrcnntantloiM* Artlvhlcn Citizens for a sound Economy are into thetr second week of radio ads and their standard Nebraska press threat on job loss appeared today. The Health Care Leadership Council/Swicky was visiting State Officials last week and they have hired staff in OMaha. Recent press on Herman Cain was included in mail today.
D) Media/Press Update
JSuU ullptl .JIlJ tJIII.' I IKICll 111 ftVll! TIJVWN UAJJJJ MiSliTlNU UW TV From Boston Globe Page 3 Health plan, likely speech focus, stirs jitters By Peter G. Gosselin Despite such problems, eome legislators and Bob Hohler predicted that Congress eventually will approve CliOBK STAI'V much of the Clinton plan. "The fundamental litmus test for the WASHINGTON - As Preeident Clinton administration and; Congreas is our ability to deal prepares for his State of the Union address tonight, with the health care s^tem iaTid the fact that it's Washington is suffering a serious case of political bi-eaking this cbuntiy both phj-sically and jitters ever what is expected to be speech's finandally," said Rep. Joseph P. Kennedy 2d, centaipiece; health care. Democrat of Brighton, Discussed and dissected for more than a year, But in interviews with almost two dozen House the issue is finally comir.g to a head, and many and Senate Democrats yesterday, many lawmakers lawmakers no longer appear sure they are ready for said their constituents had expressed deep it, Some who had offered general support for tlie icservations about the Clinton plan during meetings president's proposal now warn that it may be overly ove-f the long Christmas recess, Several said the ambitious. concerns made it less likely they will support key • The AMA redoubled its attack on the plan. Page elements ofthe measure. 5. "We shouldn't pass a bill this year unless it's "Maybe we ought to figure out how to do this bipartisan, and I don't see a ••bipartisan bill anywheic inore'iTiriw an close to-the Clmton'bill That's tho political reality," influential Indiana Dembcvat "Peopie do not think said Rep. Peter Hoagland, a-Nebraska Democrat this is a cautious plan; They're' impvessetdby its who is on the House Ways and Means Committee, boldness, but they think it's pushing the "boundaries which must approve large parts of the measure. of the politically possible.. . . "There's a lot more skepticism than there used to "I think it's pushing the boundaries," he added. be. In fact, there's i^lly.outnghtbppositiori from Clinton wili have a chance to revive public the busin ess community, which (syrprise^rne,'' s aid support for toe sweeping administration plan during Rep. Robert T. Matsui, a California Democrat who is his nationally televised address to a joint session of also on the committee. Congress. Aides said the president will seek to Health analysts say the fact that support is disaim critics by emphasizing his willingness to unoettain for tho Clinton plan at this point leave.: the bargair;. health issue in a potentially dangerous flux,wit h At the same time, he will repeat demands that l&wmakers unclear on which way to tum. any legislation to err.erge from Congress include a "There's no coalescing around any of the guarantee of heaith coveiage for all Aniericans. The proposals on the Hill, and there is not as much guaraUee is among the most complex and expensive unanimity about covering the uninsured ar.d aspects cf the Clinton plan. controlling costs," said Diane Rowland, a senior vice The White- "House faces a variety of conflicting president with the Kaiser Family Foundation, a pressures in tryir.g to mnvigorate the health issue, nonpartisan think tank ar.d activist group. 'Tie inciudirg new polls showing that crime ha.5! eclipsed momentum foi- reform has slowed," she said. health as Americans' No. 1 concern. Aides have Some lawmakers and analysts traced the engaged in a vigorous internal debate in recent days slowdown to conseivative and industry attacks rn over how much of his speech Clintcn snould devote tne Clinton plan. But others blamed the to crime to reassur? middle-class voteis. administration itself, saying it had produced a Meanwhile, critics are giving the administration complex pvoposal, then had failed to sell it to the no o.uarter. The American Medical Association public. Despite repeated assurances that it would launchsd a $1.6 million sdv'-rtising campaign launch an all-out campaigr,, the White House ha.- yet yesterday to warn that the Clinton plan, as well as to settle on a structure for the effort or name key other hills before Congress, threaten to put officials. government and insurance company bureaucrats in charge of patient care and cut doctors out.
0 02/25/93 11:40 ©912022254684 HOAGLAND $002
THE WHITE HOUSE WASHINGTON
TO U.S. House"of "Rejsresentatives Offices FR Ta&k Forcie oh'National Health Care Reform DT February 23, 1993 RE Health Care Overview
As we proceed with the 103rd Congress, it would be extremely helpful to us if you would provide our office with some background information. Please provide us with the names, work phone, home phone and fax numbers of the following: 1. D.C. Chief of Staff:
J^S- Co) 363- 5D¥S~ Ctfcn**)
2. Legislative Director:
V/sr Co)
3. Health Care Legislative Assistant: 2 ^-TTrPP
4. Press Secretary:
Also, please share any particular concerns of your Representative and your home district as they relate to health care and health care reform. Please return this form, along with any comments, via facsi»ilie to 456-6241 or through the mail to the attention of the Task Force on National Health Care Reform, Old Executive Office Building/ Room 287, Washington, DC 20500. ThanK you for your attention and cooperation. 02-11 '93 12:22 O912022234t;S4 HOAGLAND 2] nol
THE WHITE HOUSE
i'-—---- - WASHINGTON Fcbmary 2, 1993
TO: All House Offices FROM: Office of Legislative Affairs, White House RE: Phone numbers
To help facilitate emergency communication between our offices, we wouid findi t very helpful if you could fill out the information below and fax it back to us as soon as possible. We want to avoid the difficulty of tiying to contact a member with an urgent message after office hours and not being able to find him or her.
If you have any questions, please call us at (202) 456-6620. Our fax number is (202) 456-6221. Thank you for your assistance.
MEMBERS FULL NAME: ft^R Ho^hJD
STATE: Nt" DISTRICT: 0Z
MEMBER'S DISTRICT HOME PHONE NUMBER: tyz -
ER'S D.C AREA HOME PHONE NUMBER: 3Q} - fyj - L/^tf
iY D.C. OFFICE STAFF CONTACT NAME: KfrTHLEeA/ /}mB£0$£
STAFF CONTACT HOME PHONE NUMBER: ^ ^ _ ZU'S " 50 POLITICAL PROFILE Cong. Peter Hoagland Although elected to Congress in 1988, Cong. (D-NE) 2nd Peter Hoagland served for eight years in the Nebraska State legislature. A moderate Democrat, Hoagland served on the Banking Committee Housing Subcommittee, where he joined other moderate Democrats in writing legislation to provide incentives for landlords to continue renting to low-income families.
Hoagland has backed abortion rights, a higher minimum wage and has opposed a constitutional amendment to ban flag burning. Bom: 11/17/41, Omaha, In his second term, Hoagland was appointed NE to the Judiciary Committee, where he pursued Education: Stanford, U.. A.B.; his interests in drug interdiction and "boot Yale U., LL.B. Military: Army, 1963-65 camps" for drug offenders. This year, Prev. Occup: Lawyer Hoagland was appointed to the Ways and Family: Wife, Barbara Means Committee. Erickson; 5 children Religion: Episcopalian Pol. Career: NE Legislature, 1979- 87 LEGISLATIVE INTERESTS Elected: 1988 Residence: Omaha 102nd: Hoagland introduced legislation to Committees: Ways and Means simplify medital claims forms (H.R. 5245) and to establish a demonstration project ^^^^^^^^^^—i^^— reduce health care costs through medical facilities sharing (H.R. 5244).
103rd: On the first day of the new Congress, Cong. Hoagland introduced six bills:
*H.R. 72 - to expand Medicare coverage of home health services from 5 to 7 days per week for up to 40 days. •H.R. 73 - to support 20 demonstration projects to facilitate collaboration among two or more hospitals or HMOs or clinics to share expensive technology, and to exempt the facilities from antitrust action for cooperating.
*H.R. 74 - to direct State insurance regulators to develop simplified, model health insurance forms for use by all health insurance companies, Medicare and Medicaid.
*H.R. 75 - to require the President to send to Congress a balanced budget each year, and to require the Congress to consider the balanced budget. *H.R. 76 - to provide annual preventive examinations under Medicare.
*H.R. 77 - to require, as a condition of participation in Medicare, hospitals to provide parents of newborn children with information and recommendations on childhood immunizations.
ADDITIONAL INFORMATION Congres of tfje Winitth fetateg TOattyrngton, BC 20515
March 12,1993 s«-JL 4* 3h1''^V)
Mrs. Hillary Rodham Clinton The White House 1600 Pennsylvania Avenue Washington, D.C. 20500
Re: Invitation to Speak Before Institute on Health Care Law in Omafrar^ Nebraska
Dear Mrs. Clinton,
We are writing to lend our support to an invitation you received to speak before the Annual Institute on Health Care Law to be held at Creighton University in OrQaha, Nebraska in July of this year. Creighton University extended its invitation to you through correspondence date February 23, 1993, addressed to Ms. Patti Solis. In addition, we are forwarding a letter from Governor E. Benjamin Nelson of Nebraska requesting your attendance at the 1993 Institute.
The 1993 Institute will focus on "Integrated Health Care Delivery Systems and the Health Care Reform Movement" and will include attorneys, physicians, hospital administrators, insurance company executives and others involved in various aspects of health care. This forum, which is scheduled to occur after the Administration's comprehensive health care package is presented to Congress and the American people, would provide an excellent opportunity to discuss the Administration's vision for the future of health care in this country.
Omaha would be an ideal location for a major health care address because of its many "Heartland" characteristics. Omaha is a center for the health insurance industry and includes a full complement of excellent health care facilities, including two first-rate medical colleges, each with excellent research centers. In Nebraska, there are over 100 businesses involved in WELL CITY USA, a program dedicated to worksite health promotion and disease prevention. The project originated in Omaha and now operates under an umbrella organization, the Wellness Councils of America, in 21 states. WELL CITY USA serves small and large businesses alike from Scoular Grain Company to AT&T Communications. Mrs. Hillary Rodham Clinton March 12, 1993 Page Two
Nebraska also has some unique concerns related to our large rural population. In addition, the average age of the state's population is increasing with many rural counties having an elderly population of over 20 percent. Although Nebraska boasts a thriving economy, there is a recognition that health care is a lingering problem for our families, businesses and rural communities.
We know you and the President strongly support taking the message of health care reform directly to the public and we hope you will consider this opportunity to visit Nebraska. Nebraska would be honored to host your visit.
We appreciate your willingness to consider this invitation. We are standing by to help in any way we can.
With best wishes.
Sincerely,
; Exon J. Robert Kerre/L/ ited States Senate United States Senate
Peter Hoagland U.S. House of Representatives Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE
001a. letter From: Congressman Peter Hoagland, To: Mrs. Hillary Rodham 03/31/1993 b(6) Clinton, Re: Constituent letter [partial] (1 page)
COLLECTION: Clinton Presidential Records Health Care Task Force Edelstein, Steve (House) OA/Box Number: 3672 FOLDER TITLE: Hoagland, Peter (D-NE)
2006-0885-F sb668 RESTRICTION CODES Presidential Records Act - |44 I'.S.C. 2204(a)| Freedom of Information Act - |5 U.S.C. 552(b)|
PI National Security Classified Information [(a)(1) of the PRA| b(l) National security classified information [(b)(1) ofthe FOIA| P2 Relating to the appointment to Federal office 1(a)(2) of the PRA] b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute 1(a)(3) ofthe PRA| an agency |(bH2) of the FOIA| P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute 1(b)(3) ofthe FOIA| financial information 1(a)(4) ofthe PRA| b(4) Release would disclose trade secrets or confidential or financial PS Release would disclose confidential advice between the President information 1(b)(4) of thc F01A| and his advisors, or berween such advisors |a)(5) of the PRA| b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy 1(b)(6) of the FOIA| personal privacy 1(a)(6) of the PRA| b(7) Release would disclose information compiled for law enforcement purposes 1(b)(7) ofthe FOIA| C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions 1(b)(8) ofthe FOIA] PRM. Personal record misfile defined in accordance with 44 II.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells 1(b)(9) of the FOIA] RR. Document will be reviewed upon request. PETER HOAGLAND COMMITTEE ON 2ND DISTRICT, NEBRASKA WAYS AND MEANS
1113 LONGWORTH HOUSE SUBCOMMITTEES: OFFICE BUILDING TRADE WASHINGTON, D.C. 20516-2702 (202) 225-4155 SELECT REVENUE MEASURES
8424 ZORINSKY FEDERAL BUILDING 215 NORTH 17TH STREET OMAHA. NEBRASKA 68102-4910 BOUBE of lepreficntt (4021 344-8701 March 31, 1993
(b)(6) Mrs. Hillary Rodham Clinton The White House 1600 Pennsylvania Ave., N.W. Washington, D.C. 20500 V"' Dear Hillary,
Recently, I received a letter from a constituent who expressed concern as to whether the ongoing medical attention required by her seven year old son would be adequately addressed in the Administration's health care reform proposal. Ms. (b)(6) notes in her letter that her son (b)(6),,,,is totally dependent on intravenous nutrition due to the loss of his small intestine resulting from emergency surgery at
(b)(6)dP)(, birth.
Rather than summarizing the contents of (b)(6) 0lSiq correspondence, I have attached her letter which eloquently and with great specificity addresses the issues which arise in attempting to provide quality medical coverage to persons with long- term care, special-care needs. (b)(6) oais; experience in working with existing health care delivery system as chronicled in her letter presents an excellent primer for your staff members who are working on integrating persons requiring long-term, intensive medical attention into the Administration's health care delivery system.
Lastly, I have been advised that you will be in Lincoln, Nebraska on April 16 for a health care conference sponsored by the Columbia Institute and chaired by Senator Bob Kerrey. Perhaps, at that time, you would like to meet with (bxe^if your schedule would permit.
1 appreciate your willingness to consider this matter. I am standing by to help in any way I can.
With best wishes.
Sincerely,
Peter Hoagland
PH/kad
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE
00lb. letter From: Constituent, To: Congresman Peter Hoagland [partial] (2 pages) 03/16/1993 b(6)
COLLECTION: Clinton Presidential Records Health Care Task Force Edelstein, Steve (House) OA/Box Number: 3672 FOLDER TITLE: Hoagland, Peter (D-NE)
2006-0885-F sb668 RESTRICTION CODES Presidential Records Act - |44 li.S.C. 2204(a)| Freedom of Information Act - |5 li.S.C. 552(b)|
PI National Securin Classified Information |(a)(l)of the PRA| b(l) National security classified information 1(b)(1) ofthe FOIA| P2 Relating to the appointment to Federal office 1(a)(2) of the PRA| b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute |(a)(J) of thc PRA| an agency 1(h)(2) ofthe FOIA] P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA] financial information [(a)(4) ofthe PRA| b(4) Release would disclose trade secrets or confidential or financial P5 Release would disclose confidential advice between the President information |(b)(4) ofthe FOIA] and his advisors, or between such advisors [a)(5) ofthe PRA| b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy 1(b)(6) of the FOIA] personal privacy 1(a)(6) of the PRA| b(7) Release would disclose information compiled for law enforcement purposes 1(b)(7) ofthe FOIA] C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning thc regulation of of gift. financial institutions |(b)(8) of the FOIA] PRM. Personal record misfile defined in accordance with 44 I'.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells 1(b)(9) ofthe FOIA] RR. Document will be reviewed upon request. (b)(6) oc \ fa March 16, 1993 Congressman Peter Hoagland 1113 Longworth Building Washington, D.C. 20515-2702
Dear Congressman Hoagland: I am writing to express my concerns about the issue of health insurance reform, especially its potential impact on children with special health care needs. In particular, our seven year old son,
(b)(6)ee\b is totally dependent on intravenous nutrition, due to losing his small intestine after emergency surgery at birth. My husband and I have learned the nursing skills needed to care for (bxejce,t» at home, and he is a bright, active second-grader who is a cub scout and a gymnast, in spite of this disability. His medical expenses run about $100,000 a year. Although we have private insurance, it is just a matter of time before we will have to rely on Medicaid. Fortunately, (b)(6)seibqualifies for the Becket Waiver, which deems only his income for purposes of SSI. That is a very brief background about us.
My point is this: (b)(6) tt]tt disability is likely to be a long- term condition, requiring the continuous supervision of a pediatric gastroenterologist for artificial nutrition and complications related to his permanent intravenous catheter. There are several implications of this fact which are of great concern to us. First is how "managed competition" through a primary care physician will be able to accomodate special health care needs, such as (b)(6)0ol b Most HMOs and PPOs require subscribers to contact their Primary
Care Physician before each visit to the specialist, but {b)(6)ool * is under the continuous supervision of a pediatric gastroenterologist because he is on Total Parenteral Nutrition, a therapy requiring skilled nursing care. Because we are caring for me)sit home, and because we are not trained professionals, we have to be able to get in contact with the specialist or his nurse immediately. The delay involved in first calling the PCP for approval to call the specialist seems like a waste of the physician's time and not in the best interests of a child with a life-threatening condition.
I want to emphasize that the idea of "unnecessary" trips to the specialist needing to be controlled or limited by an HMO/managed competition plan is potentially dangerous in a situation like ours, where a long-term need for supervision by a clinical subspecialist has already been established. It could pose a threat to the health and life of a child like (b)(6) The additional stress to us, his parents, would be unbearable, I fear. I worry alot that I will do something out of ignorance or fatigue to hurt (or even accidentally kill) ^Lsgil^It wc,uld be unthinkable to be cut off from daily contact with (b)(6)ee»fe specialist, to be forbidden to consult without first getting the OK from our primary care physician each time. I just can't imagine how this would work — most of the time it is a situation related to the machines he is hooked to. My second concern is how a family of moderate means can afford supplemental private insurance, and how the federal/state plan will assure families like ours that private companies will, in fact, offer us coverage, and on a long term basis. In the past, families like ours have had the government "safety net" of Medicaid. Will the private sector really fill that vacuum, once government guarantees only a minimum benefits package to all? Or will the "market" in effect provide an impersonal form of health care rationing? Private companies won't want to sell supplemental policies to families with expensive preexisting conditions. Will they be required to spread the risk, as in an expanded CHIP?
Finally, and perhaps most importantly, parents like us worry that we will lose a voice in decisions affecting our children's well-being. This last concern is one that worries everyone, doctors, hospitals and families alike. I cannot stress enough how important it will be for Primary Care Physicians and third-party providers to collaborate with those parents who are providing care to their "special needs" children on a twenty-four hour-a-day basis at home. We are not medical experts, but we know — often better than the general practitioner — when symptoms require immediate attention of a specialist.
We are where we are "at" because of a complex set of circumstances, including the availability of "high tech" care and an ethical decision at birth which did not really permit us to deny initiation of life-sustaining treatment. (b)(6) \ *> treatment is not "futile," nor is it experimental. As an individual family, we are obviously not in a position to care for him by ourselves in our home without substantial financial support. We need support from the government and from our community. We cannot do this by ourselves.
C 1 nr-'OY-o 1 \T
(b)(6) PETER HOAGLAND COMMITTEE ON WAYS AND MEANS 2ND DISTRICT, NEBRASKA 1
. 1113 LONGWORTH HOUSE t SUBCOMMITTEES: OFFICE BUILDING TRADE WASHINGTON, D.C. 20515-2702 1202) 22M155 SELECT REVENUE MEASURES
8424 ZORINSKY FEDERAL BUILDING innjreoH of tfje Intteii ^tatea 215 NORTH 17TH STREET OMAHA, NEBRASKA 68102-4910 (402) 344-8701 DtouBC af ffietrrEHEirtaltueH
March 25, 1993
Mrs. Hillary Rodham Clinton The White House 1600 Pennsylvania Avenue Washington, D.C. 20500
Dear Hillary,
Thank you very much for your time during your meeting with Ways and Means Committee Democrats on March 17, 1993. It was by far the best preview any of us have had yet of your thoughts, and I appreciate it very much.
I am writing on behalf of Creighton University Medical Center and the University of Nebraska Medical Center, two first-rate medical colleges with ^A^-^i associated teaching hospitals in Omaha, whose chief administrators would i o appreciate an opportunity to meet witha representative of tKe white House'tlealth Care Task^Force, As two medical colleges /teaching hospitals committed to serving TSTebraska's underserved population, they offer a wealth of knowledge and experience in many of the critical issues facing health care reform.
As the single-largest provider of indigent care in the Omaha community, Creighton University and its primary teaching hospital, St. Joseph, lend a unique perspective in serving the uninsured and the challenges involved in bringing them into the health care system. Creighton and St. Joe's Hospital provide between $5 and $10 million of free health care services annually. Creighton University is actively focusing on the ever-increasing moral and ethical issues facing health care providers today. The Creighton Center for Health Policy and Ethics, directed by Charles Dougherty, Ph.D., is rapidly becoming a national voice at health care and legislative conferences examining issues such as national health insurance, health care for the elderly and mandatory testing for HIV persons.
The University of Nebraska Medical Center (UNMC) is well-known around the country for its Eppley Institute for Research in Cancer and Allied Diseases, one of the 15 cancer laboratory research centers designated by the National Cancer Institute. UNMC is also under the leadership of Chancellor Carol Aschenbrenner, M.D., the first woman to head a public academic medical center in the United States.
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS Mrs. Hillary Rodham Clinton March 25, 1993 Page Two
Throughout its history, UNMC has demonstrated a strong commitment to training health professionals for rural Nebraska communities. Most recently, UNMC has committed itself to innovative teaching programs such as the Rural Health Education Network and the Rural Health Opportunities Program, which are designed to positively impact primary care health manpower through a coordinated approach to recruitment, training and retention of rural health professionals.
In your meeting with Ways and Means Committee Democrats and during your extensive travels visiting with the American public on health care reform, you have often focused on the need to assure that the indigent receive adequate health care and that people residing in rural and sparsely populated areas have the opportunity to access necessary medical treatment at reasonable prices. The University of Nebraska Medical Center and Creighton University would welcome the opportunity to meet with you to share their expertise and offer their suggestions, based on their wealth of experience, for reforming the health care system.
I am forwarding a curriculum vitae for Dr. Carol Aschenbrenner, Chancellor of the University of Nebraska, and Dr. Richard O'Brien, Vice President for Health Sciences, Creighton University School of Medicine. Please feel free to call on me at 225-4155 to facilitate a meeting at your convenience.
Thank you again for your time last week, and I look forward to our next meeting.
With best wishes.
Sincerely,
Peter Hoagland
PH/kad t OD a leau: Jt\ t as 1 Wiiming course i i over public Congress By Mimi Hall By Richard Wolf USA TODAY USA TODAY
As head of her husband's President Ointon's health health-care reform task force, care experts descended on Hillary Rodham Clinton has Congress Monday in a mostly spent eight months working successful effort to educate mostly in Washington, attend lawmakers ahout his reform ing 129 meeting on Capitol Hill plan and address key concerns. and presiding over countless The all-day workshop pro closed-door sessions duced bipartisan praise for Hil Now, she focuses on making lary Rodham Clinton's prowess her case to the public, hitting as the administration's health tly Imi Dillon. USA IODA the airwaves as the chief sales care czar, but less agreement ON THE HILL: Ftrst lady Hillary Rodham Clinton wrtl\ from left person of Ihe president's on the details of the plan. House Speaker Thomas Foley. D Wash. Rep. David Bonior. D health-care refonn proposal. Dubbed "Health Care Uni Mich.; Senate Majority Leader Georg "She is serving, in effect, as I versity" by lawmaken who felt c see it as what a Cabinet officer like they were back in school, "It was nft" 1 1/1 would do," presidential coun the sessions gave about 300 HEAlTH^AWt WDEK( Rep. Sam Gil Fla. "Sh< -A selor David Gergen told NBCs House and Senate members a •>«^Qgnvinces you helming); o Meet the Press By J Scott Apf^ewNle. AP chance to quiz administration • Debate tmm up. 1A thaTsBncnoW! what she's talk o In many ways, this, Bnally, is ON THE TEAM: First lady Hilary Rodham Clinton with fomw surgeon general C. Everett K00& officials, and ihe White House • EdtorM. 11A ing about." 5 Hillary Ointon's debut as the whom she named to organize a series of forums to give doctors health-care input. ance to make its case. • HMary Rodham CMon Other lawmaken describet one of the nation's most influ Ifs the first timtXve her presentation as "spectacu ential flrst ladies. plan: She has little patience for "Nobody has staked out a po outfnMtfwpten.ia* lar" and "a tour de force" tha The sales blitz began Mon those who gripe about costs. sition and said. Well, if you » Reader quMtlont, ISA can only help the administra o day when she hasted a work "Everybody must pay some don't agree with this, then tion's chances of passing ; shop outlining the president's thing." she said recently. "Now, a you're obstructing^ what compromise refonn plan. plan for Congress members. there are some people who are l to do of p ained about the Clinton est Some Republic weren' CO -frwnme m Lawmakers from both par paying a lot, while there are HealttKare reform Is Minority Leader p an's reliance on employer
WASHINGTON (AP) Health care overhaul, including coverage for everyone, remains the goal this year, despite Republican rumblings that it's not as important as crime and welfare reform, Democratic congressional leaders said Sunday. "vWe do have to act on health care reform,'' said Senate Majority Leader George Mitchell, D-Maine, who said health care legislation and welfare reform both can be passed this year. But Senate MinorityILeaderHBob Dole of Kansas argued as he has on several occasions in recent weeks that Congress ought to scalelback HPresident Clinton's sweeping health care proposal. ""We're not going to get the vast programs that the president and Mrs. Clinton want,'' Dole predicted on CBS1 ""Face the Nation.11 He said the Clinton plan amounts to ""trying to shove something down the throat of the American people.'' Dole said that health care coverage for all Americans, an area on which Clinton has said he will not compromise, is still a goal, but added, ""You're not going to be able legislate universal coverage.11 Mitchell, also appearing on CBS, said that while various health care proposals will be considered, coverage for the 37 million Americans currently I withoutllhealth insurance must be ""the essential element1' of any bill for it to be passed. Former presidential aspirant Ross Perot, in an interview broadcast Sunday on C-SPAN, called the Clinton health plan ""an airplane with no wings' 1 and charged it would lead to rationing of medical services. House 1 SpeakerllTom Foley, D-Wash., meanwhile, rejected suggestions that health care reform is not as badly needed as refashioning the country's welfare system. ""There isn't any reason we can't work on both of them together,'' Foley said on ABC's ""This Week With David Brinkley.'' Foley discounted those who claim there isn't a crisis in health care, citing among other things the sharp increases in medical costs in recent years and the fact that many Americans are without health care coverage. Medical costs totaled only $75 billion in 1970, increased to $260 billion by 1980 and jumped to $700 billion by 1990, Foley said. ""Within a year, we're going to be spending over a trillion dollars.'' Some Republicans including Sen. Trent Lott of Mississippi, who appeared with Foley on ABC have argued that there isn't a health care crisis and say lawmakers should concentrate on welfare reform or legislation aimed heralded as a purer version of managed competition. Rep. Steve Neal, D-N.C., and Rep. Alex McMillan, R-N.C, are co-sponsors of the Cooper plan. McMillan, of Charlotte, will spend much of his time, trying to shape health-care reform as a ranking member of a pivotal health subcommittee and part of the Republican health task force. Two conservative Democrats, Reps. Tim Valentine and Martin Lancaster, also are considering the Cooper plan, according to their aides. ""I think it's a sensible middle ground. It doesn't overpromise,'' Neal said. ""It moves us in the right direction.'1 The Cooper plan is one of six health-care reform plans that have been introduced as bills. The liberal favorite is a Canadian-style plan that eliminates insurers and sets up a government-run system for all Americans. The conservative favorite is a plan that relies on private health insurance, tax-free medical savings accounts, and tax credits and vouchers for poor Americans. Watt and Rep. Eva Clayton, the Democrat who represents the poor 1st District of eastern North Carolina, have endorsed the liberal plan, in which the government collects payroll taxes and pays all medical bills. Republican Sens. Jesse Helms and Lauch Faircloth back the conservative version, and an even more conservative plan that Sen. Phil Gramm, R-Tex., is planning to introduce. Ballenger and the three other House Republicans have cosponsored a more moderate Republican plan, which Helms has cosponsored as well. The plan requires employers to offer insurance, in the belief that this will push down insurance costs, but does not require them to pay for it. Individuals could bank $2,500 a year and families $5,000 in tax-free savings accounts for medical expenses. This is meant to encourage people to buy cheaper catastrophic insurance.
Democrat Hoagland: Clinton Health Care Plan Relies Too Much On Rules By The Associated Press=
President Clinton, hoping for bipartisan support for his health-care reform package once Congress reconvenes on Tuesday, will have to convince at least one fellow Democrat from Nebraska to back his plan. Rep. Peter Hoagland says he would vote against Clinton's health-care reform plan as it stands because it may rely too much on government regulation. ""I absolutely will not support a health-care plan that heralded as a purer version of managed competition. Rep. Steve Neal, D-N.C, and Rep. Alex McMillan, R-N.C, are co-sponsors of the Cooper plan. McMillan, of Charlotte, will spend much of his time, trying to shape health-care reform as a ranking member of a pivotal health subcommittee and part of the Republican health task force.
.,Twos..conservative Democrats, Reps. Tim Valentine., and Martin ^Lancaster, also are considering the Cooper-"plan, according. to their aide's . ""I think it's a sensible middle ground.. It doesn't overpromise,'' Neal said. It moves us in-the.right direction. '1 - The Cooper plan is one of six health-care reform plans that have been introduced as bills. The liberal favorite is a Canadian-style plan that eliminates insurers and sets up a government-run system for all Americans. The conservative favorite is a plan that relies on private health insurance, tax-free medical savings accounts, and tax credits and vouchers for poor Americans. Watt and Rep. Eva Clayton, the Democrat who represents the poor 1st District of eastern North Carolina, have endorsed the liberal plan, in which the government collects payroll taxes and pays all medical bills. Republican Sens. Jesse Helms and Lauch Faircloth back the conservative version, and an even more conservative plan that Sen. Phil Gramm, R-Tex., is planning to introduce. Ballenger and the three other House Republicans have cosponsored a more moderate Republican plan, which Helms has cosponsored as well. The plan requires employers to offer insurance, in the belief that this will push down insurance costs, but does not require them to pay for it. Individuals could bank $2,500 a year and families $5,000 in tax-free savings accounts for medical expenses. This is meant to encourage people to buy cheaper catastrophic insurance.
Democrat Hoagland: Clinton Health Care Plan Relies Too Much On Rules By The Associated Press= President Clinton, hoping for bipartisan support for his health-care reform package once Congress reconvenes on Tuesday, will have to convince at least one fellow Democrat from Nebraska to back his plan. Rep.,. .Peter Hqagiand .says .he . would. vote , against C1 intonT-s^-tie^^ t may rely;,:to<^^^ "I absoiutely wiil.inot support ..a health-care..plan that,:
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ca^^Ja^^|^|^^g^sm|nt^interferenceHoagland, D - Nels^^^M^h^dmaha lasfc; week0." Hoagland, who sits on the Ways and Means Committee, said he agrees with many of the goals of health-care reform. But he said the plan should rely on competition, not regulation. ""We've tried price, controls in America, and they s imply^dbW'Wcofl^r •^O^anqr^a:mi:il ^^"-^^W^ The Clinton plan would control prices by limiting health insurance premium increases according to a cost-of-living formula that also takes into account increases in health-care costs. At least 5,000 employees in Nebraska's health-insurance industry would lose their jobs under Clinton's plan because the insurance companies wouldn't be free to compete for business, Hoagland said. Ways and Means is expected to play a key role in crafting health-care legislation because it initiates tax measures in Congress. Rep. Bill Barrett, R-Neb., criticized Clinton's plan as top ambitiousy,; •and~sad'd^ther^
crisis'• thait needs ' to' be • solved. -"; s •'-•-•^••^••••-•^.^^.•L
11s current^orm, 'S.M^^.^id^n^l^sAijaip^ las^eek. ramifications..'' ...... Barrett said a national health-care package should not address 'dental" care, • long-term-health -care- and abortions, all of..,whi^J^^:^ _: A'i w;?,::«^'6'6ff^ngr€S'smen crit'icizecl""Clintbn' s proposal tp have ' employers, pay 80 percent-of - their • employees^..c:premiums. ." "Making^employers^pay- wpuld• really'" hurt small' businesses in' Nebraska,1 ' Barrett said.
Hospitals Seek End to For-profit Health Plans HARTFORD, Conn. (AP) Connecticut's hospitals are challenging health insurance companies' control over health costs by seeking to replace the state's for-profit health plan market with a nonprofit system. The plan, approved unanimously Friday by the Connecticut Hospital Association, would create a complex arrangement in which hospitals and doctors would have control of nonprofit health plans. The premiums would be set by an independent authority appointed by the governor. The proposal faces stiff opposition from the insurance industry, which is already claiming victory in its efforts to hold down costs and to curtail what it deems the unnecessary use of medical services by patients and doctors. ""If I understand this correctly, providers (doctors and hospitals) would be negotiating with themselves?1' they'd do far more than Senator Gramm proposes,'' said Dallas Salisbury, president of the Employee Benefit Research Institute, a think tank in Washington. 'xBut at this point they don't want to be incremental. They're going to try to do more.'' Gramm said he saw nothing wrong about taking small steps early. ''I think quite frankly that success breeds success,'' he said. ''Let's fix the things we agree on now and build on that success.'' Congress is set to officially launch the 1994 health care debate Tuesday when President Clinton delivers his State of the Union address. Republican House members of the Joint Economic Committee of Congress started the sparring a day early, issuing a scathing analysis of the Clinton plan's proposed financing. The GOP analysis said the plan would fall more than $1 trillion short after seven years of operation and derided as ''quack economics'' the White House contention that the plan would actually save money and reduce the budget deficit by $58 billion in five years. The American Medical Association also took aim at the plan Monday, charging that it would force doctors aside and let insensitive bureaucrats decide the care patients should receive. It will continue to deliver its message in coming weeks in a $1.6 million advertising campaign advocating more say for physicians in any reform plan. Also Monday, advocates of undocumented aliens and migrant farm workers complained that the Clinton proposal fails to address health care problems of the U.S.-Mexican border. They told a health subcommittee the border area suffered unique problems of poverty, pollution and Third World diseases and that it needed special attention. XXX (File photo available from KRT Photo Archive through PressLink dialup via Macintosh computer. For information, call (800) 435-7578 or (202) 383-6099.)
Lawmakers growing more cautious about health care reform By Peter G. Gosselin and Bob Hohler Boston Globe WASHINGTON As President Clinton prepares for his State of the Union address Tuesday night, Washington is suffering a serious case of political jitters over what is expected to be speech's centerpiece: health care. Discussed and dissected for more than a year, the issue is finally coming to a head, and many lawmakers no longer appear sure they are ready for it. Some who had offered general support for the president's proposal now warn it may be overly ambitious. v'Maybe we ought to figure out how to do this more incrementally,'' said Rep. Lee H. Hamilton, an influential Indiana Democrat. ''People do not think this is a cautious plan. They're impressed by its boldness, but they think it's pushing the boundaries of the politically possible. ''I think it's pushing the boundaries,'' he added. Clinton will have a chance to revive public support for the sweeping administration plan during his nationally televised address to a joint session of Congress. Aides said the president would seek to disarm critics by emphasizing his willingness to bargain. At the same time, he will repeat demands that any legislation to emerge from Congress include a guarantee of health coverage for all Americans. The guarantee is among the most complex and expensive aspects of the Clinton plan. The White House faces a variety of conflicting pressures in trying to reinvigorate the health issue, including new polls showing that crime has eclipsed health as Americans' No. 1 concern. Aides have engaged in a vigorous internal debate in recent days over how much of his speech Clinton should devote to crime to reassure middle-class voters. Meanwhile, critics are giving the administration no quarter. The American Medical Association launched a $1.6 million advertising campaign Monday to warn that the Clinton plan, as well as other bills before Congress, threaten to put government and insurance company bureaucrats in charge of patient care and cut doctors out. Despite such problems, some legislators predicted Congress eventually would approve much of the Clinton plan. ''The fundamental litmus test for the administration and Congress is our ability to deal with the health care system and the fact that it's breaking this country both physically and financially,'' said Rep. Joseph P. Kennedy 2nd, D-Mass. But in interviews with almost two dozen House and Senate Democrats on Monday, many lawmakers said their constituents had expressed deep reservations about the Clinton plan during meetings over the long Christmas recess. Several said the concerns made it less likely they would support key elements of the measure. ''We shouldn't pass a bill this year unless it's bipartisan, and I don't see a bipartisan bill anywhere close to the Clinton bill. That's the political reality,'' said Rep. Peter Hoagland, a Nebraska Democrat who is on the House Ways and Means Committee, which must approve large parts of the measure. ''There's a lot more skepticism than there used to be. In fact, there's really outright opposition from the business community, which surprised me,'' said Rep. Robert T. Matsui, a California Democrat who is also on the committee. Health analysts say the fact that support is uncertain for the Clinton plan at this point leaves the health issue in a potentially dangerous flux, with lawmakers unclear on which way to turn. ''There's no coalescing around any of the proposals on the Hill, and there is not as much unanimity about covering the uninsured and controlling costs,'' said Diane Rowland, a senior vice president with the Kaiser Family Foundation, a nonpartisan think tank and activist group. 1'The momentum for reform has slowed,'' she said. Some lawmakers and analysts traced the slowdown to conservative and industry attacks on the Clinton plan. But others blamed the administration itself, saying it had produced a complex proposal, then failed to sell it to the public. Despite repeated assurances it would launch an all-out campaign, the White House has yet to settle on a structure for the effort or name key officials.
Anti-Clinton health-care ads hitting the airwaves By Gilbert M. Gaul Knight-Ridder Newspapers
Coming soon to a TV, radio or newspaper in your home: ''Health Wars: The Battle of the Reformers.'' Three national groups at the center of the debate over health-care reform are rolling out advertising campaigns aimed at winning over the hearts and minds of consumers. But their messages couldn't be more unalike. A $2.3 million campaign by the Health Insurance Association of America (HIAA) warns viewers that President Clinton's health-care plan could limit their choice of doctors and insurers by creating big government bureaucracies. A new $1.6 million print advertising campaign by the American Medical Association asks readers whether they would rather entrust their lives to an MD or an MBA. And advertisements underwritten by the Health Care Reform Project, a coalition of labor unions, medical providers and consumers, blame insurers for stonewalling meaningful reform. The initial cost is about $750,000; a spokesman said he expects that figure to grow to more than $1 million. The ads are timed to coincide with the rekindling of the debate over health-care reform, which has been on the back burner since last fall. The White House this week expects to begin a big push for its reform package, highlighted by Tuesday night's State of the Union address by the president. Meanwhile, a Foley Health Care -2-: To Avoid Sequence Of BTU Tax
PINEY POINT, Md. (AP-DJ)-- House Speaker Thomas Foley, D-Wash., said he expects the House and Senate to act simultaneously on President Clinton's health care reform package, rather than the usual procedure of allowing the House to go first. The strategy is intended to avoid the situation that developed last year during action on Clinton's 500 billion dlrs budget cutting bill. Early that year, the House adopted a first draft of the package that included the controversial BTU energy tax, which was subsequently dropped in the Senate. The sequence of events caused Democrats embarrassment, and put many House members in a position of unnecessarily supporting a proposal not popular with voters.
(END) AP-DOW JONES NEWS 01-28-94 2 051GMT
Consumer Group Finds Savings, Benefits Under Clinton Plan
LINCOLN, Neb. (AP) Thousands of Nebraskans would find better health-care coverage, savings and security under President Clinton's reform package, according to^an independent consumer group . •—~-—~***" Families USA Foundation—came to that conclusion after it studied how the plan would affect benefits of Americans with private health insurance. ''Insured Americans are big winners under the Clinton plan,'' said Ron Pollack, executive director of Families USA. The report found nearly 280,000 Nebraskans would be saved from having to go without health insurance in 1998, the year proposed for the president's plan to take effect. Millions of Americans lose health insurance every month and about half of those go without coverage for six months or more, Families USA said. The Clinton plan would provide coverage for all Americans. Many Nebraskans who have insurance also would find improvement under the plan, the study found. The Clinton proposal plan would provide prescription drug coverage to an estimated 263,000 Nebraskans under age 65 and to 151,000 Medicare recipients 65 or older. It also would help 25,000 older Nebraskans with drug coverage through Medicare supplement policies by reducing their premiums and cutting their out-of-pocket costs for medications. Dental benefits would be available to 862,000 Nebraskans under the plan. Benefits for children start in 1998 and for adults in 2001. About 992,000 Nebraskans would gain coverage for diagnosis and treatment of vision problems, including glasses and contact lenses for children. Mental health and substance abuse treatment benefits would be expanded for 992,000 insured Nebraskans by the year 2001 under the plan. Currently, most insurance provides limited coverage of mental health and substance abuse treatment. The Clinton plan would provide similarly limited benefits at first but would phase in benefits equal to those provided for other illnesses. The report also calculated that 215,000 insured Nebraskans would save money under the Clinton plan, which would limit the amount people have to spend each year on health care and provide subsidies to help low-income people pay deductibles or co-payments. Another 223,000 Nebraskans with health problems would be protected from being denied insurance or being issued coverage only at high prices, the study said. Families USA was formed in 1981 to push for health and long-term care reform. The group receives funding from various foundations and individuals. It does not receive any money from the health care industry or from political parties.
Mandated Health Plan Would Hurt Small Business, California Study Says By Norman D. Williams, The Sacramento Bee, Calif. Knight-Ridder/Tribune Business News Jan. 28--Group medical program costs in the state would soar by 50 percent if medical benefits were mandated for all California employees and their dependents, according to a health consultant's study released Thursday. The study by William M. Mercer Inc. said costs for employers would rise by $16.7 billion to $50.1 billion, and suggested that the effects of such a program would be crippling to certain segments of the business community. It singled out agriculture, retail trade, services, and small business as among the most affected. The study was not meant to predict the costs of the program proposed by the Clinton administration, which varies in numerous ways from the model used by Mercer, the company said. Mercer, the nation's largest employee benefits consulting firm, found support for its findings among business owners and representatives of business organizations. v vWe definitely agree with the study,'' said Cecelia Adams, a spokeswoman for the International Mass Retail Association. ''From an employer's perspective, costs would go up significantly. Right now, for our members, health costs might average between 4 and 6 percent of payroll. Under a PETER HOAGLAND ^Ml^ COMMITTEE ON 2ND DISTRICT. NEBRASKA 0 A A /? * ^ ^
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August 27,1993
Mrs. Hillary Rodham Clmton Chairperson Health Care Reform Task Force The White House Washington, D.C. 20500
Dear Mrs. Clinton:
In our recent telephone conversation I expressed concern regarding the impact that exclusive Health AlUances would have on my constituents within the Second Congressional District of Nebraska. Among those constituents are a number of health insurance carriers that employ approximately 15,000 individuals in the Omaha metropolitan area. During our call you requested that I follow up with written observations on the issue.
I want to make clear that I support your objectives for comprehensive health care reform, particularly in terms of universal access and cost containment. However, I believe some critical issues need to be resolved. A pressing issue relative to my district is the proposed exclusivity of Health Alliances. I would like to address my concerns in terms of the negative impact on both health care consumers and indemnity insurance carriers in my district. Also, I will present some overall concerns I have regarding the concept of exclusive AlUances; concerns I believe have validity beyond my district.
Structure of Health Alliances and Accountable Health Flan It is my understanding that one or more Health AlUances wiU be created within each state, acting as a "benefits manager" for individuals and employers. The Alliances would contract with Accountable Health Plans (AHPs) which would offer a standard benefits package. In an exclusive arrangement, all individuals and employers situated within the boundaries of a Health AUiance wiU be required to obtain their coverage through the AlUance.
Members of the Task Force have argued that an exclusive arrangement is an absolute prerequisite for managed competition to be successful, the hypothesis being that if insurers can market outside the AlUance, they would select the healthiest persons. That issue can be resolved by establishing the same ground
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS rules for insurers offering plans through the Alliance and those marketing directly to consumers; specifically, by requiring guarantee issue in a mandated environment, and by implementing risk adjusters so that no insurer can benefit from a higher proportion of healthier persons, nor would any carrier suffer as a result of adverse selection. impact of Exclusive AUiances on Consmners in the Second District
From my perspective as a Representative of a predominantly rural State, I can identify several deficiencies in the concept of exclusive Alhances.
• Individual health insurance is an important source of coverage for persons in small towns and rural communities. Exclusive Alliances would force them to change their current coverage, potentially terminate long- term relationships with physicians and sever ties with insurance agents and companies even though they may be entirely satisfied with their current service and coverage.
• A premise of Health Alliances is the competition among several closely- managed health plans; many rural areas and small towns would be unable to support even one AHP. Certainly some limited aspects of AHPs, such as formahzed peer and referral links, created by integrated delivery systems, could be viable in non-urban areas. However, competition and capitation, which are central to the concept, would not be feasible in sparsely populated areas.
• Exclusive Health Alhances do not permit the use of personal agents to assist persons in assessing needs and purchasing insurance. This is particularly crucial in rural areas where consumers have traditionally rehed upon agents to assist them. With the removal of the employer resource and the agent, where will individuals go for personal assistance? As with other government entities, I think it is reasonable to predict that Health Alliances will represent the collective interests of purchasers, with neither the capacity nor incentive to meet individual needs or provide personal service.
• Exclusive Health Alliances could severely limit the choice of AHPs for my constituents if they are required to participate in only those plans sanctioned by a Health Alliance. The limitation of choice issue is discussed in greater detail later in this letter. Individuals and employers should have the choice of purchasing coverage through a Health Alliance or outside a Health Alliance, through an agent, broker or directly from an insurer. Impact on Insurance Carriers and Tobs in the Second District
With 11 insurance companies headquartered or having a significant presence in the Second District (see attachment), Omaha has been called the "Hartford of the Midwest." Approximately 15,000 people within the Second District ~ five percent of the non-agricultural workforce — are employed in the health insurance industry.
Considering this presence, any provision of the proposed health care package which could negatively impact those jobs is of great concern to me. Although the concqit of exclusive Alliances as currently presented would theoretically allow for all players, the reality is that exclusive Health AlUances could totally eliminate the individual market, thus effectively canceling the pohdes of 18 miUion Americans.
A health care delivery system structured around exclusive Health Alliances would have a natural bias toward group managed care products. The Alliance would not be conducive to indemnity free-choice plans either by overt exclusion by the Health Alliance, or due to an absent or ineffectual risk adjustment mechanism (as persons with serious health conditions typically prefer indemnity "free choice" plans). Therefore, I beheve the exclusive Health Alliance as currently structured would eUminate jobs within the health insurance industry and ultimately limit insureds' choice of plans, physicians and hospitals.
Many of the companies on the attachment are smaller, indemnity carriers. Nevertheless, they coUectively provide coverage and service to millions of people. They are quality-oriented, cost-effective companies that have every right to exist and remain competitive in a free-market system. These companies welcome every opportunity to compete with other insurers and health plans on the basis of cost, productivity and service. The effect of a mandated Health Alliance is effectively to legislate them out of business without the opportunity to prove their value.
Global Concerns about Exclusive Health Alliances Though my overriding interest is the needs of my Second District constituents, I wish to offer some overall observations about the disadvantages of exclusive Health Alliances.
• An exclusive environment establishes the framework to shift away from a competitive environment. There is a need for an area outside the Health AUiance in which smaU, emerging health plans can develop, innovate and build the capacity to bid as Health AlUance participants. Without this "proving ground," AHPs will become concentrated, the relationship between Health AlUances and AHPs wUl get cozy, and the effort to achieve quality and cost-effectiveness wiU become regulatory as opposed to market-based. • An exclusive environment removes any fall-back system if the concept proves unsuccessful. If an Alliance tums out to be unresponsive, inept or politically motivated, consumers will have no alternative for coverage or service. Citizens living in poorly run jurisdictions will feel betrayed. At the same time, AlUances wiU have no incentive to meet performance standards, other than the threat of regulatory penalties, which in itself requires another "watchdog" bureaucracy.
• The massive challenge of launching Health AlUances that can immediately begin serving rmlUons of enroUees suggests that such AUiances should be piloted first, and that those pUots should not be exclusive. This wUl help assure continuity of care and prevent disruption to millions of Americans.
These more global concerns only serve to reinforce the projected negative impact of exclusive Alliances on my constituents within the Second District. I am anxious to be a proponent of the health care plan enacted by Congress. And I believe that with diligent attention to such issues as exclusive Health Alliances, the resulting package can be one that works for all Americans. I thank you for the opportunity to present my thoughts to you on this matter and I look forward to working with the Administration on a health care package that will benefit all Americans.
With warm regards.
Sincerely,
Peter Hoagland enclosure HEALTH INSURANCE CARRIERS LOCATED IN SECOND CONGRESSIONAL DISTRICT
Central States Health & Life Company Continental General Insurance Company Guarantee America Life Company Guarantee Mutual Life Company Medico Life Insurance Company Mutual of Omaha Companies Mutual Protective Insurance Company Physician's Mutual Insurance Company Principal Health Care of Nebraska Woodman Accident and Life World Insurance Company Unlike Clinton, Cooper hails from an established political family. His father, Prentice Cooper, was governor of Tennessee from 1938 to 1942.
Cooper, 39, was the youngest member of Congress when he was first elected in 1982. He was a bright but little known backbencher on the House Energy and Commerce Committee until the Managed Competition Act propelled him into the spotlight.
He first introduced the bill three years ago, borrowing ideas from the Jackson Hole Group, a gathering of health and business leaders who believe health costs can be constrained by making health plans compete for business, forming purchasing alliances and limiting tax breaks for health care.
Cooper would limit business deductions for health, but he would not make individuals pay income taxes on their health benefits, as some theorists favor.
He calls his approach 1'Clinton Lite'' and says he shares Clinton's goal of covering everyone by 1998.
''We think we can achieve universal coverage on the same timetable as the president,'' said Cooper. But they differ over ''whether you use government coercion from the start'' or give the marketplace a chance to work first.
Cooper claims his reforms and subsidies would solve 80 percent of the problem for the nation's 39 million uninsured, and Congress can figure out later how to cover the rest. Tennessee is home to two major hospital chains, and Cooper raised more money from health industry donors $153,296 than any other member of the House in the first half of 1993, according to Citizen Action.
Cooper jokes that he once considered accepting donations ''only from folks like Mother Teresa then L—^ realized she's in the health care business, too.'' ^ A)
Governor's Health Care Reform Discussed LINCOLN, Neb. (AP) Feb 4 -- For every shot a child receives, the state saves $10 in future health care costs, says Lt. Gov. Kim Robak.
Robak, tabbed by Gov. Ben Nelson to lead the state's effort to adopt a stopgap health care plan until a national plan is in place, told a legislative panel that 40 percent of the state's children aren't properly immunized by age 2.
Sen. Don Wesely of Lincoln outlined the first of two health care reform measures (LB1223) for the Health and Human Services Committee which he chairs.
Robak spoke in support of the bill, which is one of Nelson's legislative initiatives for 1994.
IXI hope we don't have to wait for national reform to get reform in Nebraska,'' she said Thursday. Wesely says health care reform in Nebraska boils down to getting childhood shots for kids, recruiting doctors for rural areas and ensuring quality care by disciplining bad doctors and nurses. Paying attention to those three areas won't solve all the state's health care problems, but will move the state in a very positive direction, he said. The state has established immunization clinics in 51 of the 93 counties and hopes to have 81 county clinics operating by the end of the year, Robak said.
A companion health care bill (LB1222) yet to be heard would mandate that insurance plans cover immunizations for kids between birth and 5 years old, Robak said. It would also cap the amount that physicians can charge for the shots. A hearing on that bill will be held later.
She said the measure explained Thursday would provide additional money for student loan programs aimed at ensuring a steady supply of trained health care personnel in rural areas.
''A large portion of the state doesn't have enough doctors,'' Robak said. Sixty-three counties, the communities or Ravenna and Wallace, several Omaha neighborhoods and the state correctional facilities in Lancaster County were designated as family practice shortage areas in June, according to health department figures.
1vIn addition, a large number of older doctors are retiring over the next decade,'' she said. The health department said 174 practicing doctors were 65 or older as of November 1992. In the Panhandle, for example, one in every 10 active physicians is 65 or older.
State Health Director Dr. Mark Horton told the committee that serious disciplinary action against health care professionals is improving the quality of care. He said the state fielded 431 complaints and investigated 283 of them last year. Before 1986, the state averaged maybe seven complaints a year, he said.
Health Care, Insurers Spent $1.1 Million on Lobbying MADISON, Wis. (AP) Hospitals, insurers and other groups involved in health care spent more than $2.4 million lobbying the state government on medical matters last year, an increase of $800,000 over 1992.
More than four dozen groups associated with the business spent $1.1 million lobbying legislators during the last six months of the year alone, financial reports to the State Ethics Board show.
The Wisconsin State Journal reviewed lobbying records filed by 54 insurers, hospitals, doctors and health care-related groups for the six-month period and decided insurers spent the most: $403,042.
''They've all got their oar in the water,'' Sen. Joseph Leean, R-Waupaca, a chairman of the Legislature's Joint Finance Committee, said. ''The lobbyists have been through here trying to plead their case on all points of view.''
An Associated Press review of lobbying records last summer found that 46 health and insurance lobbies employing more than 100 lobbyists spent $1.3 million during the first half of 1993.
In response to complaints that too many families can no longer afford medical insurance, the Legislatures is weighing various proposals for universal coverage.
A major challenge is establishing restraints on the rising prices charged by doctors, hospitals, pharmaceutical corporations and insurance companies.
''It's a lobbyist feeding frenzy up here,'' Sen. Charles Chvala, D-Madison, said. ''They're killing health care reform in this state.
''When you can't even get the legislation to the floor (for a vote), you know the special interests are having their way.'' Assembly Majority Leader David Travis said lawmakers have trouble hammering out a health-care plan because any change is bound to offend someone.
''They don't want to tick off every mom-and-pop store 02/09/94 ie:54
NO.924 COS •/ Tht ufi/tr, if Omahv, Ttprtunl$Ntbt4$ha'i2ndDiHTictit\ int u.o. nuu*<»—,— P./7 Variations on Health Care Theme s' with variations allowed only for mat voluntary alliances fot customers BY PETE* HOAGLAND ters such as age and geography. based on the frce-mftrket synem. Cost savings could also be accomplithed We have an op • Second, we netd to bring into the MMIttVTOtl system the 15 petcent of American* (8 through bills I h
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ISSUE #2: ^ ISSUE #3: TONE: "1 * A . y . /ArxV' J-k^J, A*^*^ - Report by: i^. ^Lr^^.-T^ww^- jf Withdrawal/Redaction Marker Clinton Library DOCUMENT NO. SUBJECT/TITLE DATE RESTRICTION AND TYPE 002. memo From: Bernard Craighead; To: Steve Edelstein; Re: Field Updates 02/16/1994 b(6) [partial] (1 page) COLLECTION: Clinton Presidential Records Health Care Task Force Edelstein, Steve (House) OA/Box Number: 3672 FOLDER TITLE: Hoagland, Peter (D-NE) 2006-0885-F sb668 RESTRICTION CODES Presidential Records Act -144 II.S.C. 2204(a)| Freedom of Information Act -15 U.S.C. 552(b)| PI National Security Classified Information |(a)(l) ofthe PRA| b(l) National security classified information 1(b)(1) of the FOIAI P2 Relating to the appointment to Federal office 1(a)(2) ofthe PRA| b(2) Release would disclose internal personnel rules and practices of P3 Release would violate a Federal statute 1(a)(3) ofthe PRA| an agency 1(b)(2) ofthe FOIA) P4 Release would disclose trade secrets or confidential commercial or b(3) Release would violate a Federal statute [(b)(3) ofthe FOIA) financial information [(a)(4) of the PRA| b(4) Release would disclose trade secrets or confidential or financial PS Release would disclose confidential advice between the President information [(b)(4) ofthe FOIA] and his advisors, or between such advisors |a)(5) of the PRA| b(6) Release would constitute a clearly unwarranted invasion of P6 Release would constitute a clearly unwarranted invasion of personal privacy [(b)(6) ofthe FOIA) personal privacy 1(a)(6) ofthe PRA| b(7) Release would disclose information compiled for law enforcement purposes [(b)(7) ofthe FOIA| C. Closed in accordance with restrictions contained in donor's deed b(8) Release would disclose information concerning the regulation of of gift. financial institutions [(b)(8) ofthe FOIA) PRM. Personal record misfile defined in accordance with 44 U.S.C. b(9) Release would disclose geological or geophysical information 2201(3). concerning wells 1(b)(9) ofthe FOIA) RR. Document will be reviewed upon request. 02/16/94 19:11 NO. 690 P09 MORANDUM TO: STEVE EDELSTEIN, CHR^S JENNINGS, STEVE RICHETTI, ET. AL. FROM: BERNARD CRAIGHEAD DATE: FEBRUARY 16, im_ RE: "/""FIELD UPDATES ^HT^V fO^rCC^ Lehman. Congressional staff told HHS that Lehman wants to move closer to President's Plan. No tangible evidence of this has been seen however. Apparently, Shalala is going to Lehman's district for a town meeting. Maybe we can get some public statement of support there. Shays. Shays sent a letter of support to a Leadership Coalition on Health Care Reform event in Connecticut. The event was in support of employer mandates and universal coverage. The Shays letter was very soft, I am trying to get a copy. Dodd. Recently Senator has told constituents that: 1) There are a maximum of 7 votes on the Fiance Committee in support of the President's plan. 2) He is concerned about long term care and premium caps. Lieberman. In a radio interview, Lieberman says that he had been "a 'little tough on the Clinton plan. " Johnston. Staffer spoke directly to Senator. Still non-committal, but acknowledges that there is a real problem. Staffer thinks we have a shot at him. Jefferson. Please have someone call Rep. Jefferson to discus his offer to help with the delegation. Bond. .The Alliance for the Mentally 111 attempted to meet with Bond or his staff last week. They were turned away. They are upset. Hoagland. Aping our tag line, Hoagland is calling for health insurance that is always there. Are insurance and care the same thing? Kerrey. Thinking of starting a move to increase Medicare reimbursement rates. Andrews (TX) . Tells people that he talks with Mrs. Clinton all the time. Told state convention on Saturday that he had just talked to Mrs. Clinton and that now was the time for "them to start compromising over the Cooper's plan. 003. TEL: Mar 11,94 13 = 25 No.018 P.04 border/•nvironaantal comission San Diego EPA announctMnt TRP for th« Univ. Fainstein Baatt closing - lost in h«r district Nard Vallsy sswags facility. 2/25 Sanator Durenberger 1. not absolutely opposed to mandate 2. believes we need to fold medicare into the program to get a real handle on oost. 3. believes allianoe site can and should be reduced - but BOOS I role for alliances (with Medicare contingency) 4. Let medicare population choose to receive care for our other AHP'S. 5. LooK at how TEFRA Risk K'a are handled 6. Voucher for medicare / also voucher low income 7. need to cost out program over time - perhaps with phased in universal coverage. 8. look for drugs in tax treatment to provide incentives. sf^rSmwtor Hoagland I ({ want a biU ^ 2. Centrist package 3. Quick - new Democratic package 4. no time for welfare reform - may undermine crime 5. lot of pressure on him 6. Open dialogue with Cooper 7. Hopefully with Republican help 8. phase-in employer mandate 9. maybe employer mandate out of Senate first 10. establish alliances in leg. but needs voluntary for small insurance companies 11. New democratic themes Wants health care not to hurt Centrist health care bill [don't want claims that turn out not to be true (POTUS)] POTUS (certain date - universal coverage - leads to real communication rating) Stanford Emp. program Hoagland would support an employer mandate 70,60 share may be better Subsidy program - not enamored with it. TEL: Mar 11,94 13 = 25 No.018 P.05 Costa 1. Wa invest more in tech's (thats good) 2. More violent - therefore, costs associated with it. 1 & 2 off table 3. Financing system 4. Change incentives for 1/2 of insurance population who get more traditional coverage Cong. Hoagland; Stress competitive framework Lynn Etheridge - talked about medicare Hoagland argues 1. wants to pass a bill 2. mandate is moving in our direction Omaha 1. two leading hospitals .2. percieved as a government takeover 2/24 sen. Danforth Kansas City - work out at Union station / train station a Science Center - Science educational center Amtrac - NOA Find $ - help with ??? appropriation Mark Soloman * staff private sector - $30-$70 million usary - $120 million total Health Thinks we'll end up at Chafee Cn \o way employer mandate will pass belives we oan get big bill time passes - people get more concerned(he does to) too much too fast - favors a more incremental approach Avoid confrontation - thinks we should build members up rather than confront them, support not to allienate Cooper Vconcerned that the numbers still don't add up, get savings first. Sen. Danforth Wondering what he may do next - career may go home to St. Louis and encourage churches and community groups to adapt schools believes he needs to go micro believes Moynihan is right and problem with welfare reform is deterioration of American family structure. Community schools (part of crime bill he strongly favors. 3/1 Sen. Boren 2 district judges (fed) 03/21/94 13:39 ©9 202 6220404 OEPSEC TREAS ^002 THE DEPUTY SECRETARY OF THE TREASURY WASHINOTON March 21. 1994 lum far Ptt Qriffin / -< - fl AijrttA Subificu BaallbLjCufi I met separately on Friday with Reps. Payne (visited hu district), Hoagland and Brewster, all Ways and Means memben. The essence of these discussions is as follows: « Payne is a down-the-lme Cooper supporter. During the town hall meeting in hia district, he defended the Cooper plan at every turn. - Nonetheless, he really doesn't understand it very well and is susceptible to further education. In the end, he wants to vote for a biH. - Brewster is tough and smart, but a bit more flexible right now than Payne. He is not opposed to any and all mandates, for example. He, too, wants to vote yes. - Hoagland is probably the most flexible of the three. He wants a reasonable facsimile of universal coverage and is groping for various solutions. The small business issues and alliance issues axe of deep concern to him. His grasp of the substance is Hmited, too. Hou gland and Brewster would like to have a few meetings, involving perhaps five or six Democrats, which are devoted to analysis. In other words, to understand the impacts of various alternatives. Hybrid mandates, for example. These would be entirely private, not fornegotiation s and cleared with Rostenkowski. I said that I would check on my end. cc: Secretary Bentsen Michael Levy Marina Weill TO'd 8X0-ON S0-.9T t76.££ ^W ^31 I l d. I No froup in the countiy li more discriminated against than small busi ness when it comes to purchasiag insur Mrs. Clinton ance, she said. Small businesses typically face costs that are 35 percent to 40 percent higher for insurance than large •Touts Plan businesses or government, she said. ; The Clinton plan would provide the opportunity for small busuwsse* to pool Via Video their money when purchasing insurance they can obtain better rates, Mrs. BY JASON GERTZEN ^linton said. — ...... • "We are trying to put small business j-HiUary Rodhnm Clinton defended dn the same fooung as big business and BretiicrU CUnton's health-care plan in government so they can obtain dis- Cntvha and five other cities Saturday oounts," she said. iternuVj in the latest of a series of '. In response to a question, Mrs. CUtt- vfcccccnference skirmishes on the issue. tpn assured Linda Larure, who ieaches -vital to explain what the president's nursing at Creighton University, that the 4>pi-ua<;h to health ca/e does and what it plan was designed to encourage people ($» not do," Mrs. Qinton said. "There tp seek preventive medicine. ii sc much misinfonnation." ; Mrs. Clinton said thc plan was intend- fcMis. Clinton discussed key provisions (id to reshape the curreat health-care 4f th : Clinton heaJth MEMORANDUM TO: STEVE EDELSTEIN, STEVE RICHETTI, CHRIS JENNINGS FROM: BERNARD CRAIGHEAD DATE: MABEH 3, 1994 tVe*VLTtt CA*^ £Af*PA-i6/0 RE: FIELD REPORT Filner Filner is being crazy over our courting of Lynn Schenk. Sec. Reich went to his district yo do a fund raiser but arrived on the wrong night. It was bad staff work on the part of the Filner staff. We have offered Filner the opportunity to pull down the HRC teleconference since we are doing a teleconference in Schenk's CD. Tauzin The head of the Louisiana AFL-CIO has told us that Tauzin is a lost cause. Eields Fields took his name off of the single payer bill because the insurance people were tying up his phone. Our organizer does not think that Fields has really changed his position. Skelton MO Hospital Association says that Skelton is straddling between Cooper and Clinton. It is unlikely that he will move anytime soon. Bond Support universal coverage at the LWV forum, but said that legislators should not determine benefits. Kerrev Senator Kerrey has formed a policy task force that meets each day via conference call. The discussions on this call focus on possible amendments to HSA. These mclude putting long term care under medicare, funding health care reform through the income tax. Our organizer thinks this is a very serious development that we may see put forward in tlie Senate Finance Committee. He also thinks that Exon and Hoagland could follow Kerrey's lead. 03/04/94 11:16 NO.196 003 In a meeting with our organizer and Labor representatives Hoagland said that he will not support premium caps or mandatory alliances. He favors "as much universal coverage as we "can afford." He will support the employer mandate only if the other votes are there. Mmm* District director says he will support employer mandate and alliances. Greenwood See attached article. SOCIAL POLICY HEALTH Panel Gives Preliminary Nod To Employer Mandate key House panel nancing his plan primarily with handed President Clin a tobacco tax and a mandate on Aton his first victory in employers to pay for employees' the health care debate March 15 insurance. The bill differs from by voting to keep the president's Clinton's in setting up cost con method of financing health in trols modeled on Medicare's surance for all Americans. How strictly calibrated reimburse ever, the margin was close. Law ment system. Also, Clinton's bill makers also sustained the would organize consumers into president's position on less cru large purchasing groups, known cial issues. as health alliances, to buy insur The ll-member panel, the ance. Stark would make the alli House Ways and Means Sub ances optional committee on Health, is the Despite the differences, first of at least five commit the subcommittee took sev tees that will consider health eral votes on provisions that reform; its first votes cannot are in both plans. Besides the be viewed as definitive. How administration win on financ ever, support from six of the R MICHAEL JENKINS ing, Democrats also turned committee's seven Democrats Reps. Levin, left, and Stark at March 16 committee meeting. back one amendment that does suggest that Clinton's fi would have allowed insurance nancing method — which would re companies to charge consumers differ quire employers to pay at least 80 per ent prices based on age and another cent of their workers' health insurance B0XSC0RE that would have lifted price limits for premiums — has a chance of winning prescription drugs. in the full committee. If it does, its Bill: Draft proposal by Rep. Pete "Our principal concern is that we fate will hinge on action in two other Stark to overhaul the health care have a bill that tracks the president's House committees with broad juris system by extending Medicare to principles," said Bruce C. Vladeck, ad diction over health matters, as well as the poor and the uninsured. ministrator of the Health Care Fi the views of the Democratic Caucus. nancing Administration, which over But the narrow win is also a harbinger Latest action: House Ways and sees Medicare. "Nothing -that has of just how hard the administration Means Subcommittee on Health happened so far puts us off track, but and its congressional supporters will debate and amendments the we have a long way to go." have to work for a bare majority. week of March 14. The 5-6 vote defeated a Republican Next likely action: Further debate Rostenkowski's Role proposal that would have stripped the the week of March 21. Now that committee Chairman Dan requirement that employers pay the Reference: Weekly Report, pp. Rostenkowski, D-DI., has won his bulk of employee health insurance pre 606, 551. 475. March 15 primary, he is expected to miums. Voting to strip the mandate take a more active role in shaping the were the committee's four Republicans bill. Rostenkowski has said that the full and Rep. Michael A. Andrews, D-Texas. The House subcommittee — the committee's bill would be more centrist The subcommittee is marking up a first in the House to work on the bill than Stark's proposal. (Story, p. 683) draft bill that differs from Clinton's — spent the week of March 14 mark But Rep. Barbara B. Kennelly, D- (HR 3600, S 1757), but its primary fi ing up a draft bill written by Stark in Conn., noted that Rostenkowski re nancing rrethod is the same. consultation with five of the six other spects the work of his subcommittees, "I wa.' unsure how the votes were committee Democrats. The seventh especially when they have debated going to come down," said Rep. Pete Democrat, Andrews, was campaigning and voted on legislation. "The chair Stark, D-Calif., the health panel's chair in a Senate primary race during the man is always very aware of proce man. "There were some surprises." drafting, and is a cosponsor of a com dure," she said. "But you will see The Senate also is concerned about peting proposal (HR 3222) that would many changes in full committee." how to pay for health reform; Demo not guarantee universal coverage. The full committee is split into crats and Republicans are beginning Stark's proposal would provide uni three groups: proponents of a "single to work together on a way to finance versal coverage by creating a govern payer" system, in which the govern Clinton's goal of guaranteeing univer ment health insurance program known ment would collect premiums and pay sal coverage. (Story, p. 676) as Medicare Part C to cover the poor, providers; a middle-ground group of the uninsured and employees of small conservative Democrats and moderate By Alissa J. Rubin businesses. Stark follows Clinton in fi Republicans who want to reorganize CQ MARCH 19, 1994 — 675 SOCIAL POLICY the market with less government in from pillow talk and the gentleman volvement; and cjmaetyative Republi from Washington got his degree from 0 cans who waptmciemfSntal change. going to medical school," he said of "Medicsrfe is ... highw regulatory," Johnson and McDermott, a psychia said Pet^r Hoagland^D-Neb., a full trist. "You guys can debate it all day committee m^rntisi>^who is leading a long if you choose." group orsjniddle-ground Democrats. "I Johnson retorted: "I certainly dis think it goes in the opposite direction of sent from that comment my hus where I'd like us to go." Hoagland is band is a physician, but I get my circulating copies of a proposal that he knowledge of the medical system from hopes will gather enough committee endless hours as a representative in support to ask Rostenkowski to present this Congress, in hospitals and physi a new draft bill for consideration. cians' offices, talking to patients." Hoagland's plan avoids price con The price-limit amendment failed trols and insurance premium caps. But on a voice vote, but drug company repre like the Stark and Clinton plans, it sentatives said they expected their sup relies on employers to pay for 80 percent porters in Congress to offer it again in of their employees' health insurance. the full committee or in the House En The mandate would be phased in over ergy and Commerce Committee, which four years for firms with fewer than 100 also has jurisdiction over health matters. employees. It also would set up volun "Obviously, we're very disappointed tary health alliances. because it will have a tremendously chilling effect on research and develop Strange Bedfellows ment," said Patrick J. Zenner, chief The Health Subcommittee's votes executive officer of Hoffman-La Roche, the week of March 14 traversed sev one of the nation's largest drug compa eral of the most difficult issues in the nies. He was in Washington to make the health care debate; some split along industry's case to the media. party lines and others brought to The first week of amendments gether strange bedfellows. amounted to a preview of the votes — Rep. Nancy L. Johnson, R-Conn., a although not the outcomes — that will moderate who would like to limit resurface in full committee, other change to market reforms, joined Rep. R. MICHAEL JENKINS PHOTOS committees and possibly on the floor. Jim McDermott, D-Wash., the leader McDermott top photo, fails to pass At the end of the week it looked as if of the House single-payer faction, to measure that wouid allow all consumers Stark's bill could remain substantially try to pass a measure that would allow to subscribe to Medicare Part C. Andrews intact in the subcommittee despite the all consumers to subscribe to Medi vows to again bring up tobacco tax employer mandate and efforts ex care Part C. Johnson liked the idea increase the week of March 21. pected the week of March 21 to re because it would foster competition. move the price controls. Under the Stark bill, only the poor, complexes of medical schools and teach "This is the beginning ofthe base the self-employed or workers in small ing hospitals. He vowed to bring the tax ball season," McDermott said. "In this firms could subscribe to Part C. The up again the week of March 21. case the ball is universal coverage, af amendment failed on a tie vote, 5-5. Another lightning rod vote came on fordable universal coverage." • Another cross-party vote was on a whether to continue to allow firms to proposal by Andrews to increase the deduct health insurance premiums for tobacco tax from Stark's proposed 99 employees as a business expense. A vote cents a pack to $2 a pack. He got to limit deductibility failed 5-6, but CORRECTION support from three Democrats — Cardin, a possible swing vote, said he Stark, Sander M. Levin, D-Mich., and might be willing to support a similar Health subcommittee markup. Benjamin L. Cardin, D-Md., as well as measure. Weekly Report, p. 606. A line inadver from Johnson. But one of his Demo tently was dropped from a paragraph cratic colleagues, Gerald D. Kleczka, Debate Tums Mean at the bottom of the first column. The D-Wis., stifled the move with a motion Tempers flared several times during paragraph should read as follows: to table it. Kleczka's motion prevailed the week. But during discussion on an "Stark's proposal differs from the 6-5 with support from McDermott, amendment that would have stripped bill (HR 3600, S 1757) Clinton put John Lewis, D-Ga., and the commit price limits on prescription drugs, the forth last fall, but it would achieve the tee's three other Republicans. debate turned unpleasantly personal, president's goals of containing health Supporters wanted the new tax as a drawing gasps from lobbyists, aides and costs while ensuring universal cover revenue source to pay for subsidies for reporters in the committee room. age. Stark's bill would expand Medi small businesses, which otherwise As McDermott and Johnson, the care, which provides health insurance would receive no government money to only woman on the subcommittee, ar for the elderly, to give similar coverage help pay for their employees' health gued over the amendment, Stark, who to the poor, the uninsured and some care. Andrews also wanted a portion of earlier had accused "the greedy drug workers in small businesses. It would the revenues to pay for the costs of companies of wasting taxpayers' vastly increase the government's re academic medical centers. His Houston money" interrupted Johnson. sponsibility over the health care sys district has one of the country's largest "The gentle lady got her degree tem. (Stark's bill, p. 609)" m CQ MARCH 19. 1994 — 677 TEL No Mar 4 ,94 16:01 No .001 p .Ot. mCC Field Reporting Form Name: Richnrd A. Lombardi ^ State: Nebraska Member Name: Kerrey, Exo March 4, 1994 I. Intelligence Update A) New Information on Members' Position on Health Care: Senator Kerrey's four task forces meet on Saturday to discuss directions. Mutual of Omaha has indicated some kind of employer mandate but most of the other insurance companies on his task forces are emasculating cost controls and alliances. Attached is a proposed amendment to supplemental children's health care along wirii h hisiinost current statements. Hoagland is quiet but clearly carrying evelry health insurance company concern. \ I B) New Inronnation on Allied Orgauizations' Activities The rehab community has scheduled a Hoagland meeting for Jthe 28th The Labor community is making phone calls. Planned Parenthood the same. Nurses state Legislative bay I pleaded again for their fight against the Cooper plan and they will help on our Satellite feed* The High Risk Insurance Pool folks and the Development Disability community is slowly responding muci to the frustration oftheir leadership which 'freaking out'. j I C) New Inronnation on Opposition Organizations'. Activities Pro Life propaganda attached. Insurance Icommunity told me that they had^ 200 personal visits with Kerrey and HOagland ovpr tie last 6 months. Health Leadership Counsel has retained soine democratic activists and the Omaha Chamber in holding a sateliite teleconference with COOPER AND BREAUX. f 'cook co1vl^^JC!)Snl,^iyeHealth Policy release. But the overall media impression here is that the President iss losing ground, HEALTH Clinton's Main Tenets Drive New Movement on Health Key conunittees begin finding common ground, but 'lots of changes' are also imminent hree key congressional commit retreat March 20-21, where « consen tees moved forward on health sus appeared to be developing on the Tcare reform the week of March need for universal coverage 21, with early results suggesting that All three committees aro utruggling whatever bill emerges later this year, to figure out how to pay for expanded the pillars of President Clinton's over insurance coverage. Key to Lheir an haul proposal would stand. Clinton's swer will be deciding how much to bill (HR 3600, S 1757) calls for univer cover and how quickly to extend cov sal insurance coverage, stricter insur erage to all Americans. ance regulation and a requirement The faster Congress phimos in uni that employers pay for most of their versal coverage, the more expensive it workers' insurance. will be. The same goes for lienefits. A However, congressional action also generous benefits package, hke the suggested that Clinton's plan would be B0XSC0RE one Clinton has proposed, will cost pared back significantly to save money. more money. Americans would be offered fewer in Bill: Draft proposal by Rep. Pete "The whole thing comen down to surance benefits, and lawmakers Stark, D-Calif., to overhaul the financing," said Tom Scully, an asso seemed unsure of how far they wanted health care system by extending ciate director in charge of linulth care to go toward the president's goal of Medicare to the poor and the policy at the Office of M/magement setting a national budget to harness the uninsured. and Budget during the BUHII adminis health system's skyrocketing costs. Latest action: House Ways and tration. "No one's figured out how to "The president gets credit for Means Subcommittee on Health pay for anything yet." starting it all," said Rep. Sander M. approval, 6-5, on March 23. Scully pointed out thai the only Levin, D-Mich. "But when he said he way to achieve universal coverage assumed there would be lots of Next likely action: Full committee would be to raise taxes, or impose changes in his bill, he was right." debate on the bill. price controls and make hunt-' cuts in Lawmakers headed home March Reference: Weekly Report, pp. government health programH, such as 25 for a two-week recess with a clear 675, 606, 551,475. Medicare and Medicaid. "They don't signal that health reform had returned want to do either of them," he said. to center stage. Still, the search for compromises to bring down costs un care spending targets for the public Changing the Financing derscored that, even among Demo and private sectors. The controversial financing mech crats, all coalitions are fragile. Despite its differences with Clin anism is expected to chanKe many • The House Ways and Means Sub ton, the subcommittee's approval times over before CongreB* finds a committee on Health made the most handed the president his first congres package that a majority can agree on. progress, reporting out a health care sional victory, giving the administra That became evident during the fi overhaul bill in a 6-5 vote March 23. tion a much-needed boost In his news nal two days of the Ways Jind Means The bill, written by Chairman Pete conference March 24, Clinton said Subcommittee on Health markup, when Stark, D-Calif., received only Demo that if the Stark bill came across his fragile coalitions among six of the pan cratic votes. It would achieve universal desk, he would sign it. el's seven Democrats almost fell apart. coverage by creating a new govern • The Energy and Commerce Com Levin, a key Democrat, couM not sup ment program, known as Medicare mittee, which shares jurisdiction with port a bill financed in part, by a 0.8 Part C, to provide health insurance for Ways and Means over health policy, is percent payroll tax. In a last-K'^P effort the poor, the uninsured and some crafting a different bill — closer to to get Levin's support, Stark rewrote the workers in small businesses. Consum Clinton's. The proposal, released the financing section to remove the payroU ers would pay more for their health week of March 21, would scale back tax. But to replace lost revenue, Stark insurance benefits than they would Clinton's benefits package to reduce added new taxes on big busin««». raised under Clinton's plan. The Ways and the federal cost of subsidies for small the cost of home health care and re Means bill would set national health employers and the working poor. quired states to put more mon<;y into the • In the Senate, members of the Fi health system. The latter pr CQ MARCH 26, I'/* — 737 Dingell Outline Softens Clmton Plan... or three weeks, while Chairman John D. Dingell Rick Boucher of Virginia, Richard H. Lehman and Lynn Fstruggled with an Energy and Commerce Committee Schenk of California, Marjorie Margolies-Mezvinsky of deadlock so tight that a markup on health care had to be Pennsylvania and Blanche Lambert of Arkansas. scrapped, the rival Ways and Means Subcommittee on Health was moving methodically through a markup to Ghosts of Clean Air ward a compromise. Whatever difficulty Dingell faces in gathering a ma But just as the Ways and Means panel neared comple jority on health care is at least partly his own doing. tion of its work, Dingell on March 21 put forward his own During the late 1980s and early 1990s, when his commit alternative, making it clear that Ms panel would not be tee faced major battles on clean air and energy legisla eclipsed in the legislative effort to produce a health bilL tion, Dingell handpicked moderates for the panel, those In order to win support from other committee Demo who would share his home-state interest in protecting crats, Dingell altered some of the most controversial the automobile industry from strict environmental con provisions of Clinton's bill (HR 3600, S 1757). He did trols. (Clean air, 1990 Almanac, p. 229) away with the mandatory government-sponsored orga "I don't remember stacking the committee," he says nizations called "alliances," which Clinton wants to put now. "I remember soliciting good members." in charge of purchasing insurance and paying for health Three of those former allies are considered certain foes care for large groups of consumers. Dingell also softened on his health care plan: W. J. "Billy" Tauzin of Louisiana, Clinton's proposal to require all employers to pay for Ralph M. Hall of Texas and J. Roy Rowland of Georgia. A their employees' insurance, and he gave states the lead fourth Democrat, Jim Cooper of Tennessee, gave him role in regulating the costs of health care. trouble on clean air and is doing it again on health care as the But following Clinton's lead, Dingell's draft proposal sponsor of an alternative health bill (HR 3222) that has would retain a fundamental guarantee of universal cover generated busmess support. His vote is considered lost age. That is the key tenet that Clinton said he Would The six undecided members are Dingell's main focus require before signing whatever bill Congress sends him. now. In the days since he released the plan, all six have As such, it represents a major breakthrough for the met with him at least once. Slattery says he spoke with White House sales effort in Congress. Dingell at length on four consecutive days; Boucher says "When John Dingell puts something on the table, Dingell asked for a two-hour private meeting. everybody knows a great deal of political work has al Though they have many overlapping concerns, each ready been done," says Philip R. Sharp, D-Ind., a senior has a different perspective on health care, posing many member of the committee. problems for anyone trying to corral all six votes: • Slattery. Panel Democrats believe Dingell's bill Dingell Can Go Behind the Scenes should satisfy Slattery's concerns about the impact of Having put forth his plan, Dingell can now again employer mandates on small businesses; the outline even recede behind the scenes, where he can use his special includes a special section for family farms. But Slattery blend of strong-arm tactics and creative dealmaking to is running for governor of Kansas and has an eye on the wrestle the plan through his committee. broad political acceptance of major reform. So far, his focus is almost exclusively on winning Demo • Boucher. Small-business concerns about the employer cratic votes, a sharp departure from the committee's bipar mandate are among Boucher's top objections to the Clinton tisan tradition. Dingell says he will talk to Republicans and plan. He also is watching out for the 14,000 tobacco farmers pledges "not to play games" with them, but he elected not to who could be hit hard by stiff new taxes on cigarettes. consult them while drafting his proposal • Lehman. Lehman's hesitation started on Election That leaves him in a precarious position if Republi Day. He won in 1992 with a 1,030-vote margin and just can resistance to his plan proves unanimous, as is ex 47 percent; Clinton took just 38 percent in Lehman's pected. The 44-member panel has 27 Democrats; 23 central valley district. He wants to see an economic im votes will be needed to approve a bill. At this point, 17 pact study before making a decision. panel Democrats are considered Hrm Dingell votes; four • Schenk. Schenk represents a politically marginal are considered lost; six are on the fence. San Diego district Describing herself as "pleased" with The six undecided members are Jim Slattery of Kansas, Dingell's effort to address small businesses, her concern who in the final minutes before the port a broad employer mandate and write his own version of Stark's sub vote, appeared ready to jump ship -^ dislike government-regulated cost con committee bill with the aim of crafting although he didn't. tainment. Liberals favor strict cost con it to gather support from a majority of The full Ways and Means Commit tainment, with universal coverage fi the committee's Democrats. tee, which will take up the bill when nanced by a payroll tax. The financing in particular is ex lawmakers return from spring recess, But a key difference will be the pres pected to change. Rostenkowski ex will only magnify the fractures apparent ence of Chairman Dan Rostenkowski, pressed irritation that the health in the subcommittee. Committee Dem D-DI., a fabled deal-maker who is loyal panel wrote financing provisions be ocrats are split between moderates and to Clinton and who believes in the need cause he considers financing to be un liberals. Moderates are reluctant to sup for universal coverage. He is likely to der the purview of the full committee. 738 — MARCH 26, 1994 CQ SOCIAL POLICY ... To Lure Energy Panel Democrats up to $2,500 annually; the Clinton bill would limit out-of-pocket spending to $1,500. • Employer mandate. Require all employers to pay part of the cost of health insurance for their employees; the amount would be correlated to the size of the firm. Firms with five or fewer employees would pay 1 percent of pay roll; firms of six to 10 employees would pay 2 percent. Firms of 11 to 75 employ ees would pay 80 percent of the cost of health insurance for their employees, but subsidies would be available. Low- wage firms would pay no more than 20 percent of premium costs. Employers with 76 to 1,000 employees generally would pay 80 percent of a standard health insurance package and would be eligible for subsidies if they had to spend more than 7.9 percent of payroll R UCHAEL JENKINS on insurance. In soiling his draft compromis. bill to other members of the Energy and Commerce • Health alliances and insurance panel. Chairman Dingell is talking only to Democrats. reforms. Drop the mandatory health alliances in Clinton's plan but allow now is for her district's biotechnology firms; they strenu consumers and employers to buy insurance through volun ously object to Clinton's "breakthrough drug commit tary alliances set up by states. An alliance would pool tee," which would regulate prices for new drugs. employers and individuals into large purchasing blocs, • Margolies-Mezvinsky. Having cast a high-profile giving them the market share necessary to bargain with vote to give Clinton a big victory on the budget last year, health plans and insurers. Individuals and employers also she says her primary concern then and now is the budget could continue to buy insurance directly from private deficit Her district is dominated by health interests: insurance companies or through insurance agents. Prudential Insurance Co. is one of the largest employers, The Dingell bill would include the insurance reforms followed by several pharmaceutical companies. required under the Clinton plan. Insurers would be re • Lambert. Lambert is taking a go-slow approach. Her quired to accept all applicants; no one could be rejected district is heavily Democratic, but largely mral, poor and because of a pre-existing medical condition. Individuals resistant to rapid change. She says she is "encouraged" and employers with 1,000 workers or fewer would pur by Dingell's bill. chase insurance under a community rating system, which bases premium rates on the average medical cost for all Details of Dingell Plan covered people in a geographic area. The outline Dingell is circulating was drafted to win • Cost containment. Make states responsible for key votes; it is likely to be adapted to win more before it slowing the rate of growth in national health care costs. becomes a bill. The Dingell plan would: Within the next few years, states would have to slow the • Universal coverage. Guarantee a standard pack rise in health costs to the general rate of inflation, ad age of health benefits. The benefits would be much re justed for population. Federal health care spending also duced from those proposed by Clinton. Consumers would would be capped; exceeding the caps would prompt auto pay higher deductibles and co-payments under the Din matic spending reductions. gell plan, which would allow out-of-pocket spending of —Beth Donovan and Alissa J. Rubin And financing will be key to his ability we'll begin at the beginning." ates on those two committees who to leverage votes for the plan. In a Most lawmakers are leaving Wash hold the balance," said Rick Pollack, press release issued after the health ington for the recess, but both Rosten vice president of federal relations at panel voted out its draft bill, Rosten kowski and his counterpart on the En the American Hospital Association. kowski made a point of underscoring ergy and Commerce Committee, Rep. "Both chairmen need those folks in that Stark's committee had over John D. Dingell, D-Mich., will spend at order to produce something." stepped its bounds. "The subcommit least some of their time working with At this point, both chairmen are tee bill contains revenue items that their staffs and with other members to likely to rely on Democratic votes are not within their jurisdiction," he craft health care bills. alone to get their bills through com said. "So when it comes to financing, "There's sort of about 15 moder mittee. Still, they recognize that Re- CQ MARCH 26, 1994 — 739 SOCIAL POLICY publican support would lend credibil the whole health reform issue back up ity to their efforts. Moderate Republi and moving," McDermott said. "You cans emphasize that idea, because can't let this thing die aborning." they want Congress to write a plan they can support. Subcommittee Amendments Rep. Mike Synar, D-Okla., a mem The Health subcommittee debated ber of the Energy and Commerce three key amendments to Stark's orig Committee who is working with Din inal bill, accepting proposals to in gell to marshal votes, said he hasn't crease cigarette taxes and rein in mal had much success courting Republi practice awards, while narrowly cans so far. "When we shop ideas and rejecting an attempt to strip cost con options, we invite the Republicans to trols from the bill. get involved, but at this point we • Cost controls. In a 5-6 vote, Demo en much interest," he said. crats defeated a Republican-led effort and Means, however, a to strip the cost-control measures from Igroup headed by Peter the bill. Cost controls are a key compo J-Neb., and Nancy L. John- nent of the Clinton plan, and Stark's bill i., will work during the re- is even more regulatory. The amend ! how much they can influence ment, offered by Jim McCrery, R-La., the full committee's bilL Johnson and a would have replaced the cost-control small group of moderate Republicans provisions with a cap on the tax deduc invited Patrick Griffin, the chief White tions that businesses could take for House lobbyist, to lunch March 22 to their employees'-health insurance. talk primafily about health care. • Malpractice damage cap. A co And in the Senate, lawmakers from alition of the four panel Republicans both sides of the aisle have been talk and two Democrats -^"Andrews and ing with one another for several weeks. a MICHAEL JENKINS Benjamin L. Cardin, MdT*— approved, Finance Committee Chairman Daniel Stark at March 22 markup. 6-5, an amendment that would limit Patrick Moynihan, D-N.Y., is meeting the amount of non-economic damages one on one with each panel member, available in a medical malpractice and administration staff members posed the bill. lawsuit to $350,000. Non-economic have visited with several Republicans. "We are about to vote on a mark damages compensate victims for pain The next two recess weeks will be that includes the most extraordinary and suffering. The amendment was of crucial in shaping the views of many transfer of power from the private to fered by the panel's ranking Republi House members. It will be the last the public sector," warned Johnson. can, Bill Thomas of California. time that lawmakers on key commit "This is a bad bill; it is ... worse than • Tobacco tax. In search of revenue tees will have a chance to listen to the president's bill; it is a bill without to pay for subsidies to help small, low- constituents. Soon after they return, precedent." Because Johnson sup wage businesses cover the cost of their Democrats on Energy and Commerce ports many aspects of health reform, employees' health insurance, Andrews and on Ways and Means will be her criticism resonated with conserva crafted an amendment to increase the pressed to sign on to the overhaul pro tive Democrats as well as Republicans. tobacco tax from 24 cents to $1.49 for posals being pushed by the committee In fact, even before panel members a pack of cigarettes. It drew support chairmen. Committee Republicans voted to approve their bill, members from five Democrats and from John will have to decide whether to break of both parties — including liberal son. Stark had proposed raising the ranks and vote for bills largely crafted Democrats — launched broadsides in tax to 99 cents a pack. The amend by Democrats or risk looking like opposition to it. ment stipulated that of about $6 bil naysayers and vote against committee Said Jim McDermott, D-Wash., the lion to be raised by the additional tax, bills. The key committees are sched leader of a House coahtion that favors a $4.15 billion would be spent on small- uled to vote on health care overhaul Canadian-style single-payer system: business subsidies; $1 billion would plans before the end of May. "What we have got here is a benefit fund academic health centers (An package that is inadequate ... This bill drews has a large medical center in his Health Panel Markup will not pass in full committee." Houston district); $750 million could If the ll-member Ways and Means Under a single-payer system, the help inner city and rural clinics and Health Subcommittee is any measure, government would collect insurance hospitals, as well as doctors who serve holding together a coalition of Demo premiums and pay doctors and hospi the poor. The remainder would be crats — let alone Republicans — is tals. McDermott's single-payer bill split among pregnancy prevention likely to prove difficult. The bill that (HR 1200) would cover many more programs, lead abatement and the re emerged from the subcommittee after benefits than the Stark or Clinton training of tobacco farmers. two weeks of bruising debate barely bills, including full mental health care Five members offered full-fledged managed to draw the votes of six of the coverage and long-term care. How substitutes to the Stark bill, including panel's seven Democrats — the number ever, it would put the health insurance the Clinton bill. necessary to approve a bill. The seventh industry out of business, a move that The substitute bills, all of which Democrat, Michael A. Andrews of many members are reluctant to make. failed, represented a first chance for Texas, said from the start that he would Despite his harsh words, Republicans to explain their bills and vote against the panel's draft bill. McDermott and five colleagues voted have a vote on them. Most of the re All four panel Republicans op- yes on the Stark bill. "We had to get sults were predictable: bills drafted by 740 — MARCH 26, 1994 CQ, .J- SOCIAL POLICY Republicans generaUy won only Re HEALTH publican votes. But there was one sur prise: Andrews voted for a bill (HR 3704, S 1770), written by Thomas, Bill To Assist the Disabled that closely resembled a bipartisan bill (HR 3222) of which Andrews is a cosponsor. His vote suggested the pos Wins Final Passage sibility of building a bipartisan bloc of votes around a middle ground plan. ith broad bipartisan support, the family members • Clmton bilL The Clinton bill failed WSenate adopted a conference re and professionals when the four Republicans voted "no" port by voice vote March 24, clearing a better understand and the seven Democrats voted bill that would help people with devel the problems of "present," at the White House's request. opmental disabilities gain more inde the disabled, the The bill would include market reforms pendence. The House had adopted the bill funds univer and caps on national health care spend conference report by voice vote March sity programs ing. It was offered by Thomas in a move 21. President Clinton is expected to that run early-in that Democrats said was designed to sign the bill. tervention, aging embarrass the president. The legislation (S 1284 — H Rept and community • Chafee bilL Thomas also offered 103-442), sponsored by Sen. Tom Har support pro the bill he crafted with GOP Sen. kin, D-Iowa, would renew a 1970 law, grams. Harkin John H. Chafee of Rhode Island (HR authorizing $117 million in fiscal 1994 • Discretionary fund. The legisla 3704, S1770), which would rely on an and unspecified sums in fiscal 1995 tion funnels money to a Health and individual mandate to attain universal and 1996 for states and universities to Human Services fund for special coverage by 2005. The bill failed 5-6 assist the disabled. projects to promote independence, with the support of one Democrat: An The measure would allocate money collect data, issue reports and assist drews. It would set up voluntary alli to four grant programs: state councils and university pro ances that businesses and individuals • State councils. State developmen grams. could join to buy health insurance, tal disabilities councils provide advice More than 3 million Americans and would cut Medicare and Medicaid to state agencies that help the disabled suffer from mental or physical disabil to fund subsidies for the poor. with job training, education, medical ities that affect their mobility, learn • Cooper-Grandy. Rep. Fred assistance, child welfare and other so ing and ability to take care of them Grandy, R-lowa, offered HR 3222, the cial service programs. selves. bill he co-wrote with Rep. Jim Cooper, • Advocacy groups. The legislation The Senate approved its bill (S D-Tenn. It failed 5-6 but won the vote of funds nonprofit agencies that publish Rept 103-120) by voice vote Aug. 5. Andrews, who helped write it. Under advocacy literature for the disabled and The House amended the Senate ver the Grandy bill, small businesses that assist in resolving complaints. sion, substituting its version (HR 3505 paid for their employees' health insur • University programs. To help — H Rept 103-378) and passing the ance would be required to join together bill Nov. 21. (1993 Weekly Report, p. to purchase insurance. But the bill has By Brad Wong 3275) u no employer mandate, no requirement that individuals purchase health insur ance and no guarantee of universal cov erage. VETERANS that the VHA — • House Republicans. Johnson of which administers fered the bill crafted by the House the VA's health Republican leadership, HR 3080, Panel Exempts VA care facilities — which takes an incremental approach, needs to retain all putting in place stricter insurance From Staff Cuts of its employees if regulation and making it more diffi it hopes to be ca cult for victims of medical malpractice The House Veterans' Affairs Com pable of attract to sue for damages. It failed 4-7 on a mittee gave voice vote approval March ing patients in party-line vote. 23 to a measure (HR 4013) that would this new environ • McCrery. McCrery offered a sub exempt the Department of Veterans ment. stitute, which failed 4-7 on a party- Affairs (VA) from Clinton administra The bill also Rowland line vote, that would have knitted to tion plans to cut 25,000 full-time posi would authorize the VA to estab- gether several strategies, including a tions from the Veterans Health Ad lish pilot projects in up to five states cap on the tax deductibility of health ministration (VHA). The cuts would that are currently overhauling their insurance and the use of medical sav be part of an overall plan to reduce health care systems. The programs ings accounts. the federal work force by 252,000 over would allow the VA to restructure its • McDermott. McDermott won the next five years. state facilities to fit into a new sys three other votes — John Lewis, D- Meanwhile, under the administra tem. Ga., Stark and Kleczka — for his sin tion's plan to overhaul the nation's The Veterans Affairs' Subcommit gle-payer plan, which would guarantee health care system, the VA would be tee on Hospitals and Health Care ap universal coverage and set a national required to compete for many of its proved the bill, sponsored by J. Roy health care budget. It would be fi patients with private health care pro Rowland, D-Ga., on March 16. nanced through a payroll tax. • viders. Veterans advocates contend (Weekly Report, p. 679) m 742 — MARCH 26, 1994 CQ DOCUMENT= 6 OF 8 PAGE = 1 OF 7 ACCESS # OMHA348852 HEADLINE Gore Lauds Hoagland; Visit Ties Up Traffic Byline: HENRY J. CORDES Credit: WORLD-HERALD STAFF WRITER Notes: The online version is longer than the published version. LENGTH ESTIMATED INFORMATION UNITS: 7.0 Words: 988 DATE 04/08/94 SOURCE The Omaha World-Herald (OMHA) Edition: Sunrise Section: News Page: 1 (Copyright 1994 Omaha World-Herald Company) KEYWORDS. Vice President Al Gore jammed rush-hour traffic, touted the Clinton administration's "gridlock-breaking" in Washington and raised * $80,000 for Rep. Peter Hoagland in a whirlwind visit to Omaha Thursday. Gore praised Hoagland, D-Neb., at every turn, particularly Hoagland's vote that helped Clinton's budget bill pass in the Congress. Hoagland has taken some heat in Nebraska for the vote. "You talk about pressure," said Gore, who himself provided the tie-breaking vote that passed Clinton's plan in the Senate. "We were able to pass it because of people with guts." During his remarks before 500 Hoagland supporters at a fund-raising rally, Gore said time has vindicated those who voted for Clinton's package of tax increases and budget cuts in August. He said it has reversed the nation's economic downturn while at the same time reducing the nation's annual budget deficit by 40 percent. "The ones who wanted to keep gridlock and keep the status quo told such terribl tales about what would happen . . . that we would go into a depression," he said. "We're seeing America back and competitive." Gore's quickie, three-hour visit was intended to boost the campaign of Hoagland, who is expected to face another tough election as he seeks a fourth term in the 2nd District Congressional seat. The visit started at 5:25 p.m. when Air Force Two touched down at Eppley Airfield - just in time to allw Gore's motorcade to snarl rush-hour traffic. Law officers blocked access to Interstates 80 and 480 and a long section of 72nd Street to allow the Vice President's motorcade to travel unimpeded to a fund-raising event. The $1,000-per-couple event drew nearly 100 people to the home of Harland and Nancy Noddle, near 84th and Pacific Streets. Gore then spoke at a $10-per-person rally at the National Guard Armory. The two events raised an estimated $80,000 for Hoagland's campaign, said Paul Landow, an aide to Hoagland. The crowd at the armory, 6929 Mercy Road, was smaller than anticipated by Hoagland's campaign. The campaign had printed 750 tickets and sold 500. It was far less than the overflow crowd of more than 2,000 who attended a rally for Gore when he campaigned for the Clinton-Gore Democratic ticket in the same building in October 1992, his last visit to Omaha. Gore continually heaped praise on Hoagland during his 20-minute remarks at the rally, at one point saying, "There is no member of Congress with whom I have been more impressed." He said Hoagland helped talk the administration out of eliminating a law enforcement grant program that the congressman said had aided Omaha. Gore also said Hoagland had bucked the gun lobby by pushing a proposal making it a felony for an adult to sell a gun to a minor. Because of Hoagland's efforts, Gore said, that proposal is now part of the crime bill pending before Congress. Gore said something must be done about the nation's "upswing of violence," which he blamed on drugs, guns, social injustice, poverty, unemployment and the breakdown of values. "There are so many causes for it," he said. "But now is the time for a smart, tough, comprehensive crime bill." Gore acknowledged that Hoagland, who is opposing the Clinton health care plan, has not always voted the way the administration has wanted. "We respect that," he said. Gore talked little of Clinton's health plan, a plan that even Gov. Nelson - a Democrat who joined Gore on the podium - has said has no chance to pass. Gore said it was "just ridiculous" for anyone to sugges the country does not have a health-care crisis. Gore, who served 16 years in Congress before joining the 1992 Democratic ticket, touted the other bills the new administration has been able to get through Congress. Among them: the family leave bill, which gave workers unpaid time off for family medical emergencies; the "Brady bill," which requires a waiting period for purchasing handguns; and a "motor voter" bill offering people the chance to register to vote when they apply for a driver's license. He said he was especially glad he has been able to help on occasion. The vice president breaks ties in the Senate, as Gore did on the budget bill. "Sometimes it comes down to the narrowest of margins," he said with a smile. "Every time I vote, we win." Gore sounded many of the same themes at the private fund-raising reception, said frmer U.S. Rep. John Cavanaugh of Omaha, who served with Gore in the House in the late 1970s. Security was also tight around the armory, with some people complaining that they had to detour around 72nd Street to make it. Officers could be observed on the roof of the nearby 7000 Building. Police on horseback surrounded the building. The security requirements and blocked streets may have reduced the size of the crowd at the rally, Hoagland campaign officials said. Jim Crounse, a Hoagland campaign advisor, said ticket sales and rally promotion was cut off early Thursday at the urging of the Secret Service. The crowd at the armory included at least one dissenting voice: Jon Christensen, one of three Republicans seeking to bounce Hoagland from Congress. He said he hadn't come to antagonize but to listen. He did, however, take opportunties to criticize the event, saying he thought efforts by Hoagland to tie himself to the Clinton administration would backfire. "I hope he brings in (Attorney General) Joycelyn Elders, or maybe Hillary," he told a reporter. "If we're really lucky we'll get Hillary's stockbroker." At that point, a man wearing a Hoagland campaign sticker walked up, and Christensen offered his hand. "I wouldn't shake your hand for nothing," the man said. "I can't believe you're here." State Treasurer Dawn Rockey, a Democrat, dismissed GOP suggestions that Gore's visit will hurt Hoagland. "Whether or not the people approve of everything Clinton and Gore are doing, they're still the president and vice president," she said. "There's a certain amount of respect that goes with that." §Art: Jeff Bundy/WorId-Herald/Isf/1 End of Story Reached DOCUMENT= 7 OF 8 PAGE = 1 OF ACCESS ## OMHA347986 HEADLINE Clinton's Trip To Nebraska April 7 Is Off Notes: The online version is longer than the published version. LENGTH ESTIMATED INFORMATION UNITS: 1.9 Words: 188 DATE 03/31/94 SOURCE The Omaha World-Herald (OMHA) Edition: Metro Section: News Page: 17 (Copyright 1994 Omaha World-Herald Company) KEYWORDS. White House schedulers tentatively had planned to have President Clinton come to Omaha April 7 to push his health-care plan, but the trip has been scrapped. Richard Lombardi of Lincoln, the Nebraska coordinator for Clinton's health-care proposal, said it is likely that the president will come to Nebraska within the next couple of months, however. Nebraska is considered important to Clinton's health-care initiative, Lombardi said, because of the important role in the issue played by Rep. Peter Hoagland, D-Neb., and Sen. Bob Kerrey, D-Neb. Both have been proponents of health-care reform but have not been enthusiastic about the Clinton proposal. "Peter and Sen. Kerrey are prominent in the national health-care reform debate," Lombardi said. Hoagland is considered a key player in fashioning the House health-care bill becausehe is part of a centrist group of Democrats on the House Ways and Means Committee, Lombardi said. Kerrey's long-standing interest in health care and his close ties to Senate Finance Committee Chairman Daniel Patrick Moynihan assure the Nebraska Democrat's role in the Senate health-care debate, said Lombardi, who is under contract with the Democratic National Committee to promote the Clinton plan in Nebraska. End of Story Reched DOCUMENT= 5 OF 8 PAG = 1 OF 10 ACCESS•# OMHA349397 HEADLINE Health Debate Not Getting Simpler Mandates? Alliances? Deductions? Maze of Issues Is Before Lavmakers Byline: PAUL GOODSELL Credit: WORLD-HERALD BUREAU LENGTH ESTIMATED INFORMATION UNITS: 10.7 Words: 1444 DATE 04/12/94 SOURCE The Omaha World-Herald (OMHA) Edition: Metro Section: News Page: 5 (Copyright 1994 Omaha World-Herald Company) KEYWORDS. Omaha businessman Dennis Brozak has a message for his congressman: Do not force businesses to pay for their employees' health benefits. "I don't think an employer should be mandated," said Brozak, who met last week with Rep. Peter Hoagland, D-Neb. "Businesses should attract employees by whatever benefits we choose to offer." But Mutual of Omaha, the biggest employer in Hoagland's district, has a differet view of health-care reform. For Mutual and other insurers, an employer mandate is acceptable, probably desirable and perhaps even necessary. That is an example of the mixed signals that Hoagland and other lawmakers have been getting from their hometown businesses as they return to Washington this week to consider health-care legislation. Large and small companies, insurers, hospitals and labor unions have widely varyin views on what Congress should do. Far from speaking with one voice on health care, each interest has its own agenda - virtually ensuring that someone will be disappointed regardless of the final outcome. Hoagland held one meeting in Omaha last week with a group of constituents that included a restaurant owner, an insurance agent, a hospital administrator and Brozak, who runs Design Basics, a 56-employee firm that designs homeplans. "Many of the individuals were on opposite sides of the key issues," Hoagland recalled. To influence the debate in Congress, business and labor groups are using direct meetings with lawmakers, both at home and in Washington, and an increasing amount of newspaper, radio and television advertising. "Over the past year, we've had more than 300 visits on Capitol Hill," said Terry Calek, a Mutual vice preident and director of public affairs. Business groups are talking to all 10 members of the Nebraska and western Iowa congressional delegation. Some of the most intense lobbying recently has been aimed at Hoagland, who serves with Rep. Fred Grandy, R-lowa, on the House Ways and Means Committee. Last week, for example, the Coalition for Jobs and Health Care, a diverse group of restaurants, small businesses and manufacturers, bought a full-page advertisement in The World-Herald to urge Hoagland to oppose employer mandates. Supporters of President Clinton's health-care proposal, which contains employer mandates, have broadcast television commercials in Omaha. Hoagland said his office is deluged with calls every time Citizens for a Sound Economy airs its radio ad that talks of health-care rationing. Hoagland also has been the target of several "action alert" letters from the National Federation of Independent Business, a 600,OOO-member organization that is considered one of the most powerful business lobbying groups. The federation's letters urge local business owners to contact Hoagland to press the no-mandate argument. "It's clearly a targeted district," said Mark Isakowitz, a health-care lobbyist for the federation. "Hoagland is going to be a key on the Ways and Means Committee." Here is a look at what some Nebraska and Iowa businesses want on major health-care reform issues: Insurance Reform Nearly all of the business and labor interests, including insurers, agree on the need for changes in insurance laws. Individuals should be able to keep their health insurance when they change jobs or move, and they should not fear losing affordable coverage if they becoe ill, according to those people interviewed. But not everyone agrees that there should be pure community rating - where everyone is charged the same insurance premiums regardless of age, sex or health status. That could raise costs for businesses with young, healthy workers. Steve Salem, who runs an employment agency in Sioux City, also said it isn't a good idea to require insurers to take all comers - a change that others favor. "You shouldn't force companies to take a bad risk," he said. Employer Mandates Clinton's main goal in health-care reform is universal coverage - ensuring that every American has health insurance. In his plan and others, that goal is accomplished by requiring businesses to pick up at least part of the tab. Some sort of employer mandate, perhaps combined with a requirement that individuals obtain coverage, may be the best way to get everybody into the health insurance system, Ms. Calek said. Insurers say they want an employer mandate and universal coverage because it makes it easier for them to assess risk. "If you don't have everyone in the system, then people who are waiting to get sick before they get covered benefit at the expense of everyone who is in the system," Ms. Calek said. The American Hspital Association advocates an employer mandate as a way to reach universal coverage and guarantee hospitals that they will be paid. Harlan Heald, president of the Nebraska Association of Hospitals and Health Systems, said smaller Nebraska hospitals have some misgivings about an employer mandate but do not want to fall short of universal coverage. "If we don't go to universal coverage, there's going to be more cost-shifting," he said. Labor unions support an employer mandate, as do some companies that already provide benefits. But smaller businesses or those with large nxmbers of lower-wage employees, like Godfather's Pizza, are fiercely opposed to employer mandates - even when the businesses provide some health benefits already. Brozak, who covers 40 of his 56 employees, said he fears that his existing benefit osts will double if health-care legislation requires community rating, standard benefit plans and coverage of part-time workers. Hoagland has tried to bridge the mandate issue by suggesting several alternatives to phase in the employer obligation. Brozak said he is skeptical of any employer mandate on health insurance, even if it is phased in gradually and includes subsidies for some firms. "Once it gets i there, it'll get screwed up eventually," he said. Isakowitz, of the National Federation of Independent Business, said the argument that some form of employer mandate may be necessary is unacceptable to small-business owners. "The two things they hate most are mandates and payroll taxes," he said. "There's no way Hoagland's going to be able to finesse that." Health Alliances Clinton's plan cals for establishing health-insurance alliances or cooperatives to pool the purchasing power of individuals and small firms. Other bills, including one introduced by Reps. Fred Grandy, R-lowa, and Jim Cooper, D-Tenn., also would create purchasing cooperatives. Under Clinton's proposal, the alliances would have regulatory powers and could limit the number of private insurers. In addition, all individuals and businesses with fewe than 5,000 workers would have to obtain their health insurance through the alliances. Grandy's bill would have a similar requirement, although only for firms up to 100 workers. There is little opposition to purchasing cooperatives, but insurers such as Mutual have been fighting to make them voluntary. Ms. Calek said Mutual appears to be winning that battle with Hoagland's help. Medicare, Medicaid Heald said hospitals are alarmed by proposals to finance health-care reform through cuts in Medicare for senior citizens and Medicaid for low-income people. Both programs already under-reimburse providers, he said, forcing hospitals to absorb losses or charge other patients more. Nebraska and Iowa lawmakers generally support hospitals on the issue, Heald said. "I'm pretty confident that they all understand what's at stake here," he said. Tax Deductions Businesses currently may deduct the full cost of health benefits, no matter how elaborate or costly. Grandy's bill would limit those deductions to encourage more cost-effective coverage and to raise revenue to cover the uninsured. Both unions and employers who offer generous benefits are concerned. "We shouldn't be penalized for providing quality health-care coverage," said George Franklin, vice president of government affairs for Kellogg's. Said Terry Moore, president of the Omaha Federation of Labor: "Benefits should not be taxed. The employer is doing everyone a service by providing these benefits." But Ms. Calek said Mutual would support limits on deductions as a cost-containment device. Meanwhile, self-employed people and certain small firms are pressing for expanded deductions to allow them to write off 100 percent of their health insurance costs. State Regulations Large employers that have employees in many states are worried that health-care reform will take away their current exemption from state regulations. Under current federal law, companies that meet federal benefits rules do not have to comply with state rules. But several bills, including one advanced by theHouse Ways and Means health subcommittee last month, would allow states to establish single-payer health plans and force all employers to comply. Union Pacific is one company lobbying to keep its current exemption from state laws, said Roger Blauwet, a Hoagland aide. While many businesses are fighting to keep certain provisions out of health-care reforms, Hoagland said some companies, including U S West, are telling him hat they want Congress to pass "at least a bare-bones package this year." The reason? "They're worried that the states will take over," he said. "They want to be sure there's a basic federal plan." End of Story Reached DOCUMENT= 4 OF 8 PAGE = 1 OF ACCESS # OMHA349626 HEADLINE Democrats Hammer Out Health Plan in Private Byline: PAUL GOODSELL Credit: 1 WORLD-HERALD BUREAU LENGTH ESTIMATED FORMATION UNITS: 2.7 Words: 300 DATE 04/14/94 SOURCE The Omaha1 (OMHA) Edition: Sunrise Section: ]New s Page: 7 Origin: 1 Washington (Copyright KEYWORDS. Democrats on the House Ways and Means Committee held closed-door negotiations Wednesday as divided committee members began work on comprehensive health-care legislation. "Everyone recognizes the importance of compromise," said Rep. Peter Hoagland, D-Neb. But some committee Democrats favor a single-payer, Canadian-style system while others want a market-based approach with private health insurance. At the session Wednesday, the first of six days scheduled for private meetings of committee Democrats, lawmakers outlined their main concerns. Hoagland said he spoke against government price controls and mandatory health alliances, which could cost jobs in the insurance industry. He said he also argued all Americans should be covered by health insurance if Congress requires insurers such as Mutual of Omaha to change the way they take risk in writing policies. Hoagland said he was optimistic the full committee would modify a bill advanced by the Ways and Means health subcommittee. That measure, proposed by Rep. Pete Stark, D-Calif., would expand the Medicare program to cover the uninsured or hard to insure, an approach that Hoagland described as a single-payer, government-run system. "The fundamental approach needs to be different from Stark," he said. Hoagland has assembled a group of six moderate or conservative Democrats on the committee who may hold the key to health-care reform. Since the 14 committee Republicans are not expected to support the bill. Chairman Dan Rostenkowski, D-Ill., needs some of the six Democrats in order to muster a majority on the 38-member panel. The six Democrats ae Hoagland, J.J. Pickle of Texas, Andrew Jacobs of Indiana, Bill Brewster of Oklahoma, Michael Andrews of Texas and L.F. Payne of Virginia. "We're working together," Hoagland said. He acknowledged, however, that the six had not reached agreement on several key issues, such as the need for a requirement that businesses pay for employee health benefits. End of Story Reached DOCUMENT= 3 OF 8 PAGE = 1 OF 6 ACCESS # OMHA349818 HEADLINE 2nd District Candidates Differ on Issues 2nd District Issues Byline: HENRY J. CORDES Credit: WORLD-HERALD STAFF WRITER LENGTH ESTIMATED INFORMATION UNITS: 5.9 Words: 749 DATE 04/15/94 SOURCE The Omaha World-Herald (OMHA) Editio: Sunrise Section: News Page: 16 (Copyright 1994 Omaha World-Herald Company) KEYWORDS. State Sen. Brad Ashford differs from Jon Christensen and Ron Staskiewicz on gun control, abortion, term limits and private school vouchers as the three Republicans campaign for the 2nd Congressional District seat. Ashford favors gun-control measures such as the Brady bill, opposes vouchers and ter limits, and also backs abortion rights. Staskiewicz and Christensen said they oppose all gun-control measures, back term limits and vouchers, and support a ban on abortion in all cases except to protect the life of the mother. Staskiewicz and Christensen were in lock step on a series of issues questions asked of the candidates. The three Republicans are vying in the May 10 primary for the chance to take on Democratic Rep. Peter Hoagland, a three-term incumbent, in November. Staskiewicz, the former Douglas County attorney who twice before has sought to unseat Hoagland, said that although he and Christensen hold similar views on the issues, they can be distinguished. He said Christensen is inexperienced, lacks maturity, has lived in Omaha for only six years and has voted in only one of four elections since moving to the city. "I have the judgment necessary and proved what I can do as county attorney," he said. Christensen said the difference between him and Staskiewicz is "I'm going to stay positive and talk about the issues. . . . Ron has had two opportunities to defeat Peter Hoagland. It's time for a new voice." Here's how the candidates expressed their views on the issues: Health Care: None of the three Republicans favored universal coverage on health care, a provision President Clinton insists be included in any plan emerging from Congress. Christensen said the uninsured are already provided for by the current system. "There's not anyone denied access to health care," he said. Ashford favors making health-care premium costs fully deductible under the federal income tax system to help the uninsured obtain individual policies. Staskiewicz said he has seen no specific health plan he would back. Term Limits: Staskiewicz and Christensen back a national term limits measure similar to what Nebraska voters approved in 1992. Ashford said he thinks term limits limit voter choice. He said he supports other changes to make clear elected office is not a career, such as abolishing the congressional retirement program. Abortion: While Christensen and Staskieicz oppose abortion, the issue is not a big part of either campaign. Ashford, who has touted his support of abortion rights, said his opponents need to answer whether they favor arresting women who have abortions. "That's what you have to do if you want to make it illegal," he said. Vouchers: Christensen and Staskiewicz said they both think parents who send their children to private schools should not be penalized by paying both tuition and school taxes. Ashford said vouchers would cost all taxpayers millions of dollars, forcing them to pay part of the educational cost of all the students currently attending private schools. Budget: All three Republicans said they favored giving the president line-item budget veto powers. Ashford differed from the two others on one budget issue: Medicare, the fast-growing budget program paying health-care costs for the elderly. While Staskiewicz and Christensen said they favored no future changes in the program, Ashford said changes will have to come if the federal budget is ever to be balanced. "I don't think our generation and people in their midworking years can expect full Medicare coverage," he said. Gun Control: Staskiewicz and Christensen oppose the Brady bill passed by Congress last year that requied a waiting period for handgun purchases. They both said gun control measures don't work. "Criminals get their guns on the street," Staskiewicz said. Ashford said the Brady bill has worked, keeping 23,000 felons from buying guns in the few months it has been in effect. "Why as a society would we want it to be so easy for a criminal to get a gun?" he said. 2nd District Issues Ashford....Christensen....Staskiewicz Health Care Do you favor a health-care plan that includes universal coverage? No No No Abortion Ban Do you beleive abortion should be banned in all cases except to protect the life of the mother? No Yes Yes Budget Do you favor giving the president line-item veto power on the budget? Yes Yes Yes Term Limits Would yu support a constitutional amendment limiting congressman to four, two-year terms? No Yes Yes School Vouchers Would you support tax-funded vouchers to help parents send their children to private schools? No Yes Yes Gun Control Do you support the Brady Bill, which required a waitng period for handgun purchases? Yes No No §Art: WORLD-HERALD/1 End of Story Reached DOCUMENT= 1 OF 8 PAGE = 1 OF ACCESS # OMHA349951 HEADLINE Bill Keeps Doctors Within Law Byline: PAUL GOODSELL Credit: WORLD-HERALD BUREAU LENGTH ESTIMATED INFORMATION UNITS: 3.2 Words: 359 DATE 04/16/94 SOURCE The Omaha World-Herald (OMHA) Edition: Sunrise Section: News Page: 3 Origin: Washington (Copyright 1994 Omaha World-Herald Company) KEYWORDS. Hospitals and doctors who establish new business arrangements would be able to learn in advance whether those dealings violate * federal law under a bill introduced by Rep. Peter Hoagland, D-Neb. Hoagland's bill, co-sponsored by Reps. Bill Brewster, D-Okla., Bill Thomas, R-Calif., and Porter Goss, R-Fla., would help health-care providers ngotiate legal minefields as the industry consolidates and changes. The bill would require the U.S. Department of Health and Human Services to issue advisory opinions on the legality of proposed business ventures, including new managed-care plans. "They would all love to have the guidance," said Bob Cohen, an Omaha lawyer who has worked on such transactions. "They're all in absolute panic about doing something that will land them all in jail." Under a series of laws passed by Congress, health-care providers who participate in the Medicare or Medicaid programs are subject to restrictions aimed at preventing fraud and abuse. The laws make it illegal for providers to pay or receive remuneration for referring patients. Providers also may not refer patients to other providers with whom they have a financial relationship. While there are eceptions allowed, Cohen said, it is not yet clear whether specific financial arrangements developing between doctors and hospitals will pass muster with the federal government. "Most real-world transactions don't conveniently fit into those safe harbors," he said. Hoagland said the advisory opinions required by his bill would ensure compliance with federal laws while protecting providers who want to develop innovative - but legitimate - business practices. Hospitals that want to recruit doctors for a managed-care or preferred-provider network would know whether the inducements they offer are legal, he said. At the same time, consumers would benefit by having federal officials review new business relationships between providers, said Peter Young, a health-care policy analyst from Fort Myers, Fla. If a given arrangement would undermine an open, ompetitive market, it would be better for consumers if authorities blocked it in advance, he said. Hoagland's bill, introduced last month, has received strong support from the health-care industry, including the American Hospital Association, the American Medical Association and 16 other organizations. Hoagland's campaign received $34,900 in 1993 from the health-care industry. End of Story Reached H B C ^ C R 0 2 R - 3 THU 15 : S •* OMAHA WORLD-HERALD Thuraday. March 31.19M 1993 PAC and Individual Contributions X array HMgland Intwanca M.76S 7.600 7.UO 3S.4I5 Hcauh pfofcsoiOAjii 2S0 3.&S0 16.$00 HojimiMUioilom MO 2M 11.500 Hcaiih sorviees 32.000 250 Pharmacftuttcalt. 1.550 SCO health prMuets n.sao 6.500 T'»,»,» 1«».»« •.•00 12,500 M^,S Soure* Wor Id-Hw oM 4Mh*» of Mmpaign eoninautions (•iodwtihvr« f Moral Qoelton Conuniuion. Health-Care Debate Boosts Contributions indixSJual contributions. BVPAULGOODJELL • Sen. Bob Kerrey. D-Ncb* hid S!69.$i3 from health or insurance don WitSincion — Mutual of Omaha ors, or 12 percent of his itemued contri- docin"! STMN-* ame »iih Rep. John bunonii Dintdl, thc Michigan Democrai «to • Rep. Bill Barren. R-Neb. col lected hctti ihe HOUK »j\cr£y and Commcrw SI2JO0 in healih and insurance money, Commiilet or 15 percent For oiampl*. Dingell U a eo-fponxw B Rep. Doug Bereuter, R-Neb- re- of PwkJcni Oinion'i hcalih On March 28, 1994 at 10:00 a.m. Administrator Bowles visited Plastrglas Inc., an SBA success story, with Congressman Hoagland. Plastraglas Inc. President Wally Wilson gave the Administrator and Congressman a tour of his plaster column manufacturing facility. (The media present followed along.) The key issue discussed was access to capital for small business. As Plastraglas Inc. has been assisted on two occasions by the SBA 7(a) guaranty loans, Wilson was very pleased with the agency. Health care reform was not discussed. Following the visit to the small business the Administrator and Congressman attended a luncheon hosted by the Greater Omaha Chamber of Commerce. Thirty local small business people were in attendance. The Administrator gave a speech on the four goals the President has given him for the SBA and the SBA programs he has initiated to accomplish these goals. The Administrator took questions for thirty minutes. The concerns raised covered various topics including the SBA 8(a) program, the Low Doc program and the new Greenline of credit program. As illustrated in the attached clip Omaha is eager to be included in the Empowerment Zone/Enterprise Community project. Notes: The Congressman's staff was much more hesitant to about talk health care reform than the Congressman. The Congressman gave the Administrator the attached information on a health care reform proposal. The Administrator said on many occasions he would work with the Congressman to get a microlender in Omaha to service the large Hispanic and African American communities. Media: The Administrator met with the Omaha World Herald editorial board. He outlined for the members the benefits of the Presidents plan. The luncheon was closed to the media. The following media attended the tour of the small business: Omaha World Herald photographer, KFAB radio and WOW radio, and KPTM TV (ch.42) 9:00 p.m. news. Qore cites Hoagjap$^ 'guts/ indepen(J|ni^|i; ^ fcrJ*,im*t Pox W.Hom n •toaruavratauiancrtt*R«paedM *K*r+»m*iM.a N !; > •Aw h tt*an w tar ( Mrt. (Mfh. 8>HU»i Qoai'l M MMt« nvoMx vai m t( tan CT.*-1* MM. ' Cent pni*( ftr ft* ) ttmlm ii m 6m nt, wmti > Owi «4 Mi kit OMta OMAJU S A CtSTT* ttamp* Xe»flM* t*l « tlwr OW H »U1 ao( M^rt Mint IM|« tkHM «ta.Hfl«->arHln»l»»HiiMI *te tti eoatrr lM*. Oi «te in i a* tt irani wm. k \uiinm*i^<« nd mtkti Nun J --\. land; Visit Ties Up Traffic BY HF.NRYJ. CORDES CflaA rtwee-bour vuii wu urtcsd- «« to boact the canpaipi of Nug- fattd. w*io is eapccicd to face aoaifccr Vice Vtaidtsl M (fon jafwnnt ioug)i ekdion as he weJu a founh lerm ia tkc 2a4 Ctap«ask>oal Disisid ft ~]nullodk4>rcah»-' in Wwto^to. •wfaiwd SKUUI fcr The viol UMlad « 5:2) pun' Rep Paw HMM M » «Hnil«wtf Air Poruc Two tOHetwd down al ^>pley Aufwld — jafl ialimc to altow Cone pniicrf Hau|ta4. D-Hc*.. «• 4 Owe ! motorcade 10 saul rush-koM cvwy inn*. pvticuWty Hmr^uid'i irafBc •ote thai hcffwd PWiiaM Ckaion'i OkmAu f«lior and ihc Suie fMrol hui^t* btU nu* m UM CAnpctt.» vote biwJrad * KMC)tod *ui«t hu jOndMic vo- ' •tm •MiCt •tthciyy. at oacMiai nytM, c "That b—•wit u of CoaywHb wh— I haw tww nicifi iiimwaml" He aid Hoa^aaJ hdgit OM aAmiau tration oat of cfrtiwintt a law €*IotcaatM naot pnptn tim o ihe owytwaMi said had aided 1* Omaha. CMC alio fed butted ihc MI labty h/p ptonoaat awkiai il a felony for wa adiih to sell a fua to amino*. Boca*** of htmtfmi't enom. Oo#e Mid. that pw^wMi is now aanad #te rtiir Ml pending befotc CaMWO. Cone satd soawlhaf masi he dooo aboul ihe naiiart crirae "tpukTwc." aAichhcMiMdfndniifkpnMociai inpodiw. powc/iy. HnwoftoffacM and Iht hwakdoww ef wdaw. c There are so nwaf cauws fot •t." V he aaid. "Bui NOW is lha lifne for a wnaic lowrk, eompichuMioc rraac bfll.- Ootc aJk«iowl«d|Mdlha« HcM^smt. who it oppociig the Oiman hcahb- ft case plan, has «M always voted Ihe HJND-RAimt Md Vita ACSMMI Al Obte Aaia way the adtninisuaiioo haa wMNrd. fodhmrtAe OmttAmmty. About SMfa^ananded *"An dwe respect I hat" he said. Core UftcrfUtkofCkMort's hwd* Rep. John Ckvanaa^h of. ptan. a plan Dial OMEB GOV. Nclion - oho tomd aalh Gorein dw The a Democrai oho joined Core oa the House an feiMslfNa. bloc4«d stiecu may1 bm aeduoDd dkc podiuin ~- hu said has noetonoe so CevanM^t and Ame Baidt ak- sue of ibe crowd ol the nUy.-Mott-' inatad*coowd*i abowl 100. > ., toadj ioMiiiui offibik uA- im Coic said it was "iUi cidkuloiu" Securiiy wu also ligM woond Ihc fot anyane \o theooualsy does mmoty, with Mmc people oorepUft- «uc*; mi tichec tal« end ntfjr jvoJ- c •oi havt a heahhaase ensi*. iij thai Ihey had so JOMOW osoaad. motioo one cm off earlr Ihondty c Core inondnd many ef Ihc tame 72od Suaei io nMlce it Ofheoi codtf. iheurtiMofibeSeauScTvtoc. tbonea ai the pnvaic fuai4-ffaiiir\| o be obrorwd oa the sooT of lha oauVy o (oocplMm at Ihe Noddles' hone, (aid WW BoMaj, rohce on hoorbad Burley battle Area farmers fighting for livelihoods GREGORY LEAMINC^ wkios County Bureau f** Tobacco facts in 1st ^t—When freefl'-bkttcd tobocco m'farmers descended on Nash- Congressional vjtUe eariier thil month, tbey District: had a couple of messages for state and federal lawmakers. ranking of tobaoco-produdnQ counflw , One President Clintons proposed 75.cent per-pack tax on cigarettes needs to go up in smoke • Two: Tobacco is king, or at least crown prince, in Tennes see . Grown in 70 of Tennessee's 95 counties, tobacco is tho live lihood of 98.651 Tennessee fam ily farmers According to the R.J Reynolds Tobacco Co., another 51.9S4 Tennesseans work in tobacco-related jobs "Approximately one-third of people participate in tobac co." estimates Ethendge Par- . Please see AREA, page SA Region stronghold of pro-tobacco poliffcs By ALAN WESTON Times-Newj Siaff Wnter INSIDE / o American Indians introduced tobacco to Euro- ooani as a ei* Soma can it * curio. Paoe 4A. Attacking the tobacco mdustry is politically a Farmar 'I don't bellava moat p«ooi« reaillt correct in many other parts of the country, but that what will hurt us will hurt them ' Paoo SA.' it's a different story tn Southwest Virginia and Northeast Tennessee, where many people re gard tobacco as a livelihood rather than a kill Boucher, in a recent interview, offered the er. following analysis of tobacco's political stand ing "Sixty-six percent of the Amencanjmblic Rep Jimmy Quillen. a Kingsport Republican who represents Tennessee's 1st District, and does not smoke and does not reside in." £ place Rep Rick Boucher an Abingdon Democrat who where tobacco is important to the economy represents Virginia s 9th District, are both out spoken supporters of the tobacco industry Please see REGION, page 9A Reg'onremans stronghol CoaUnued from page IA "The domestic market is into that market. But most "The attitude among that shrinking by about 5 percent Russians dont have enough two-thirds of the population is per year That's been the trend money to buy < Amencan) cigS very supportive, for example, over the last five years. rettes " of an excise tax increase on to "Given the current atti There is the moral issue t. bacco products. It is very sup tudes, that may accelerate to exporting products ov«neJ portive of new restrictions on some extent." tbat have lost favor in tif smoking. The overseas market for to United States because of ufc "Those of us who live in an bacco has the potential to evidence of their health risks area, and represent an area, more than make up for the do but Boucher says the federal wben tobacco is important to mestic market losses government won't restrict to tht economy ... resist those ef "For example, the United bacco exports because of the forts very strenuously. SUtes is Just now beginning to beaJth issue. "It U a task that gets more have opportunities with re "Our U.S. trade representa i diflicult every year." spect to the Chinese market. tive takes quite tbe opposite t While tbe anti-tobacco "As China becomes more view, aad tbat is that tobacco -forcet are growing stronger, economic ally prosperous ia a major cootributor to tbe ! Boucher said, "There is. how there will be more opportuni U.S. balance of trade and ... ever, in the face of ail that, a ties ahead. China is tbe largest tbe posture of our government, ' remaining high level of sympa- nation in tht world, with more as far as inteniaxional trade is ! fthy for tbe concerns and eco- than one billion inhabitants A concerned, should be to pro- , t nomic oeeds of tobacco vary largo percentage of tbe mote exports. 4. ! "fanners. Even tbe harshest Chinese population smokes. "That is the-Clinton admin- j . critics of the industry are very "Tbey smoke today ciga- istration's position. Tbat was , aympathetlc with regard to the rtttts tbat are produced in the Bush and Reagan admini*- I economic oeeds of tobacco China and they aren't very tratiwis'poaitioas " fanners." good in quality. There's no Boucher wouid like to tee a questke about tht fact that if change in the CUnion adminis- , What tbat means, in terms peopie there could afford to do tration s position on hiking the 1 of political action, is that "the so, they would prefer to smoke cigarette tax to pay for health . more dramatic of the propos- cigarettes produced in the care refonn, but doesn't sound . aia to restrict smoking are not United States optimistic. •- going to pass." said Boucher. "The same really is true (in "Some two-thirds of the 'The most dramatic pro Russia) We now have entry population supports an in- poaal at the moment would de clare nicotine to be a drug. Ii tbat were done, sales of all to- . ij; .A ibacco products would be out la wed. I do not anticipate that campaign being successful." 1 But Boucher does expect Ic's wonderful co have thc the domestic market for tobac co wtll continue to shrink. ability to 20 inrn a rnno-— But Boucher said he's not cise tax down to a more mod crease in the excise tax. making a "li»e-in-the-sand est level. "Congress typically reflects pledge" to vote against any ex •Part of the art of legislat public mood 00 matters such cise tax increase ing is to Uke an ineviUble «• this. Most members oi Con ••We may be in a position consequence and to make it as gress for that reason do favor palatable as possible. ' some increase in tbe excise where we can negotiate an ex tax" Boucher vows to "make ev CHKIS DC I* A KT ME NT STOKL ery effort to defeat any in crease in the cigarette tax US F. IACKSON ST. • CATL CITY. VA increase." ' <703) 386-7611 Would he keep that commit ment even if meant the defeat of health uare reiorm1 -l believe that there are other ways that health care re Bumfonnl J form can be financed." said Boucher I ^ink we ought to ^ ««rw»ssi«iP«o*"-"«*ri L"Tr2^ have a broader taxing vehi cle." ! Tiawkins County grower" Lea ^ - CoatJoued from page IA • Johnson saw doom In the feder- • ker president of the Tennessee I al tax when he took his crop to I £ We're talking millions 1 Burley Warehouse Association market last faU. • " - ^ of people. A lof of peo They smoke or they re in- "They'll have to go sign up \ • volved In the business We re a for welfare or starve," Johnson • ple selling tobacco already • minority Wt're the largest mJ- said of hts fellow growers K get food stamps or some ofl norlty around - why pick on "We re talking millions of peo er kind of help. ^ us? ple A lot of people selling to-" P r er >ay> 1 bacco already get food stamps _ — L— Johnsc . . f ^ tobacco is the or some other Und of help :: states No. leash crop. Tennes- : produce more They say that guns kill people : S 2fm'" toin4 — they ought to tax guns, liquor 0 00 8 already .•148 miUion pounds of the lea/, L taxL ^ ,' ^ ™» % every year - a crop valued at ' and everything else." taxed Industry in America, Pai •'nearly $271 miUion. Parker says he wanli the The 1st Congressional Dis r federal government to tax any According to his figures trict IJ home to three of the thing but tobacco And with state s top 10 burley producing tongue in cheek he offers alter '0417 percent increase oi counties Greene (No 1) Wash- natives chewmg tobacco and a 3 47- ; * Jifton (No 31 and Hawkins (No "Let's put a tax on newspa Percent increase on snuff' A ; The 1993 crop in the district pers," he said. "Let's put a tax v Z*{ ^ "t 186 05 million. on Big Macs. Let's get some c 0 PPOduced,nT ] Sullivan County farmers har t body else. If they can do it to !»V.s^ . ddS - vested more than 1,500 acres us. they can do It to anybody' , and 3.25 million pounds of bur. To single us out and say, ; ley Jn 1993. figures that rate the You're going to take the bur ; county 13th in the state den.' that's not the way this I The president's proposed country was founded." Landsmark at Christmastimt ' Sii "y^"0 Proponents, But the anti-tobacco lobby and admitted being the one whf 2? a,^»dy shaky; says the president s proposed instigated the attack at Cit) i Industry The current tax on a1 tax wouldn't devastate tobacco- Hall Plaza ; Pound of tobacco ii $12.25 If to- growing regions like North Car "If Bobby 3 visit has an; J bacco shoulders the funding olina and Tennessee. According meaning to me. It's that change ; burden for the president's to a report prepared by the Co occurs over 20 years and recon alition on Smoking Or Health of ciliation ts possible." Lands ' ? c,fe reform Program, the tax wiU shoot up to $31 a Washington. DC, the proposed mark said a 161 Increase will "significantly af • - P*rcent increase. fect only a fraction of the Jobs : That spells gloom, if not ... and create many new jobs " ; doom, to Tennessee's tobacco . nisrket, say tobacco Industry "There are only 259,616 jobs Powers, with about 120 fel- ; leaders. Consumption will de- involved In growing, warehous low residents of the Charles- ; crease 12 percent, Tennessee ing, manufacturing, supplying town neighborhood, was leaving ; will lose millions in tax money .• and selling tobacco products," City Hall followmg an anti-bus- since the feds will reap the rev. the report states "Jobs In these ing meeting with a city coun enue, losses to local economies T fields have declined and will cilor The whites opposed ^Ul reach more than $135 mU-f continue to decline even if no having blacks bused to their .Uon, and more than 6,000 Ten Ux Increase is enacted." schools as part of a desegrega nesseans will be out of work. The impact will be felt in to- tion plan bacco-growing areas such as Parker says the tax would North Carolina, the report con smother as many as 2.700 Joba tinues, and that Impact will be in Northeast Tennessee alone slight because tobacco^growing 4. ^ttii,ey don,t understand neglons "have become less de « this: The tobacco farmer pendent upon tobacco and more raises tobacco, he sells It, he diversified " pays for his farm, he educates Jus children, he pays his taxes, Don't tel) that to East Ten he's the man who sits in the nessee tobacco fans church pew next to you. he Pro-tobacco Parker says Plsyi golf with you, and he goes that "every industry has its ••.••ma wim juu. ne is H grrmii Independent businessman': tobacco Industry is In a valley Parker iiid. i ' right now He compares it to "Today, tbe public perceives the steel industry. tobacco as a man on a white "Every Industry today Is horse on a Marlboro pack — the j going through a re-evaluaUon In big corporation That's not true. )obS,"hesaid . "There may be some loss, The producing It being done by there may be some gain, de small, rural farmers. They're pending on supply and demand the settlers of this country if and consumption ThaVs true In you're a fourth or fifth-genera any Industry — some of them tion Tennessean, tobacco has ' are going down, some of them touched your life." he added. are going up." 0 22 ©maha SSM-Jkrald MORE MIDLANDS WS Midlands News WediicMlay.Apnl20.l994 PtagcU Health Study May Be Out of Date BY PAUL HAMME L more ted tape if the Cnion plan lhat the mandatory health albanoes orig to say untU wc know whai wiU happen." quenccs of the CKnton plan on the* were adopted inally proposed hy Chnton were dead. The sludy. prepared by the Nebraska That eflort was oriiidzcd ie u. The study was made public om Cov. The alliances would be agencies from Deportmcul of Economic Dcvetopmeni. when Nelson refused to make pub Lincoln — An advoc*lc for Picsidcot Nelson's objectkra. A bwsiut had chal which most businesses and individ said that as Tew as two of tbe sute's 28 stalTs estimates on the Clinton a Gmion's hcakh-cuc plan and a spokes u lenged his decision not to disclose uals would buy insurasee. health inturancc carrien would survive impact oo state spendiag. woman for Muiual tt Omaha said Tues it under Clinlon's onpnaJ heaUh-carc re dav (hat the refonn plans now being That, they said, would help retain the Ndsoa and the cstiaaates were • Hie insuranoe indastry "wiB grt out of form plan. ingless because Ihe CUnton nb u debated would hurl ihc inttiianoe mdus this debate rclalively unhirmcd." said market for individual health insurance It predicted dire consequences for n try less than the prtsideM's original plan. plans supplied by Mutual and other onenally pioposed. was dead. To Rich Lombaidi of Linoobt. sute director Nebraska's insurance cam or industry, pabbc the esomates. Nclsoa said, i They oonunented aflef Ihe release for the Nabonal Heallh Care Campaign, which employed I.6M worken and had only "add insult to injuiy" to the Monday of a preliniinaiy stale study that a lobbying e/Torl funciod by the Dcrno- "I think we've made a lot of prorrest an anaua) payroll of 5240 nuiioo ia dent's proposal. said Nebraska's health-nnnnoe indus mitcPany. in educa ting people in Washuigton, Ms. 1991. try would lose jobs and inoonte, small- Olson said Former Stale Sea. John DeCs in business exparwon would be dis- Lombardi and Kathy Olson, a spokes "Jobs wdl change.- sbe said. "Whether The study was prepared as part of Republican candidate for goveraoi o oouiagpd and all companies would face woman for Muiual of Omaha, agreed or oot jobs will be lost will be impossible Nelson's cnbrts lo assess the omue- PhaMhratolVetK Nelson Cu Additiona $9.8 Millie t * ..v ,;• opSpendine g Vetoes Totota; l $16.8 Millie BY BILL HOR t> Lincoln — Gov. Nelson vetoed spendiag totaling 59.5 million ov New York: 2;2-30'P.! PROGRAM News CITY Omaha, NE DATE April 27, 1994 6:25 AM AUDIENCE SUBJECT Health Care Reform BROADCAST EXCERPT NEWSCASTER: Some Omaha doctors and nurses want to see the health care reforms passed. They're urging Congressman Peter Hoagland to back comprehensive changes. Lynn Anderson of the Nebraska Nurses Association works with women who have cancer, and she says she sees entire families wiped out financially during medical treatment. She says there is no health care crisis as long as you and your family stay healthy. LYNN ANDERSON [Nebraska Nurses Association]: But as soon as any member of your family or you become ill, you better have excellent health care coverage, you better work full-time for a large employer and you better not be laid off or lose that coverage because you won't get it back. NEWSCASTER: Anderson and other local health care professionals say they see a need for affordable guaranteed insurance coverage that isn't dependent on your job or your marital status. And they want to see an end to exclusions for pre-existing conditions, drastic rake — rate hikes and other conditions they call insurance abuses. New York: 212-309.I4CC Chicago: 312 5412020 RADIO/ - 1 W "^[2r)/ ^\r) rC . Detroit: 313-344 '1 77 \ ~ O Lo» Angeles: 213 466 6124 Washington, D.C: 301-656-4068 NATIONAL MARKET COVERAGE Boston: 617-536-2232 Philadelphia: 215 -567-7600 San Francisco: 213-466 6'>24 TRANSCRIPT Miami: 305 35 8 3358 HEALTH CARE REFORM PROJECT KKAR-AM Radio FOR STATION PROGRAM News CITY 0maha' NE DATE April 27, 1994 7:35 AM AUDIENCE SUBJECT Health Care Reform BROADCAST EXCERPT NEWSCASTER: Godfather's President Herman Cane of Omaha still doesn't agree with the numbers in President Clinton's health care plan. But a group of local health care professionals is making it clear they do support the health care plan. Pam Battalion is a nurse and she wants Congressman Hoagland to ignore the negative ads. PAM BATTALION [Nurse]: We believe these ads using paid actors have grossly distorted the true intentions of responsible health .A care reform proposals. NEWSCASTER: The group is mailing letters to Hoagland and other leaders of Congress urging them to support the health care plan. While Radio TV Reoorts endeavors to assure the accuracy of material suoolied bv it. it cannot be responsible for mistakes or omissions. New York: 212 309.MOC Chicago: 3'2-54:.2C20 Detroit: 3;3-344.] \77 Los Angeles: 2i3-466.6i24 TVREPORTS Washington, D.C: 301-656-4068 Boston: 617 536 2232 NATIONAL MARKET COVERAGE Philadelphia: 215 567.7600 San Francisco: 213-466-6124 TRANSCRIPT Miami: 305 358 3358 HEALTH CARE REFORM PROJECT WOW-AM Radio FOR STATION PROGRAM News C(TY Omaha, NE DATE April 26, 1994 5:05 PM AUDIENCE SUBJECT Health Care Reform BROADCAST EXCERPT NEWSCASTER: The Nebraska Catholic Health Care Association issuing an eight-point plan for health care reform during a news conference this afternoon. Lynn Anderson, the District 2 President of the Nebraska Nurses Association says too many people are swamped with too much paperwork, too many questions, not enough answers. LYNN ANDERSON [District 2 Pres., Nebraska Nurses Assn.]: And insurance companies, even when you call for pre-certification, will not tell you for sure if a particular procedure is going to be covered. They will say, "Well, send in the bill and we will look at it." And yet, if you bring the person in and it's not covered, they can't afford to cover it themselves. NEWSCASTER: The association has forwarded a letter to Congressman Peter Hoagland saying reform must be acted on immediately in Congress. WhiU Podio fV ReDcts e^d^avors to assure Hie accuracy of material suoolied bv it it cannot be resoonsible for mistakes or omissions. A staking out of temtorj on Ckpitol Hill Mike Synar, D-Okla. a tee Chairman Dan Rostenkowski, D Going is slow, A\C CUnton ally. "I think we've 111., faces possible indictment And got more momentum now." key comminee chairmen — such as "» . ' ReadinRegardlesg C s of arguments over pol Sens. Edward Kennedy, D-Mass., icy and politics, the most imponant and Daniel Patrick Moynihan, D- but compromise thing happening on Capitol Hill now N.Y. — lace re-election. is in the works is the process. Comminees are meet • Taxes Rostenkowski, for one. Bv Richard Wolf and Judi Hasson ing publicly and privately, arms are argues that a broad-based tax will be USA TODAY being twisted, deals are being struck. needed to pay for comprehensive "It is a very large undertaking health-care reform. But moderates A multiple choice question: both from a substantive point of view and conservatives oppose any such a) President Clinton's health-re and from a procedural point of tax increase form plan is dead. view." sax's White House deputy • Timetable. The calendar has b) Congress is likely to pass health chief of staff Harold Ickes. "Given slipped already, with no major com reform this year. the sue and complexity, we think minee bills likely to win passage by c) Both the president and Con enormous progress has been made." Memorial Day. With a four-week va I gress will be back at the drawing Opponents see it differently, insist cation looming in August and leaders board in future years. ing any eflort by Democrats to put hoping to adjoum by early October, O •inton's plan back together again d) All ofthe above. time is running out. < If you chose (d), you win: live will fail Tbe only package capable Clinton, for one, still wants action more months of watching Washing of passing, says Sen. Phil Gramm, R- this year. "We need to do it in 1994, ton's best and brightest squabble Texas, is a smaller one that can gain not later," he says over purchasing cooperatives and bipartisan backing. (A price controls before their inevitable "You have to put together a cen But the public may be more pa Oi decision to do some now, more later. ter-right, Republican-onented bill." tient A recent USA TODAY/CNN/ Gallup Poll showed nearly 6 in 10 A<- the health-care reform debate says GOP pollster Pill MdnturB. Oi s•"ft« into high gear on Capitol Hill, That implies more of a one-step-at-a- Amencans want health-care reform 'j-.e ground is beginning to shift. Be- time approach than Qinton prefers. handled on a gradual basts over sev \ ond the partisan rhetoric, lawmak The roadblocks to reform: eral years. Harvard University professor ers, lobbyists and administration liai- • Policy While Democratic lead Iin • are laving the groundwork for a ers and comminee chairmen are in Roben Blendon says voters have CL ; :;b!e compromise. Clinton's comer, the rank-and-file is "grown more cautious" about health "What we're seeing at the moment running from such elements as em- care reform while weighing its possi I i-- the staking out of territory," says ploser mandates and price controls. ble effect "People got nervous and p^sician James Todd, executive • Politics. All House seats and said, "Why not be cautious and work vice president of the American Med one-third in the Senate are up for re this out,'" he says. ical Association. "Sometime in the election, and interest groups ranging That caution is winning suppon in next week or 10 days, people are go from doctors to insurers to small Congress, particularly among mod ing to decide what the common over business owners are lobbying hard. erates who will control the fate of lap of that temtorv is and begin to • Personalities Major players are health care reform. come up with a consensus bi1' " leaving Congress or face tough chal "We're not sure how this experi Since Clinton proposed the Jump- lenges. Senate Majority Leader ment is going to work," says Sen. ry Dumpty of health-care refonn last George Miichell, D-Maine. is retir John Breaux. D-La. "So let's start it October — a 1.342-page plan to re ing House Ways and Means Commit- off gradually ... ar.d then see what is make one-seventh of the US econo left to do in the next Congress." mv — it has been in a free fall. But make no mistake: Whether working from Chnton's roof down or from the foundaoon up, Congress stiii is likely to patch together a sub On 3 panels, a lack of consensus stantia] package of reforms this year. By Richard Wolf ease the burden on small business And the issue will resurface in 1995. USA TODAY • Tbe Senate Finance Commit "My political judgment is that tee, with a bare-bones 11-9 Demo menbers can't go home without it," A coaJrtion of moderate Demo cratic majority, is so fer from > Bill Gradison, a nine-term Re crats threatens to Mock the House agreemenl it's tossing out Ointon's publican congressman who resigned Ways and Means Committee from plan and starting from the ground las; year to head the Health Insur enacting a bealth-care refonn plan up with Insurance-market reforms. ance Association of America, Clin to President CUnton's liking. "Nothing turns out to be easy," tons most well-financed antagonists. Chainnan Dan Rosienkowski, D- fays Sea Daniel Patrick Moynihan, "They don't have to do it all ju 1994 DL, said Wednesday that "fve or D-N.Y., finance panel chairman. . but they have to do something" six" Democrats on his committee Tbe problen; on Ways and That view is shared by Democrats have balked at a com Means isnt the con and Republicans, nearly all of whom prehensive refonn troversial employer are co-sponsonng at least one bill. pian he favors. mandates. Moderate And polls continue to show public With a 24-14 Demo Democrats are support for expanding coverage and cratic majority and no squeamish about a controlling costs, Clinton's top goals. Republican support, proposed Medicare StiL Clinton's plar, is cemfiably Rostenkowski must program approved dead. It received no votes in the have 20 Democrats on by tbeir health sub House Ways and Means Comminee's his side fo- a plan that committee, price heallh subcommittee, the only panel includes employer- controls and Rosten to pass a plan so far. Its three most paid insurance, price kowski's call tor a contentious components — forcing controls, higher taxes broad tax Increase. employers to pay for coverage, cap and an expansion of Tt b a slow ride ping insurance premiums and pool Medicare to cover the beck to the 1960s," ing consumers into purchasing uninsured. says Rep. Michael groups — face stifl opposition. Tm going to have Andrews, D-Texas, The process of scaling back Clin to convince them If ROSTENKOWSKJ: Try of the plan spon ton's plan gives a false impression of I'm going to get a bill ing to sway key votes sored by health pan doom, however The building blocks out of commiaee," he el chairman Rep. of healih reform — insurance said after tbe panel opened debate Fortney "Pete" Stark, DCalif. changes, administrative streamlin Wednesday. "We need a private-sector, com ing, malpractice reforms, even some The vote shortage puts the Ways petition-based system," says Rep cost controls and purchasing groups and Means Committee in the same Peter Hoagland, D-Neb. Tf we — enjo\ broad suppon in Congress f shape as two other key panels: move too quickly or with too heavy And Clinton is sucking by his de-1 • The House Energy and Com a band of government, we tace the mand that all .Americans be" covered. | merce Commiaee is one vote short danger of rtamaging what we set "We've taken a shelling for aboul r of a majonty needed to advance a out to tx." six months a", we're st::: there." health-care plan twice amended by chairman John D:^" D-Vic1-. tr bc-health congress (wap) (ATTN: National editors) Legislators, Home on Break, Face Pressure on Health Care Reform (Omaha) By David S. Broder and Dan Balz= (c) 1994, The Washington Post= OMAHA First came the delegation from the American Association of Retired Persons (AARP), seeking assurance the long-term care and prescription benefits promised by President Clinton will be in the health bill passed by Congress. Next Rep. Peter Hoagland, D-Neb., sat down with executives of 10 major insurance firms, eunong them several of the city's largest employers. They wanted to be sure the legislation will keep them in business, impose no price controls on their policies and rid them of the increasing threat of restrictive state regulation. Immediately afterward, Hoagland returned to his office to find 10 labor leaders, led by the state AFL-CIO president, waiting to tell him to support a requirement that all employers buy health insurance for their workers and to fight taxation of health benefits. Hoagland's situation is typical of the cross-pressures nervous incumbents of both parties faced at home last week ori their last break before House and Senate committees must make critical decisions on health care legislation. The 52-year-old third-term congressman, an uncommitted swing vote on the Ways and Means Committee and a politician who carried his district with just 51 percent of the vote in 1992, took it all in stride until he was most of the way through the meeting with labor. He had tried to give each group some comfort, while making it clear Congress could not satisfy all their demands. Suddenly he found himself talking about his own quandary. '"This Congress, we've already made so many tough decisions,'• he said. "Assault weapons. The Brady bill. The budget. Tax hikes. The stimulus package. What else?'' NAFTA,'' prompted one of the unionists, a reminder of Hoagland's vote for the trade pact bitterly opposed by most of the people in the room. "Right,'1 Hoagland said ruefully. "You know, I used to think the fault lines in politics ran between the Republicans and the Democrats or the liberals and the conservatives. Now,•• he said, drawing -n imaginary line from his navel to the top of his nose, "the fault lines runs right through yours truly.'' In Massachusetts, freshman Rep. Peter I. Blute, R, waa trying to balance conflicting constituent demands while looking out for his political survival in a district that tilts decidedly toward the Democrats. "I predict we will see some type of reform bill in October,'' Blute told senior citizens eating lunch in a Plainville, Mass., church basement. "I think it will be a much more modest plan than originally envisioned.'' But his potential Democratic opponents are prepared to make an issue of health care if Blute supports something they see as too modest. He is under pressure from major health maintenance organizations in his district to support something more significant than many conservative Republicans in Congress may like. Hoagland is one of four Ways and Means Democrats who have withheld the votes needed to clear a variant on the Clinton health plan, and his position has made him a special target for pressure. While meeting with retirees, insurers and labor, his office phones periodically were ringing off the hook. Opposing lobbies the pro-Clinton Health Care Reform Project and the anti-Clinton Citizens for a Sound Economy were running radio and TV spots that included his Omaha office phone number. "You can tell when one of them goes on,'' said a harried aide. "All the phone lines light up.'• Hoagland said he finds the public's response to advertising simplicities "distressing.•1 But the sophisticated people in the three delegations that came to plead their cases were having problems figuring out just what they want done. "We met before ve vent in to see him, and ve don't all agree among ourselves,•' said AARP member Jerry Austin. "I hope they (members of Congress) just use their common sense.'• Frank Barrett, a lawyer vho put together the consortium of insurance executives, said, "It took us tvo years to get vhere ve are-and there are still differences among our members.'' But the public's ambivalence and interest groups' conflicting agendas make Hoagland's job tougher, not easier. What he is saying, vith different emphasis for each group, is that he cannot support the Democratic bill the Ways and Means health subcommittee put before the full panel, the bill acting Chairman Sam Gibbons, D-Fla., said he vants to use as his starting point vhen Congress returns from its Memorial Day recess. That bill would expand Medicare to bring in what Hoagland said could be as many as 100 million more people. "I think ve should give managed competition and the marketplace much more of a chance before ve expand the government,'' Hoagland said in all his meetings. Hoagland vill vote for employer mandates, vith big escape hatches for small business and retail firms. That makes labor, AARP and the insurance executives happy, but not the small merchants he met vith the previous day. But he also said he does not see the votes to pass mandates this year, something none of the other three delegations vanted to hear. He said he thinks Sen. John H. Chafee, R-R.I., is right in saying that insurance reforms and managed competition should be required to produce projected savings before Clinton's promise of universal coverage is implemented, "even though that means a real delay in reaching an important objective.'' But he does not support Chafee's requirement that every individual buy health insurance. "We should take the first step this year,1' he said, "and realize ve'll have to come back to this issue in every Congress to come.'' That is not a position that fully satisfied anyone, espepially not seniors and unionists who are at the heart of his constituency. "It's going to be very hard to do something that makes sense to everyone.'' Blute, like Hoagland, favors a go-slow approach this year and feels pressure for significant reform has waned. ""It's somewhat faded as a major issue,1' he said. ""Crime has overtaken it.'' That was evident in Plainville, when he talked to senior citizens. After outlining his views of health care and talking about other issues, he asked for questions. No one asked about health care. ""The seniors don't know where it's going or what it's going to cost them or whether they'll be covered,•' said Pauline Kirby, who heads the Plainville Council on Aging. ""They're more worried than enthusiastic.'' — Broder reported from Nebraska, Balz from Massachusetts. **** filed by:LAWP(—) on 06/06/94 at 02:18EDT **** **** printed by:WHPR(160) on 06/06/94 at 07:21EDT ***•* Battlers in health care war shift targets (HCRP), said the Memorial Day make it absolutely clear that mem publican National Committee. recess "could be the last one be bers of Congress mus! be held ac- Spending $500,000, the RNC is Two new panels fore the major committees pro counlabk "or s|>ons< ring health running ads in 10 selected ni.u ^ duce bills for the floor but one care legislation that will give their kets, as well as nationally onCJ take the hot seat never knows." constituents less coveiage than promoting such relbrm^^f^being "We are coming down to the they receive," said (Jail 'Dratch, able to keep an msufance policy point where if it doesn't happen ClIS^execulive director even if sompwrte loses a job or By J Jennings Moss soon, it's not going to happen at On the opposite end philosophi change^etfiployers. THt MMSHWaiON TIMS all," he said cally is Citizens for a Sound Leon wanted to make the point Between the last congressional The HCRP, the most active omy (CSK), a grass-roots lohhying fiat Republicans are in agreemenl recess in early April and the one group advocating President Clin group that is running televi>«ifi and we think there are a lot of that ends tomorrow, those who are ton's proposal to require busi and radio ads in Ixiuisiana^New Democrats in agreement that at trying to influence the health care nesses lo pay most of their work Jersey and Nebraska Those states tins stage, there's a lot we can do reiorm debate have shifted their ers' health insurance, last week also are being targeted by the . . without Clinton's government public relations strategy to target began a $500,000 campaign of ra HCRP in the hope of influencing run system," said RNC spokeswo- a different group of lawmakers. dio and newspaper ads in 10 key Senate Finance members John jnan Anne Gavin. Last time, members of the congressional districts and states, Breaux of Louisiana and Bill Brad For its part, the White House is House Energy and Commerce as well as direct mail and public ley of New Jersey and Ways and relying on visits from Cabinel Committee were the prime targets rallies. Means member Peter Hoagland of members to key districts to dis of most of the advertising cam The ads make the point that all Nebraska, all Democrats. cuss health care and counting on paigns. This time, the focus is on Americans should have the same The CSL ads say tax increases, the free media coverage such vis members of the House Ways and choice of health plans and the unemployment, waiting lines, loss its bring. The activity of Cabinet Means Committee and the Senate same benefits as members of Con of choice and rationing are the members during this break, how Finance Committee. gress receive, both of which are "price we must pay for so-called ever, was less intense than the two The reason for the strategic extensive. universal coverage." Mr Clinton week Easter break partly because change is twofold, according to Relying on the same message is has said lie would veto a bill that of several of them are taking part those who manage the ad cam the Campaign for Health Security did not provide health benefits for in the U Day celebrations in Eu paigns. First, it reflects the atti (CHS), part of the public interest all Amei iw:iis rope. " lb the best of my knowledge, tude that the most influential com group Citizen Action But rather "Congress is at a different stage mittees in the debate are Ways and than target key Democruis, the this is the first time anyone is tak ing on the issue of universal cover than they were at the Easter recess Means and Finance, with an em group is running 60-second radio because now you hit ve committees phasis on the latter. And it's also a ads in the states of seven Republi age head-on," said CSE spokesman Brent Bahler. So far in the health actually engaged in the process," pragmatic use of resources, be can representatives and senutors, said Lorrie McHugh, the adminis cause targeting a lawmaker more including Senate Minority Leader debate, CSE has spent $650,000 to influence public opinion. tration's health care spokeswa than once can be counterproduc Boh Dole of Kansas and rjnking man. tive. Finance Committee member Bob Also mounting an ad campaign, Bob Chlopak, spokesman for the Packwood of Oregon. although not tied directly to the • Kurcn Riley LDiiinbutcJ to this Health Care Reform Project "We are running these ads to congressional recess, is Ihe Ke rfiuirt. ©JC UllWljilUltu., gjmc<, . MONMY. JI'NI- 6. JWJ PM-NE- Health Care,510 Employer Coalition Rallies Against Clinton Plan jjajmr2 By JASON AUSLANDER= Associated Press Writer= OMAHA, Neb. (AP) If President Clinton's health care reform plan becomes law, businesses will be forced to either increase prices or lay off workers, says a coalition that claims to represent more than 1 million employers nationwide. The Coalition For Jobs and Health Care met with Rep. Peter Hoagland, D-Neb., on Wednesday at an Omaha hotel and urged him to support a different health care reform plan. After the meeting, the group held a news conference. Those business leaders present said the employer mandates in the plan, which would force employers to pay for their employees' health insurance, would force them to lay off workers. Dwayne Richard, president of the Nebraska Retail Federation, said that if mandates are put into effect, 5 percent of retail industry jobs in Nebraska would be lost. "We don't believe that national health care reform should come at a cost of thousands of jobs,•' Richard said. Another employer, Mark Anthony of Ryder Systems Inc., said the Clinton plan would triple the amount he now pays for health insurance for his employees. "They (the mandates) would cut down on what we can do for them in the future and that doesn't represent what we can do for America,•• Anthony said. The employers said they could increase prices, but most operate in competitive markets that would make such an action impossible. The only other option would be to lay workers off, they said. Employers from such businesses as the Marriott Hotel in Omaha and a local painting company called the Clinton plan "detrimental1' and ""devastating'' to their business. Hoagland, who didn't attend the news conference, said in a later telephone interview that the employers provided good arguments against the mandates, though he wasn't sure which congressional plan he would support. Most of the employers at the meeting don't provide health insurance to all their employees because many own or run businesses with high turnover rates, Hoagland said. Some of the options he talked about with the coalition included a six month waiting period before the benefits would go into effect, gradually phasing the benefits in or not having the mandates at all. ""We're searching, now, for things that will work for Nebraska,'' Hoagland said. In a letter to Hoagland, the coalition said, ""The employer community strongly supports health care reform, but will vigorously oppose employer mandates because we believe reform should not come at the expense of the economic health of American business and its employees.•• Hoagland said he doesn't support any particular health care reform plan yet, but thinks the one Sen. Bob Kerrey, D-Neb., recently signed on to is a good way to go. That plan, authored by Sen. John Chafee, R-R.I., doesn't contain employer mandates. Hoagland said that if a health care reform bill is passed this session, it will be similar to the Chafee plan because it will have to cross party lines and appeal to moderates. The Coalition For Jobs and Health Care claims to represent more than 1 million employers and trade unions with 40 million employees from large and small companies in all 50 states. **** filed by:APW-(NE) on 06/02/94 at 01:56EDT **** *•** printed by:WHPR(160) on 06/02/94 at 07:06EDT **** BC-NE—Hoagland-Rostenkowski,250 Hoagland Surprised At Severity of Charges Against Rostenskowski jjajmrl OMAHA, Neb. (AP) Rep. Peter Hoagland said Wednesday that he was surprised at the extent and severity of the charges his colleague Rep. Dan Rostenkowski, D-Ill., was indicted on. The Nebraska Democrat said it has been common knowledge that Rostenkowski was experiencing some fallout from a House Post Office scandal, but the fact that Rostenkowski was indicted on 17 charges surprised and disappointed him. Hoagland said he has worked with Rostenkowski quite a bit lately because they both serve on the House Ways and Means Committee. Rostenkowski was chairman of the committee until he was indicted. "I think the important thing is that he not be given special treatment,1' Hoagland said in a telephone interview from Omaha. Rostenkowski was indicted by a federal grand jury Tuesday after he chose to fight the charges instead of agree to a plea bargain offered by prosecutors. He maintains his innocence. The grand jury indictment said that Rostenkowski hired ghost employees, including some who performed personal services for him; had some of the ghost workers to kick back part of their paychecks to his office; asked a witness to withhold information from the grand jury and obtained cash illegally from the House Post Office. Rostenkowski is one of President Clinton's main allies in the health care reform debate and some have said the charges could jeopardize getting a reform bill passed this session. Hoagland said such statements are an exaggeration. "Congress is just as likely to get a bill out as before,'' he said. **** filed by:APW-(NE) on 06/02/94 at 01:53EDT **** **** printed by:WHPR(160) on 06/02/94 at 07:06EDT **** Health Bill Fimding Snarls House Panel Support of 'Employer Mandate' Shaky By David S. Broder and Dana HEALTH. From Al ment, the chairman realized that the Wutajtm POM Sufl Wntm 3£ on Congress to revisit the issue at tobacco tax rollback—key to his ef An abrupt adjournment of the some later date. forts to woo Payne as a possible sub House Ways and Means Committee However, in the House Gibbons is stitute for McDermott on final pas yesterday signaled that the struggle puslung ahead with a bill that would, sage—was in trouble. So Gibbons he to deliver on President Clinton's at least on paper, guarantee insur adjourned the committee. promise of health insurance for all ance to all through a mandate re It was also Thomas who taunted Amencans has become almost as quiring employers to pay 80 percent the Democrats about the "black hole tough in the House as in the Senate. of the cost of insurance for their em of the Senate," a fear that many of With Republicans taunting com ployees. Yesterday's Ways and them had voiced after the Movmhan- mittee Democrats that it made no Means session began with the defeat Packwood meeting with the presi sense to send a provision requiring of a Repubbcan anti-mandate amend dent. For months, House Democrat all employers to buy health insur ment, with onlv four Democrats de ic leaders have promised their mem ance for their workers to likely de fecting and a 20 to 18 majonty back bers that they will not be asked to feat in "the black hole of the Senate," ing the chairman. vote for politically controversial Democrats shut down the commit But then trouble began with what health plan provisions that have no tee rather than nsk losing a vote Rep. Mike Kopteski (D-Ore.) called chance of surviving in the Senate. that they had hoped would solidify .an "Elmer's glue" amendment de The Moynihan-Packwood declara their shaky 20 to 18 majonty for an signed to comfort small busmess and tion raised fears that the Senate "employer mandate." tobacco interests and thereby solidi would emasculate any measure the Acting Ways and Means Chainnan fy the shaky majonty. House sends it. Sam Gibbons (D-Fla.) said he would The proposal offered by Rep. Wil try again today if he thinks be can "Across tne board (the announce liam J. Jefferson (D-La.) would cut win. The Ways and Means panel is ment) doesn't help," said Rep. Bar struggling to avoid the plight of the the costs to small employers in half bara B. KennelJv (D-Conn.), a Wavs equally pivotal Senate Finance Com and give a smaller break to firms and Means member. "But we're still, mittee, whose leaders told Clinton wuh 25 to 49 workers. That was the in our heads, saying we've got to ao Tuesday that their committee was concession Jefferson and Rep. Peter this." deadlocked over how to finance uni Hoagland (D-Neb.) were promised in "I think the whole world is waitLi? versal coverage. return for thetr opposition to Repub for the Senate Finance Committee.'' The news from the Senate Fi lican amendments on Tuesday. A said Rep. Jim Cooper (D-Tenn.). The nance panel "could have an effect on separate section of the Jefferson Fmance Committee met m closed- members on the (House] floor," said amendment, trimming the proposed door session yesterdav to begin to Ways and Means member Rep. Rob increase in the federal cigarette tax try to put a bill together, but mem ert T. Matsui (D-Calif). "It is really from 60 cents a pack to 45 cents, bers said it is far from cenam they unfortunate," he said. "We don't was aimed at wooing support from will be able to. want to get Btu-ed again." He was Rep. Lewis F. Payne Jr. (D-Va.), Republicans have been increasing referring to the energy tax in Clin who has 5,000 tobacco growers in the pressure on their members nut ton's five-yearbudge t package nar his distnct. to senously engage in efforts that rowly passed by Congress last year, Jefferson would offset the $36 bil might fmd bipartisan approval. a tax that House members reluctant lion cost of these concessions by Sen. James M. Jeffords (R-Vt ). ly supported, only to see the presi postponing the start of long-term the only Republican to vote with dent abandon it immediately tn the care for the aged by three years. Democrats last week for a Clinton- face of Senate oppositwn. Several members made it clear they hke bill in the Labor and Human Re At a Tuesday evening White would have to swallow hard to ac sources Committee, said Republi House health care meeting and again cept that. cans tried hard to get him to vote in a public statement yesterday, But Reps. Jim McDermott (D- agamst the bill. Clinton reiterated his flexibility on Wash.) and John Lewis (D-Ga.), both Rep. Fred Grandy (R-lowa) said the means to achieve universal cov pan of Gibbons's coalition, attacked his "marching orders" had been erage, but not on the goal, the tobacco tax rollback. McDer made very clear by House Minority mott. the leading advocate of a sin Tm not convinced" the Senate Fi Whip Newt Gingrich (R-Ga.) and nance Committee proposals "would gle-payer or Canadian-style health that, reluctantly, he has agreed not achieve universal coverage," Clinton plan, went further, warning Gibbons to offer an amendment he had said yesterday. "1 made dear that I that he would not vote for the chair planned to inuoduce in Ways and was very flexible on how to get man's bil] on final passage unless it Means. "It's disappointing," said there, how to solve this problem... was strengthened. and that's still where 1 am." Grandy. "We now have a leadership When Rep. Bill Thomas (R-Calif.) that preempts policy with politics. The proposals presented to Chn signaled Gibbons that he would ask My thrust on health care was not to ton Tuesday by Finance Conunittee for separate votes on each of the fmd the best Republican advantage Chairman Darnel Patrick Moynihan provisions of the Jefferson amend but the best policy." (D-N.Y.) and ranking Republican Bob Packwood (Ore.) would allow voluntary measures to reduce the number of uninsured Americans and, if those did not work, would call up- THE ^USHINCTOV PO«TTHIHSDO. JIM: 16. 1Q(U See HEALTH, AIS, CoL 1 ^Date: 06/17/94 Time: 15:55 Democrats Accuse GOP of Blocking Health Bill, GOP Urges Compromise WASHINGTON (AP) In an atmosphere of intense partisanship. House Democrats charged Republicans on Friday with obstructing passage of health reform legislation. GOP Whip Newt Gingrich called for a compromise stripped of President Clinton's xxbig government'' approach. While Democrats labor to advance Clinton's proposal through balky committees, Gingrich said he had urged Republicans in the House to forget about improving it. **To say, xWhy don't you go for 40 percent socialized medicine instead of 100 percent socialized medicine goes against everything our constituents believe in,'" he said. *xHis bill is dying." But Democrats pounced on his attitude as evidence of obstructionism on the top item on the administration's agenda. House Speaker Thomas Foley said House Republicans were pursuing a strategy of ^flat opposition to achieving health care legislation," and added that their ^mask of cooperation" had been removed. Majority Leader Richard Gephardt, D-Mo., told reporters that Gingrich's strategic advice showed the ^Republican effort seems to be to stop any bill." The Democrats leveled their attacks as the Republican National Committee announced it was airing a radio advertisement aimed at Rep. Peter Hoagland, D-Neb., for voting to uphold a requirement that most employers help finance health insurance for their workers. ^This mandate with its huge payroll tax will hurt the economy and cost jobs," said the ad. The political activity came as the panel continued work on a measure patterned on Clinton's proposal, voting 3 6-2 to let businesses with 100 or more workers self-insure. That was a change from the threshold set at 250 in draft legislation presented by Rep. Sam Gibbons, D-Fla., the acting chairman. Democrats earlier had closed ranks and rejected, 24-14, an attempt by Rep. Bill Archer, R-Texas, to allow any individual or group, no matter how small, to self-insure. x*Nobody would insure until they got sick," Gibbons protested. The Ways and Means panel is the central arena in the House for Democratic attempts to fashion a bill modeled on Clinton's proposal for private insurance for all Americans. In contrast to the Senate Finance Committee, where bipartisan efforts are under way, House Democrats are assuming they will have no Republican help in passing a bill. Because of diverse views within the party's caucus, this has greatly reduced maneuvering room, particularly along the lines of the employer mandates, the tobacco and other tax increases that Clinton's plan would require, and his proposals to impose government price controls on medical costs. At the White House, senior aides emphasized Clinton is determined any health plan provide coverage for all. *xThere is no doubt that all the things we are trying to achieve are rooted in universal coverage," economics assistant Robert Rubin told reporters. Gingrich's advice to fellow Republicans was relayed on Wednesday by Rep. Fred Grandy of Iowa. He said Gingrich, who is certain to become Republican leader next year, had urged against offering an amendment that would have made some workers pay income taxes on a port-ion of their health benefits. Grandy complied, but said it was a case of politics triumphing over policy. Democrats swiftly used the information in two ways first by rallying Democrats on the Ways and Means Committee behind a key amendment. Then, when The New York Times carried a story on Friday saying House Republicans were trying to keep health reform legislation from passing, they pounced. -A ^It's clearer and clearer to me every day that the agenda on the other side is to not have a bill," said Gephardt. *xThe Republican effort seems to be to stop any bill." Gingrich countered swiftly. ^That's plain not true." Speaking on the House floor, he read aloud the first paragraph from the story, which said Republicans were trying to keep health reform from reaching the floor in a form that can pass. **Now that paragraph's just plain factually wrong,'' he said. xxIt is true; we are opposed to the Clinton health plan. We believe the Clinton health plan is big government, big bureaucracy, big taxation.'' He called on Democrats to begin bipartisan talks based on a measure that has the support of 70 House members, 35 from each party. It includes insurance reforms that would limit insurers' ability to deny coverage on the basis of a pre-existing medical condition; restrain medical malpractice awards; and create a network of community health centers for the poor and uninsured. But unlike the approach favored by Clinton and the Democratic leadership, it doesn't require any individual or employer to purchase insurance; neither does it mandate a minimum set of benefits that all insurance plans would have to provide. Gephardt said if legislation is limited to insurance changes, xxyou'd increase premiums for all American and they get nothing in return.'' ^The American people want ^fundamental reform," he said. APNP-06-17-94 1554EDT Clinton s Senior Advisers Are Divided Over Strategy for Passing Health Plan By JEFFREY H. BDLVBACM Republicans once also expressed support are healthcare reform that already And DAVID ROGERS for universal coverage. And other Demo "OrK5. Sra// Reporter! of THE WAU. STREET JOURNAL cratic leaders are putting rhetorical pres rJ^, ^sociatlon also plans to blitz the WASHINGTON-With time running out sure on GOP moderates. on the legislative clock. President Clin House Majority Leader Richard Gep doctors and nurses to rally and meet with ton s advisers are still split over when and hardt, for instance, suggested to reporters how much to compromise the president's that the GOP was marching in "rote, eluding HMOs, are cunently battling phv- health-care plan in order to get it passed unified opposition" on health care and had sioan groups and other health-care Jm- this year. reverted to the domestic policies of the Mr. Clinton's top legislative and politi defeated Bush administration. "Republi cal advisers are counseling him to resist cans know what they're against," the compromising too quickly, arguing that Missouri Democrat said. "They don't know the public wants sweeping health-care what they're for.'' At the same time, more conservative Senators' Stockholdings GOP groups are urging the members of At least eight members ofthe two princi their party to pull out of health-care discus pal Senate conunittees crafting health sions altogether. Empower America, a legislation held stocks last year that group that represents former GOP cabinet might be affected by their actions. Arti officers such as Jack Kemp and William cle on page A4 In related coverage: Bennett, put out a release declanng the • Community-rated health plans are president "has run out of time" on health linked to universal coverage. A20. care, and urged that any consideration of changes and that voters will blame the legislation be postponed until after the 1994 Republicans if they don t get them. elections. But some of Mr. Clinton s economic At least some members of Mr. Clinton's advisers are fighting to persuade him to economic team, who have felt from the start making deals now in order to break beginning that Mr. Clinton's proposal was the logjam in Congress. The longer the too ambitious, would be comfortable with a president waits, they warn, the greater compromise that fell short of that plan. But the chances he won t get any bill at all. the White House has yet to coalesce on a strategy to achieve a compromise with Narrow Victory at a Cost Congress, if one is possible. The president, who will meet with con At the Ways and Means Committee, gressional leaders from both parties today, Democratic Reps. William Jefferson of did get some modest good news yesterday Louisiana and Peter Hoagland of Ne from the House Ways and Means Commit braska said their support for an employer tee, where a narrow Democratic majonty mandate was conditional on the commit voted 20-18 to uphold Mr. Clinton's pro tee's later providing a more generous posal to require employers to pay for their credit for small businesses. "It's not just workers insurance. But the victory was Republican rhetonc. Sometimes they're costly, the committee had to promise that right." said Mr. Jefferson, whose district billions more would be pumped into a in the New Orleans area includes a large proposed tax credit to help small, low-wage constituency of small, often low-wage busi businesses cover the costs. nesses. "We just can t impose these costs Meanwhile. Senate Republicans appear Pfeose T^m ro Page A8, Column 5 prepared to block any significant progress on the administration's ambitious initia wfibout having some impact." tive. The president met yesterday with As now proposed, the maximum credit Chairman Daniel Ptff$ Moynihan (D.. In ttieeommittee' s bill seeks to cover about N.Y.) of the S«nat^lliance Committee 25% of the health-care costs imposed on and Sen. Bob Packwood of Oregon, the small, low-wage firms. But this would still panel's ranking RepuMican. who informed mean employers could be faced with added him that there is not now a majonty for costs equal to about 60 cents or more an any health-care reform plan in the Senate hour per worker. Finance Committee,'' according to Sen. Rep. Gephardt said yesterday that if Moynihan. health reform passed. Congress would be Sen. Packwood offered the president a responsive and put off future increases In compromise plan. But he acknowledged the minimum wage to offset the cost. But that plan fell far short of the president's Rep. Hoagland said he is seeking an goal of universal coverage.'' and would expanded credit equal to about 50% of offer only a marginal improvement in mandated health-care costs for the small insurance coverage beyond today's levels. est firms with 25 or fewer workers. Initial In an almost taunting fashion, the Oregon estimates indicate the proposed change moderate said that the administration and other concessions for small business must now decide whether it wants a health could add at least $3 billion a year in care bill at all this year, or just an issue subsidies. going into the fall elections. However welcome for the beleaguered Trigger' Options Are Pushed White House, yesterday's Ways and The president encouraged the two sena Means vote is only the beginning of com tors to look at various "trigger" proposals mittee debate, and the new acting chair as a means of compromise. Under such man. Rep. Sam Gibbons, faces further plans, Congress would pass a bill without defections on the sensitive issue of cost requiring employen to pay for health-care controls. With Republicans solid In opposi coverage. But if the legislation didn't suc tion, the Florida Democrat can't afford to ceed in getting coverage to a high percent lose more than four of his coUeagues at a age of Americans over the next few Ume and must live by his wits and a years, an employer mandate would then be narrow, rolling majority to prevail in each "triggered" into place. case. Administration officials say they would Separately, the Group Health Associa accept a trigger, provided it was written tion of America announced the launch of into law now and didn't require a congres yet another entry into the health-care sional vote later to be activated-the so- advertising ware. The association, whldi called hard trigger. Sen. Packwood's plan represents more than 360 healtb-mainte- would require Congress to vote at a later nance-organization companies, said It date on whether to put a mandate into would spend an initial SI million on inside- place-making it a "soft trigger." the-Beltway print ads and television spots GOP Moderates Under Pressure on the Cable News Network and Sunday White House political and legislative moming news shows. The message: HMOs strategists continue to cling to the belief that Republicans will eventually soften In their opposition. Mr. Clinton himself re- i minded Sen. Packwood that at least 20 .rr-CnA V n'NE 15. PHOTOCOPY PRESERVATION Page 14 ROLL CALL Thursday, June 16,1994 Political Bnefing Missouri: Hardy ing the combination of factors resulted in "a who was unopposed for the nomination to the House seat heldby freshman Rep. Karen situational depression in Rick that is forcing face freshman Democratic Rep. Tim Hold Shepherd (D), is pushing a combination Quits Volkmer Race, him to withdraw from the race." en (Pa), dropped out after being hospitalized term-1 imits/runoff initiati ve that, if passed by Hardy, 46, was not present at the an for depression. After the May 10 primary, voters on Nov. 8, would take effect immedi Citing Depression nouncement, but said in the statement that it Republicans picked Fred Levering, a real es ately. A highly touted Republican challenger, was "time to find a candidate who is willing tate broker, to replace him on the ballot. The first part of the proposal is a typical University of Missouri professor Rick and able to tackle this difficult, but possible, — Tim Curran term-limits provision: a limit of eight years Hardy, last week dropped his challenge to challenge." for House Members and 12 years for Sena Rep. Harold Volkmer (D-Mo), citing de Hardy was the only Republican to file for tors. But the second part would provide for pression and exhaustion. the seat and his name will remain on the Aug. Utah: Shepherd Foe an early December runoff if none of the gen In 1992, Hardy lost to Volkmer 48 to 46 2 primary ballot, but the 9th district Repub eral election candidates receives more than percent while being outspent by better than lican Committee will be allowed to choose Pushes for New 50 percent of the vote — a strong likehhood three to one, and Republicans thought this a new candidate after that. in this contest, which pits Democrat Shep could be the year they beat Volkmer, in of "I hate to see it end this way," Volkmer Runoff Initiative herd and Independent Cook against Repub fice since 1976. told the St. Louis Post-Dispatch. "I don't If perennial Independent candidate Mer lican Enid Greene Waldholtz. A statement released by Hardy's campaign want to see an opponent or anyone have this rill Cook has his way, a Utah ballot initia Cook has until July 11 to collect the 76,000 last Monday at his Columbia campaign head happen. But I will keep campaigning." tive this fall could send the state's three-way signatures necessary to place the initiative on quarters pointed to the "grueling schedule" Hardy, in fact, is the second GOP candi race for the 2nd district House seat into a De the general election ballot. He told the De- of a Congressional candidate, the terminal ill date to drop out of a race with a Democrat cember runoff. seret News last month that he's placed job ness of his mother-in-law, and the late filing ic incumbent this year citing depression. Cook, who's made two previous unsuc advertisements seeking workers to circulate of a required financial disclosure form, say- This spring, GOP attorney Carl Cronrath, cessful runs for governor and is now seeking his petitions and is willing to pay them 25 cents per signature. There is overwhelming support for term limits in the state, and it's likely the wording of the initiative will be designed to make the most of that support. Republicans in the state, meanwhile, have promised to campaign against the initiative, claiming it is a thinly disguisedeffort to boost Cook's chances of winning the seat at the ex pense of Waldholtz, who narrowly lost to Shepherd in 1992. Cook says he expects his petitions to be challenged vigorously by the office of Lt. Gov. Olene Walker, a Republican, who has responsibihty for certifying the signatures. Shepherd has been quiet on the issue. "We' 11 run against himonce.We'llrunagainst him twice. Bring him on," said Shepherd's campaign spokesman, Paul Svendsen. If the Utah initiative is approved, the state would become only the second in the coun try with a post-general election runoff for Consrress. Genrcna akn hnc cnrh o nmnirinn campaign spokesman, Paul Svendsen. If the Utah initiative is approved, the state would become only the second in the coun try with a post-general election runoff for Congress. Georgia also has such a provision, and its use in 1992 led to the defeat of Sen. Wyche Fowler (D) in a December runoff. THE FUTURE OF — Craig Winneker Nebraska: Polls Show Hoagland America's Schools Trailing Challenger Schools mirror society. Both are American communities. Nationally, Three-term Nebraska Rep. Peter struggling with issues that threaten What programs—many designed and Hoagland (D-Neb) is a perennial GOP tar not only the learning process, but Psychologists Do led by psychologists—are steering get, but this year he may be more vulnerable n Schools human development. Educators young people away from drugs and than ever. Two new polls show him trailing Promote health Repubhcan challenger Jon Christensen by need the body of knowledge that is teaching them to resolve conflicts significant margins. Provide crisis intervention psychology to fulfill their mission. without resorting to violence. Addi One survey, taken June 5 to 7 by the Gallup Psychologists possess an understand Train staff in effective tionally, as part of integrated pupil Organization for the Omaha World-Herald teaching ing ofthe cognitive, emotional, service teams, psychologists newspaper, showed Christensen with a 50 to Test and assess 39 percent edge over Hoagland. The other, behavioral and organizational pro students lend their understanding of how conducted June 2 and 3 by Moore Infonna- cesses important to education. They and why people learn to create more . tion for the Christensen campaign, produced are skilled in the diagnosis, preven effective teaching methods. In pre similar results, giving the challenger a 52 to 36 percent advantage. tion and treatment of cognitive and Issues Psychologists paring young children to begin Deal With in Schools Hoagland was re-elected in 1992 with just emotional processes critical to learn school ready to learn, psychology 51 percent of the vote, and in this year's De ing. Psychologists' work promotes Discipline problems provides the foundation for many mocratic primary, a candidate who filed as a Family dysfunction student welfare and enhances educa successful child development pauper received 27 percent of the vote Violence against him. tional effectiveness and student programs, including Head Start. Depression In the GOP primary, Christensen waged achievement. Suicide an effective grassroots campaign against two Psychology: Fundamental to other more moderate candidates, state Sen. Sexual activity and its Brad Ashford and former prosecutor Ron The National Education Goals consequences education. As the 21st century Staskiewicz, who was making his third at provide a virtual blueprint of the approaches and American education tempt for the seat. important contributions psychology makes faces new challenges to teaching Johnny and Ming Democrats hope to make hay out of Chris- to education. For example, psychologists have and Mary and Carmencita to read, reason, and tensen's ties to the religious right and claim he is a fringe candidate who is unelectable in extensive experience in dealing with the environ think, psychology has considerable knowledge and November. Christensen says he'll paint mental factors which endanger learning in too many experience to contribute. Hoagland as a liberal who's out of touch with the Omaha-based district. AMERICAN Meanwhile, the Gallup poll showed Sen. 750 First Street. NE PHOTOCOPY Bob Kerrey (D) with a comfortable 55 to 37 PSYCHOLOGICAL Washington, DC 20002-4242 PRESERVATION percent lead over former USWest executive ASSOCIATION 202/336-5700 Jan Stoney (R). — C.W. Congress must be held accountable for sponsoring health care legislation that will give their constituents less coverage than they receive." Anncr.: "How can you make sure that health care reform helps you? By urging Congress to guarantee every American health care coverage at work like Congress has. Today everyone in Congress is guaranteed coverage. Has a choice of plans. Prices are affordable. And their employer — that's us — pays a fair share of the cost. The bottom line ... we treat (member's name) and every member of Congress right. But now Congress is debating health reform for the rest of us, and (member's name) supports a bill that gives you less coverage than he has. His bill doesn't cover everyone, and doesn't guarantee that your boss contributes to your insurance. Get it? You cover him at work, but he doesn't think your boss should cover you. Well, that's not fair. So call (member's name). Tell him you've provided him V with good health insurance. Now you want coverage that's as good ^ as his, not less. Call (member's name) at (phone number). Paid Hj for by the Campaign for Health Security" (release, 6/2). CSE: Citizens for a Sound Economy has "targeted" Sen. Finance Cmte. member John Breaux (D-LA) in a $250,00 TV and radio ad campaign intended "to stir up fear over one of President Clinton's key reform goals," universal coverage as well as employer mandates. Cmte. member Sen. Bill Bradley (D-NJ) and House Ways and Means Cmte. member Peter Hoagland (D-NE) have also been "targeted for similar ad campaigns," according to CSE's Brent Bahler. New Orleans TIMES-PICAYUNE reports the Louisiana ads begin today and will run at least through 6/7. Each one urges residents to call Breaux's district offices and ask that he vote against any bill reguiring universal coverage. Excerpts from ads: "Mandated universal coverage. Fancy words for government-controlled health care. Are you willing to risk your future on it?" More: Universal coverage would result in "a big bureaucracy, tax increases, loss of jobs, waiting lines, limiting your right to choose doctors, rationed medical care. ... Creating a large bureaucracy will cost the average family in Louisiana about $6,000." Families USA's spokesperson Kevin Anderson said the $6,000 figure was an "outright lie" and found it ironic that businesses who say they won't be able to afford health insurance, have money for advertising (John McQuaid, 6/1) *6 NURSES: CHANGING ROLES IN A CHANGING HEALTH SYSTEM Balto. SUN notes, "It was a different era of health care reform when the" Visiting Nurses Assn. of Baltimore was founded in 1895. "And against what is happening in today's medical marketplace, the VNA may have outlived its usefulness." SUN notes the VNA's recent sale to a group of hospitals and medical care cos.: "Today the value of the VNA is as a delivery system for the home health care made possible by technology" (Patricia Meisol, 5/31). "An apple a day keeps the nurse away? Don't worry, you'll get used to the idea," writes N.Y. TIMES columnist Anna Quindlen. Quindlen: "One of the most revolutionary parts of health care reform in America is bound to be the burgeoning role that nurses will play, including providing many of the services that were once confined to physicians. Their new prominence will benefit patients — and raise some questions about the importance of tender loving care and the economic value of medical services. While the use of nurses and nurse practitioners in growing areas of patient care will require some adjustment for patients and doctors and some thoughtful resolution of salary issues, it is clearly the future of health Ways And Means Lacks Votes To Move Gibbons' Mark The House Ways and Means Committee today kicked off its first voting session on healthcare reform several votes shy of enough votes to pass the chairman's mark with certain expected modifications, Democratic panel members said beforehand. Acting Ways and Means Chairman Gibbons needs 20 votes to pass a bill, all of which will probably by Democratic, and that means he can lose up to four Democrats. Members said Gibbons was anywhere from one to three votes short of the necessary 20, and that he was working with members on compromises in areas such as price controls and the Medicare Part C program designed to cover much of the uninsured population. Sources identified the tough Democratic votes on the committee as Reps. Peter Hoagland of Nebraska, Michael Andrews of Texas, L.F. Payne of Virginia, Bill Brewster of Oklahoma and Andrew Jacobs of Indiana. Andrews indicated there was little chance he could support the chairman's bill, but he did not rule out the possibility if significant changes could be achieved. Andrews cited as a primary concern price controls in the private sector, and said he had enough votes to remove them from the bill. Both Andrews and Health Subcommittee Chairman Pete Stark, D-Calif., said the change would not be very expensive, and Stark offered a rough estimate of about $1 billion a year. "It's the other side that's prohibitive," Stark said, refering to public sector price controls. Nonetheless, Stark called the idea "irresponsible. It leaves businesses at the mercy of insurance companies. But Andrews never understood much about business, so that doesn't surprise me." Andrews also said he would try for a larger increase in the tobacco tax. Hoagland, meanwhile, who would prefer to eliminate Medicare Part C, continued to work with Gibbons and other members on a way to pare the program. Rep. Jim McDermott, D-Wash., however, warned that "when you restrict Medicare Part C too tightly you get into practical problems" in such instances as job loss. But even if that issue can be worked out, Hoagland said there still were "a lot of other provisions I have trouble with." Many members said they were uncomfortable with the concept of a trigger for mandates, with the harshest criticism coming from Gibbons. "Triggers are for guns, not legislation,11 said Gibbons. The committee today was expected to reject a GOP effort to remove employer mandates from the bill. Jacobs said he could not support any employer mandate. The Congress Daily Tuesday June 14, 1994 £ J> *. ^7s Votes Lacking for Health Plan Financing, By Dana Priest Woheron Pwt Sufi Wrmr — Under the alternativesSenator, if a nation s Tell Clmton al commission determined that vol Leaders of the Senate Finance untary measures had failed to ade Conunittee told President Clinton quately reduce the number of yesterday that they lack the votes to uninsured, then Congress would be pass the key financing element in tus obligated to revisit the issue under bealth care plan. special procedures that would pro Instead, they proposed two alter hibit filibustering and amendments. natives that do not ensure universal But neither alternative would guar coverage, a provision Clinton has antee universal coverage in the end. said any bill must contain or he will White House officials said Clinton veto it did not threaten to veto a bill that ^I'EDVESDAY. Jl NE 13. l^t THF \U»HIM.TiiN PIST The House Ways and Means contained the alternatives, but Pack- Committee, however, gave the wood said the president repeatedly White House the opposite message: questioned the senators rhetorically, that it was moving toward a bill that saying, This is not universal cover would include a requirement that age. This is not universal coverage." employers pay most of the cost of in •We're not convmced" the alterna surance for their employees—the tives proposed "will achieve univer main financingtoo l in Clinton's and sal coverage," said a White House most other committee plans. official who attended the meeting. In its first vote under acting Chair The president is waiting to see." man Sam Gibbons (D-Fla.), the Ways Moynihan held a late afternoon and Means Committee voted 20 to 18 closed-door meeting with his commit to defeat a Repubhcan amendment to tee yesterday. Although it may be eliminate the so-called employer man some time,i f ever, before the com date, with Democrats picking up two mittee can reach a consensus, the previously undecided Democrats, ramifications of yesterday's White Republican amendment to stnp em Reps. Peter Hoagland (Neb.) and Wil House meeting were immediately liam J. Jefferson (La.). A third. Rep. ployer mandates from the bill. dear to Senate and House members Uncomfortable as they were, both Lewis F. Payne Jr. (Va.), has report who have witnessed the indecision edly struck a deal with Gibbons that stuck with Gibbons and the president. and growing apprehension within Jefferson, who reponedly felt strong would get the committee closer to a their ranks on the employer mandate. majority it needs. pressure from New Orleans restau Rep. Jim McDermott (D-Wash.) rants and hotels, said: "I will vote Meanwhile, the House Education said the Finance panel proposal and against the amendment today, but I'm and Labor Committee, the most liber White House discussion of it "could not sure I will tomonow. I have very al of the five committees considering undercut" the difficult Usk of getting great problems with the concept of bealth care bills, voted 28 to 15 along mvHTtiea for an employer mandate. mandates and with the levels (of tax party lines to uphold key elements of es) they require." Hoagland. too, said Clinton's plan, including the employer Packwood said after the White House meeting that Clinton "made no he wanted relief for small busmess, mandate. The Senate Labor and Hu retailers and restaurants. man Resources Committee last week offers but he talked details." He said adopted a similar bill, and picked up Clinton told them "he would just as Gibbons promised publicly that he one Republican vote for it soon we not vote on anything now." would try to find ways to satisfy Also, in a speech before the Packwood, who has supported an them but warned it will be "very League of Women Voters yesterday, employer mandate since the 1970s, hard" to make up the lost revenue. Hillary Rodham Clinton appeared to when he introduced then-President On another front, Gibbons was open the door to a compromise on Richard M. Nixon's version, said he close to agreement with Payne on whether to include abortion in a gov has come to believe the issue "has cutting the proposed tobacco tax ernment-designed benefits package, the same intensity [with opponents] from 60 cents to 45 cents a pack, an issue that could add complications as gun registration or abortion." phased in over five years. Several to efforts to pass a bill. Gibbons's victory in the first test committee Democrats said the deal Asked "Should we compromise on vote since he became acting chair had been made, but Gibbons refused reproductive health coverage?" Hil man of Ways and Means, succeeding to confirm that. Payne said he had lary Clintoo responded: It's one of the indicted Rep. Dan Rostenkowski told Gibbons that 45 cents is "the those questions we cannot answer (D-DI.), was the product of a week of most I can vote for" and said Gib dosed-door negotiations. bons "is very interested, but he right now It is very difficult to wants to be sure it's compatible with tell exactly where we are going to He took a strong stand against the the rest of the committee." have to make whatever compromis amendment to kill the employer man es" are needed to pass a bill date, offered by Rep. Fred Grandy Also yesterday, House Majority In a morning meeting at the White (R-lowa) and backed by all the com Leader Richard A. Gephardt (D- House, Senate Finance Committee mittee Republicans. "If this passes," Mo.), responding to a vow from Sen Chainnan Daniel Patrick Moynihan Gibbons said, "health refonn would be ate Minority Leader Robert J. Dole (D-N.Y.) and ranking minority mem dead for the rest of this Congress and (R-Kan.) to block the employer man ber Bob Packwood (R-Ore.) told the 20th century This is a drop- date, sought to recast the Republi Preaident Clinton that there is oot dead, do-or-die question." cans in the mold of producers (rf con gressional gridlock. now a majority for any health care Needing 20 of the 24 committee reform plan in the mmminrie, after "Republicans... want to continue Democnts for a majority, and know what they were for in the Bush ad a month d bipartisan negotiations. ing that three others in addition to The Finance Comminee is pivotal ministration, which is nothing," Gep Payne were beyond reach on the hardt told reporters. "I don't think because it reflects the composition mandates issue—Reps. Mike An of the Senate. While committee Republicans do themselves any favor drews (Tex.), Andrew Jacobs (Ind.) by repeating that mistake." memben have been able to agree on and Bill Brewster (Okla.)—Gibbons several secondary issues in a bill, bargained hard with Hoagland and Rep. Mike Synar (DOkla.) took a they have deadlocked over the em Jefferson. longer view of yesterday's pro ployer mandate. nouncements. Moynihan's announce Both have strong union backing, ment "was nothing surprising," he Moynihan said he and Packwood but real reservations because of their said. "Everybody is going to be pos told the president they were work small-business constituencies. They turing for the best position In ing on two alternatives; both would combined on an amendment that the end this thing may have 6 heads, give votantary, market-oriented would ease the burdens on small busi 15 tails and 30 legs." measures a chance to reduce tbe ness, but Hoagland said "the liberals percentage of uninsured Americans in our caucus" refused to let Gibbons Staff writers Davtd S. Bnder, to about 4 or 5 percent allow them to offer the compromise Spencer Rich and Kenneth J. Cooper before the up-or-down vote on the contributed to this report. Somber Change at Helm As Ways and Means Meets additional limits on the amount any Gibbons Holds Gosed Session on Health Billlow-wag e firm with up to 75 employ ees could pay for insurance. ness about how easy it will be to get Bingaman. who has worked with a By Dana Priest group of three Democrats and three Wastunpon Post Staff Wntrr the 20 votes to pass the bill out of the committee. "Oh sure, we'll get it Republicans to find areas of compro The elegant gold "ROSTENKOWS- worked out," said Gibbons. "Mr. Ros mise in the bill, was unable to attract KT lettering has been removed from tenkowski." he added when asked, any Republicans other than Jeffords to the dark wood entrance to the private "was very cooperative." support the Clinton plan. sanctum of the chainnan of the House "We've probably got more votes The disagreement over the employ Ways and Means Committee. Rep. than we need," joked Rep. Fortney er mandate runs deep within each par Sam Gibbons (D-Fla.) has moved in. "Pete" Stark (D-Calif.). "We'll be able ty and within each house of Congress. "I don't think minds are going to Rep. Dan Rostenkowski (D-Ill.). to save some for later." change on whether or not to have an Other members said, however, it is forced to step down after a federal in employer mandate," said ranking mi dictment, sat along the side of the ta not at al) certain that Gibbons's bill, nority member Sen. Nancy Landon ble yesterday as Gibbons convened which contains politically controver Kassebaum (R-Kan.). the committee for a private discus sial elements such as price controls Members of the other Senate com and the requirements that employers sion of his health care bill—a version mittee with major junsdiction over the of a plan Rostenkowski drew up. pay for health insurance, has sufficient matter, the Senate Finance Commit Members of the House's major tax- support to pass the committee. tee, said Chairman Daniel Patrick writing committee, most hand-picked "1 fmd it discouraging," said Rep. Moynihan (D-N.Y.) intends to present by the deal-maker from Chicago, de Peter Hoagland (D-Neb.). Members members with a Clinton-style bill to scribed it as an awkward, somewhat said preliminary Congressional Budg day. et Ofifice estimates show the bill would emotional, transfer of power. Moynihan, who has held bipartisan add slightly to the deficit in the first "The meeting started with a very members-only meetings over the last sad feeling," said Rep. Charles Rangel five years and then help reduce it in month to craft a bill, has failed to find (D-N.Y.). the years after that. agreement on any major area of re '1 just hope none of you and your On both sides of the Capitol yester form, from whether or how to guaran families ever in your lifetime have to day, the congressional health care tee universal coverage, to whether or go through what we've been spectacle advanced through an obsta how to have the government control through," one member quoted Ros cle course of personal and policy mis health spending. tenkowski as saying. "But like every haps that more than once have threat "We went as far as we could go with thing else, this too shall pass." ened to bnng it down for good. the informal discussions," said Sen. In the hallway afterward, Rosten On the Senate side, the Labor and Thomas A. Daschle (D-S.D.) The on kowski, looking tired and drawn, Human Resources Committee became ly way we can reach an agreement is joked that he intended to "pitch fun- the first of five committees with major to have some paper before us," mean goes to the Yankee outfield" now that jurisdiction over health to approve an ing a specific proposal. he is no longer chainnan and said he employer mandate—a requirement Other members said Moynihan, ran for Congress this year because, in that aU employers pay most of their who has been alternatively cntical and part, he thought enacting comprehen employees' insurance costs. This is approving of Clinton's plan, believes sive health care reform "could culmi the main financing tool in President the only way to show the White House nate a pretty decent legislative ca Clinton's plan and in four other bills that the votes are not there for his reer." under discussion. style of reform is to put it to the com Rostenkowski, Gibbons and other With all Democrats and one Repub mittee members. members talked with unusual casual- lican—James M. Jeffords (Vt.)—vot "It's a way to show there's not a lot ing yes. the conunittee adopted an of support," said Sen. John Breaux (D- amendment by Jeff Bingaman (D- La.) N.M.) that would ease the cost of thr The Finance Committee has at employer mandate to the smallest eni- tracted considerable attention from ployers and help the government sub both House and Senate members be sidize those workers by imposing a cause it is considered more repre $1.50 per pack tax on cigarettes, the sentative of the Senate in general tax would be in addition to the current than Kennedy's committee and be 24-cent-a-pack federal tax. cause House members fear taking In an interview, Kennedy, who nsky positions that might then be launched his reelection campaign in undercut by Senate action. Massachusetts dunng last week's re Senators said the Moynihan bill will cess, said that the public is skeptical contain new proposals to reform the and angry with federal spending pro msurance mdustry that have biparti grams m general. "It's caught up into san support. The changes will include this as well," he said. laws prohibiting insurers from deny The Bingaman amendment would ing coverage to people after they require low-wage firms with up to 5 have become sick or from carrying employees to pay 1 percent of their their msurance from job to job. It will i payroll costs toward coverage and also restrict how much insurer.-* can ! tirms with 6 to 10 employees to pay 2 charge older or ill customers. • Dercem. The federal government would subsidize parr of tne coverage Moynihan is also preparing a set uf i ior these firms' empiovee> options to be discussed if Cunion - proposal fails in the committee. The;- All otner firms would be reauired to include from now u, reach univi-r.-.;ii pay 80 percent of tne cost of their em coverage or something r ;ar it, tu how ployees' insurance, with workers pav to contam soaring health costs. ing 20 percent. There would also be / Democrats accuse GOP of blocking health care refonn Associated Press "flat opposition to achieving health care legislation." and WASHINGTON — In an at added that their "mask of co mosphere of intense partisan operation" had been removed. ship. House Democrau Majority Leader Richard charged Republicans on Fri Gephardt. D-Mo.. told report day with obstructing passage ers that Gingrich's strategic of health refonn legislation. advice showed the "Republi GOP Whip Newt Gingrich can effort seems tb b$ to stop called for a compromise any bill." stripped of President Clinton's The Democrats leveled "big government'' approach. their attacks as the Republi While Democrats labor to can National Committee an advance Clinton's proposal nounced it was airing a radio through balky committees, advertisement aimed at Rep- Gingrich said he had urged Peter Hoagland. D-Neb.. for RepubUcans in the House to voting to uphold a requirement forget about improving it. that most employers help fi ' To say. "Why don t you go nance health insurance for for 40 percent socialized medi their workers. "This mandate cine instead of 100 percent so with its huge pay roll tax will cialized medicine' goes against hurt the economy and cost everything our constituents be jobs." said the ad. lieve in." he said. "His bill is In a telephone interview, dying." Hoagland said the ad was part But Democrats pounced on of a Republican strategy of de his attitude as evidence of ob feating all health reform mea structionism on the top item on sures. "It pulls out one small the administration's agenda. piece of tbe health care set of '• House Speaker Thomas Fo- issues... and casts it in an ex l*y said House Republicans tremely misleading light." he were pursuing a strategy of said. ^Key Panels Diverge on Employe. Funding of Health Reform ttr David S. Broder and Dana Priest bill that will pass the House, much less middle-of-the-roaders like Hoagland, come out of [a Senate-House] confer is the daunting task facing the House health care legislatkxi continued its ence, but this is where it begins." leadership. "We'll have to have a lot of uncertain course yesterday, with tbe House Majority Leader Richard A. intense caucuses to get people to feel House Ways and Means Committee Gephahlt (D-Mo.), who will lead the comfortable about this," said Rep. narrowly approving a biH that would effort to pass health care on the floor,Barbar a B. Kennelly (D-Conn.), a guarantee health insurance for every- . expresse—r d a degre„ e of optimisr m in an Ways and Means Committee member oaie, white, the Senate Finance Com- I interview yesterday. He said the Ways and deputy House whip. It's a long ^ n*tee reJected even a flayed re- i and. Means bill had removed some shot," said Rep. Benjamin L. Cardin P r^v qqireraent that all employers pay for I "troublesome" features of the Clmton (D-Md.), who helped negotiate pas \J\\^i\tl£ir workers' medical benefits. i plan—notably rigid cost controls and sage in Ways'and Means, "but we -The 20 to 18 affirmative vote in ' mandatory purchasing alliances that have a chance." 0$ Ways and Means ended committee de j would require virtually businesses to , tn Senate Finance, five moderate liberations in the House, making it . join regional insurance purchasing OK Democrats joined the committee's certain that a bill embodying Presi operatives. Asked about the prospects nine Republicans in rejecting the de dent Clinton's goal of universal cover for an employer mandate, Gephardt layed mandate, which would have 4 age, financed largely by levies on busi I said, "I think there will be" a majority gone into effect several years from ness, will reach the floor later this for that in the House. now and only if a prescribed percent summer. But the narrow margin sig But the shakiness of the Ways and age of people had not been guaranteed nals that it faces a tough fightthere . Means Committee vote and the strong coverage by voluntary efforts. It was .At the same time, the 14 to 6 vote ! majority against even a delayed man- supported by six Democrats, including in'Senate Finance against a watered- 1 date in Senate Finance makes that Chairm.in Daniel Patrick Moynihan down employer mandate confirmed prospect uncertain. (D-N.Y.), who had warned the White White House fears that the influential Two Ways and Means Committee House for months that any bill requir panel's bill will not ensure universal Democrats who voted for the bill yes ing employers to pay for worker bene coverage as Clinton has defined it. terday said privately afterward they fits would fail. Sen. John D. "Jay" Rockefeller IV did not expect the employer mandate After rejecting the mandate, the (D-W.Va.), a Clinton ally on Finance, to survive on the House floor and committee voted 12 to 8 for an alter said the "retreat" from universal cov were uncertain whether the Medicare native, proposed by a "rump group" of erage "makes a mockery of health expansion would make it either. three Democrats and three Republi care refonn." Stark, who expressed optimism cans, and included as well in a plan of- Two other committees—House about the floor vote, jokingly told re . fered by Moynihan, to set up a nation Education and Labor and Senate La porters that he had warned Leon E. al commission to devise a universal bor and Human Resources—have ap Panetta, the new White House chief of coverage plan. The commission would proved bills embodying the main fea staff, "he better find 30 bridges and report in 2002 if, by that time, chang tures of the Clinton plan, with the 15 military bases" to give away, "be es in the insurance system had failed former also approving a "single-pay cause we might need them" in order to bnng 95 percent of the population er," or Canadian-style, system under to get the votes. under coverage. Congress would have which the government would finance The final roll call on the Gibbons bill to accept, reject or modify its recom health care for all from tax money. showed how tricky the path ahead mendations within a limited time or Because of their liberal membership, may be. Four of the 24 Democrats— they would automatically take effect. both committees were seen as being the absolute maximum Gibbons could This is the kind of "soft tngger" less reflective of their parent bodies afford to lose—voted with all 14 com that the White House has opposed be than Senate Finance or House Ways mittee Republicans against reporting cause it does not guarantee everyone and Means. the measure to the floor. health insurance by a certain date. One was Rep. Jim McDermott (D- The committee also adopted a "The fifth committee with major Wash.), leader of the bloc of 92 House strong but novel cost control measure health jurisdiction, House Energy and Democrats supporting a single-payer devised by Sen. Bill Bradley (D-NJ.). Commerce, gave up early this week plan. McDermott had given Gibbons It would impose a 25 percent tax on trying to draft a bill, because no ma crucial support in fending off amend high-cost health plans, paid by the jority was in sight for a measure ac ments, but in the end said he was dis plans themselves. Bradley and other ceptable to the White House. satisfied because the bill's limit on advocates said the effect would be to The news from Finance yesterday families' out-of-pocket expenses was drive down health costs, but oppo was not unexpected. It came just mo too high, because insurance compa nents said it would simply add to con ments before Clinton made a congrat nies were still allowed to charge dif st Tiers' costs. ulatory phone call to Rep. Sam Gib ferent people different rates and be Ti e provision passed 11 to 9, with bons (D-Fla.), •acting chairman of cause there was not an adequate several senators saying that harsh Ways and Means, who engineered the guarantee that individual states could cnticism by Sen. Robert J. Dole (R- shaky passage of a version of universal impose a single-payer system on all Kan.) had galvanized Democratic sup coverage largely designed by commit employers. port. Dole's own health care plan, re tee member Rep. Fortney "Pete" Two of the most conservative leased Wednesday with the backing of Stark (D-Calif.). Democrats on the committee, Reps. 39 other GOP senators, was endorsed The bill includes a a Clinton-like Michael A. Andrews (Tex.) and Bill by 26 major business organizations provision requiring employers to buy Brewster (Okla.) also voted no, with yesterday. Brewster telling reporters, "The bill But Clinton, in a speech to small insurance for workers—the so-called as it is will have tremendous problems employer mandate—but also envi business owners who support the ad on the floor.I' m pro-choice but my ministration proposal, said the Dole sions adding 55 million to 60 million own Baptist pastor says that if it pass plan—which relies on insurance re people to Medicare, the 29-year-old es, he'll be under government orders form and limited subsidies for low-in staple of government-financed health to provide health care coverage in come families—"walks away from the insurance for the elderly. Under the cluding abortion benefits for his 10 middle class and small business." plan, Medicare would be expanded to employees. Those two provisions [em insure millions of non-elderly Ameri ployer mandates and abortion bene Staff writer Spencer Rich cans who now are uninsured or at risk fits] are killers." contributed to this report. of losing their coverage. The fourth negative Democratic Republicans charged that the Medi vote came from Rep. Peter Hoagland care provision was a long step toward (Neb.), who won a 52 percent victory a complete government takeover of in his Omaha district in 1992 and the health care system—a character whose Republican challenger has been ization Gibbons and other Democrata hammering him for two weeks for angrily denied. casting an earlier committee vote in> Rep. Dan Rostenkowski (D-III.), favor of employer mandates. of whose indictment for misuse of feder With solid Republican opposition al funds forced him to yield the Ways expected on the House floor,findin g a and Means chairmanship just as work formula that is acceptable to both the on the health bill began a month ago, liberal single-payers like McDermott said, '1 don't know that this bill will and some of Andrews's and Brew get 218 votes [a bare majority] on the ster's fellow conservatives, while re- assiirina fhp nnlifimllu ttir'aiti^oJ' .cr. THE LEGISLATION Bill Passed by Panel Would Open Medicare to Millions of Uninsured People By ROBERT PEAR Many small businesses provide Spenal to Th^ New York "Iimw HIGHLIGHTS some health insurance lo iheir work WASHINGTON, June 30 — Thc bill Critics say even one ers now. Under Ihc bill, Mr New iipprovcd loday by thc House W;iys house said, small businesses would be IIIHI Means Committee would open more Federal health Ways and Means Committee's Plan free lo drop such insurance and enroll Medicare, the Pederal health insur their workers in Medicare. ance program for Ihe elderly, lo mil insurance program is MEDICAID RECIPIENTS and Ihe uninsured could enroll in a new Part C Representative Peter Hoagland, lions of people who have no other ol Medicare Democrai of Nebraska, said he could source of insurance. If ihc proposal is not supporl thc new Part C of Medi- • idopied, Congressional experts say, too many. EMPLOYERS would be required to pay 80 percenl ol the cosi of rarc because il would become a huge nearly half of all Americans will l>e health insurance under ihis plan 84 cents an hour lor a single government program. Moreover, he em oiled in Medicare within a decade. worker. $1 63 an hour lor a single parent and $2 22 for a married said, Medicare has done a poor job of I he pi oposed new program, known people wno are not employed, people worker with children controlling cosis, arid Ihc new pro as I'ai l C of Medicare, was conceived receiving welfare benefils and people gram would pay doctors and hospi by Represemalive Pelc Stark of Cali- wuh incomes below certain specified SMALL BUSINESSES would be eligible lor subsidies, allowing Ihem tals wilh the same (ec schedules and 3 ftnnia, chairman of the Ways and levels Most Medicaid recipients formulas used by Medicare. Means Subcommittee on Health, who lo pay as litlle as 42 cents an hour lor heallh insurance for a would be transferred lo the new pro Bui Mr. Siark coniendcd that Medi has long favored "Medicare for all" single worker. 5 gram. care had controlled costs much better as the best way to guarantee cover CO* Part C of Medicare would start in than private insurers. age for all Americans. ANNUAL LMMfTS would be set by Ihe Government on heallh spending 1998. In lhat year, il would be open lo "Medicare is simple: no new rules, lor Ihe nation as a whole and lor each stale The Governmeni would Gail E. Shearer, manager of policy people with incomes up to twice the analysis at Consumers Union, said no new bureaucracy," Mr. Stark said impose Medicare-style lee schedules in any slate lhal exceeded 0 poverty level In 2003 and later, peo in ;m interview loday. the Ways and Means Commiuee bill ple with incomes up lo 2 4 limes the ils limit "nt many Republicans and some would help many people who now had poverty level could qualify Ihe |>ov I" inot rals. including some in the no health insurance. But she added, erty level, now $14,764 for a family of PRIVATE INSURANCE PLANS would have to provide at least Ihe same Clinton Administration, say the Ways "We are concerned that there will be four, is adjusted each year lo reflect and Means Committee bill relies loo level ol benelils as Medicare Part C Elderly people would gain a multi tier health care system, and changes in consumer prices heavily on the Government to cover prescription drug coverage Part C of Medicare could become a 5 the uninsured. They say il would be lower tier, for low-income people and bener to help people buy private in Health Coverage and Costs FINANCING would come in part Irom a gradual rise in Ihe currenl 24- high-risk consumers." surance, ralher than creating a new People in the new Medicare pro cents a pack Federal tax on cigarettes, lo 69 cents by 1999 Represemalive Jim McDermott, a Federal heallh insurance program as gram could obtain a wide range of Democrat from Washington State pan of Medicare. medical services, including prescrip who favors a "single payer" system tion drugs and mental heallh (arc. of national heallh insurance financed Emphasis on 'Prlvale' Lmployers would be required lo pay with (axes, expressed similar con- In his State of the Union Message ceins. He said Part C of Medicate 80 peirent of Ihe premiums for their people, accouming for nearly half of in many slates the income ceiling for lasl January, President Cliniun said would attract large numbers of peo workers. People enrolling in Ihe new Ihe nation's total projected popula these programs is far below the pov Ite wauled to guarantee every Ameri program would have to pay ihe re ple needing costly medical care who tion, would he in Medicare in 2004 erty level In addition, single people can "pnvale heallh insurance that maining 20 percenl themselves, Iml had no jobs and no connection to ihe Ihe Congressional Budget Office can never be taken away." White could gel Federal subsidies if ihey wilh no children have difficulty get labor force. Indeed, some of these eslimales lhal ihe cost ol Ihe new House officials emphasize the word had low incomes. ting Medicaid in many stales. people are unable io work because of "private." Part C of Medicare would rise from 1 'Feasible' Wilh 'Uncertainty' sickness or disabiluy. The Ways and Means Committee SI/. ) billion in I'I'M lo $332 billion in The Congressional Budgei Oflice From an actuary's potnl of view, bill would generally require employ 2004 A sigmfit ani poi lion of Ihis Joseph P. Newhouse, a professor oi esliniatcs lhal bb million people will Mr. McDermoti said, it would be diffi- ers to buy insurance for their work money, moie than $r>0 billion a year, heallh policy at Harvard Universily, culi lo design "a worse risk pool." ers or io pay premiums for those who panicipate in Ihe new program in would be spent imdei cm rent law for said Ihe proposed Pari C of Medicare enroll m the new Part C of Medicare I'J'JK if ihe Stark proposal becomes hospital care and diiclors' services to was "an admmisliatively feasible the new program would be open lo law, and il sees total enrollment ris Medicaid recipients way lo move lowaid universal cover IK.ri nme. temporary and seasonal ing to OS million in 2004 I he Govern Medic,nd covers fewer Ihan half of age'' But he added, "Ihere is great GIVE A CITY CHILD A VACATION: '•mirtiiyi.es. hill-timc employees of meni expects lhal Ihere will be 42 Ibe nation's poor people. Stales have uncertainly aboul how much it will compan.es wilh 100 or fewe, workers million people in the regular Medi wide discretion in setting eligibility cost and how many people will go inlo SUPPORT THE FRESH AIR FUND care program in 2004 So 137 million rules foi Medicaid and welfaie, and the piogram " ^ ARE DEBATE: An Issue Dodged onthe Campaign Trail THE HEARTLAND /Getting Even With Harry and Louise, Or, a A Moderate Democrat From Omaha Republicans Get a Taste of Their Medicine 3 The Democratic National Committee In the spoof Harry and Louise are in aught in the Middle on Health Care has taken revenge on Harry and Louise, bed. Harry is in a full body cast; his head S the yuppies who star in television com is bandaged. Louise's arm is in a sling. voters illustrates Ihe predicament By DIRK JOHNSON ^ the 1992 Presidential election, George mercials for the nation's health insurance She chides Harry for having been skepti Bush outpolled Bill Clinton by 15 facing moderaie Democrals like Mr. industry. It has maimed them and left cal about proposals for universal heallh tu Spnial 10 Ihe New Yuili I imei Hoagland on Ihc heallh care issue. OMAHA. July 9 — It scarcely had points. All three of Mr. Hoagland's them penniless. insurance coverage. Harry, it seems, has victories have been squeakers, and he "A lot of people are simply uneasy For months. Harry and Louise have lost his job, his health insurance and most the (eel of radical politics: church : about anything Congress might do," bells pealed in (he distance and a sod now faces a strong-ch¥llenge'from a been raising doubts about President Clin of his financial assets. candidate with suppon among funda Mr. Hoagland said as he climbed into ton's heallh plan, suggesting lhal it would breeze fluttered an American (lag as mentalist Christians, a conservative the backseat of a mini-van and head The spoof was conceived by Harry § some 40 Nebraskans, most of (hem : ed toward another slop. "If the House ration health care and establish a huge Thomason, a Hollywood producer and elderly, sat in lawn chairs on a sultry who favors the leaching of creation- regulatory apparatus. Last week the Clin Clinton friend. While it may be clever, it ism in public schools, opposes abor can come up with a bill lhat I can ton Administration struck back, with help S evening, sipping lemonade and talk tion even in cases of rape and incest defend here — well, that would be also suggests how effective the insurance ing with Representative Peter Hoag and has been a fierce critic of Gov great." from the Democratic National Commit industry has been in shaping the health >— land about health care. ernment involvement in health care. But he made it clear that no plan tee. The committee is running a new com care debate. "Imitation is the sincerest c: But on the sidewalk, a grimacing mercial, "Harry Takes a Fall," which c "We have blanketed the Omaha has yet met the lest. He has called for form of flattery," said Charles N. Kahn man in a baseball cap and T-shirt the creation of consumer pools that spoofs the ads run by the Health Insur 3d, executive vice presideni of the Heallh >aced back and forth with a card- market," said Brenl Bahler, the ance Association of America. o spokesman for a group called Citi could negotiate affordable rates on , Insurance Association. ROBERT PEAR xtard sign that declared, "Give me medical plans. liberty, not socialism I" zens lor a Sound Economy, a conser IS Long before Mr. Hoagland re vative group based in Washington Mr. Hoagland has voted in favor of turned to his district for the Fourth of that has spent more than $1 million on requiring employers to pay for heallh <• July recess, voters here had been health care advertisements. "We go care for workers, as long as small deluged with television and radio ad duck hunting where the ducks are. businesses and those with high work vertisements that cast Democratic And if you look at the Omaha district, er turnover receive tax credits. But you'll find that it's conservative Mid last week he voled against a plan thai efforts to revamp health care as a dle America. And after our ads ran, dangerous, even sinister threat to the phones in Congressman Hoag would enroll Americans without free enterprise. land's office were ringing off the health care in the Medicare syslem, a And wherever the three-term Dem hook." measure that barely cleared the ocratic "Congressman appears (hese Ways and Means committee. days — Omaha Optimists Club, B'nai One advertisement says Ihe conse And in response to voters' ques B'rith. trade union halls — he hears quences of all the Democratic health tions about universal coverage, he the plaintive questions of frightened care plans would be ruinous: "tax said flatly: "It's just not going to constituents,often framed Inthepre- increases, job losses, less money in happen. Politically, it's just not possi giant the Mutual ol Omaha, which edly that he is no lett-wing liberal, B'nai B'rith cise .waraingsipfjihe adyertisemenis your pocket to spend the way you ble." favors requiring employers lo pay for and that markets-oriented solutions But few of the Omaha voters aimed sponsored byicdhservative groups. want lo spend it." To be sure, not all voiers here op heallh benefits, but has been critical are. the key to improving health care any barbs al Mr. Hoagland as sharp pose efforls lo expand health cover of other elements of many proposals. coverage. as those in the advertisements. "Will I still be able to go lo my own He appears eager lo distance him doctor?" a retired woman asked. Deep Skepticism Abounds age. Rita Carroll, a young woman Even in talks wilh trade union One woman, Mary Johnson, even Groups that support changes in who looked the picture of healih and members, whose national leaders self from President Clinton, at leasl said lhal if nothing was accomplished "Are my taxes going to skyrock on heallh care, while his opponent, et?" a union electrician asked. heallh care, like the A FL-CI O.. prosperity, told the Congressman: "I have called for extending coverage to on health care, the voters were as have also-run advertisements here, have multiple sclerosis. There is new all Americans, Mr. Hoagland was Jon Christensen, portrays him as a much to blame as the politicians. "Am I going to lose my job?" an liberal out of step with his district. In insurance agent asked. bui they have been dwarfed by those medication out now, but il costs $1,100 warned againsi making any rash "I hear these sad stories about opposing the. kind of changes sought a month. If I was on welfare, it would moves. a poll published in mid-June by The people without coverage and I feel A Vulnerable Democrat by Presjden^Clinionr.esi^cially his be paid (or. But 1 can't pay for it. No "Now. I haven't read all 800 pages Omaha World Herald, Mr. Christen terrible," Ms. Johnson, a first-grade The advertising blitz in this district goal of cdVera'ge'for all Americans. way — none." of the plan, mind you," said Jim Pic- sen, a 31-year-old insurance sales teacher, said after a neighborhood coni, a 55-year-old union electrician. man, was leading by 11 points. might ^be "unmatcheti' 'anywhere, Whether the advertisements are More than 90 percent of the people gathering wilh Mr. Hoagland on M largely because Mr. Hoagland, a shaping public opinion, or simply re "But our coverage right now is pretty The Democrat has been the target Street. "But then I start to think in Omaha, however, have health in good. And I don'i want lhal lo of negative advertisements before, Democrat who represents a relative flecting it. there appears lo be deep surance, Mr. Hoagland said. And to aboul the money coming from my ly cohseryative districi, is seen as skepticism here about almost any change." especially during the budget debate own pockeibook, and I get a little them, fear of crime and dissatisfac lasi year, and worries lhal they could vulnerable on the issue. change in health care coverage. Cou tion with the welfare syslem appear Mr Hoagland, whose style blends greedy. "I guess I'm like everyone Until his election six years ago, the pled with what appears to be a gen Ihc manner of the sel(-e(facing Mid- doom his political career. else. I want uiopia. I want everybody to have a much higher priority, inis "One man's reputation can stand Omaha district was represented by eral antipathy toward President Clin is also the home of the insurance westerner and the polished Yale law to be covered for everything. And I Republicans for 40 of 46 years. And in ton and Congress, the mood of Omaha school graduate, emphasizes repeat just so many of these negative ads," don't want any of us to have to pay for Mr. Hoagland told an audience at any of it." between scandal and redemption, In a concurring opinion, Jus President Clinton into the White the new Bob Packwood — which tice Thomas said what began in House in 1992, says USA Tbday. Today's Q&A is to say the old, pre-scandal Bob 1965 as a successful effort to re "Give them some details, the Q: What is a podwojny? Packwood — is back in view." move obstacles to black voting potential costs and a glimpse of A: The popular McDonald's became "a disastrous misadven the partisan battle brewing in double hamburger in Poland, Moving tho court right ture in judicial policy-making" Washington and many Pennsylva eaten by President Clinton for that invites more racial tension. Judge Stephen G. Breyer's ap nians are greeting the health re lunch during his visit, reports the Inside Mitics The courts' willingness to di form debate with ambivalence New York Times' Jane Perlez. pearance before the Senate Judi ciary Committee tomorrow is vide the country into electoral and dread," said USA Tbday's likely to be characterized by lack districts along racial lines is an Richard Wolf. of risk or drama, says the Phila enterprise "of segregating the Mr. Wofford, a Pennsylvania delphia Inquirer. races into political homelands Democrat who put the issue on Pundit Leno "A genial, smart, prudent, that amounts, in truth, to nothing the map in his election, admitted NBC's Jay Leno, on the presi pragmatic judge and a panel of short of a system of 'political reformers are "on the defensive" dent's plan to "give Russian sol supportive senators will talk for apartheid.'" and must prove revision will not diers a $25,000 voucher to buy hours about such matters as reg Adds Mr. Gigot, "Even as South mean higher costs, more bu new houses when their bases in ulation, privacy and the Ninth Africa abandons its experiment reaucracy and reduced choice of Latvia are closed": Amendment," writes the Inquir in racial segreation, American doctors. "If you worked at a military er's Aaron Epstein. liberals embrace their own." In three polls, Millersville Uni base here in the United States "Just about everyone already versity political scientist Tbrry that was closed, your best bet at rather than an asset. Voters care knows how it will tum out: Un Health care politics"" Madonna found that jobs and getting help now is to defect to Today's prediction more about cutting the budget crime dwarf health care. Of Russia, get the 25 grand, and less lightning strikes, the Senate A tour of western Pennsylvania Friday's Wall Street Journal than getting local pork-barrel will overwhelmingly, perhaps health care, he says: "I don't then move back here ... headline: "As U.S. Begins Thlks projects." found little of the enthusiasm for think there's any sense that they "1 think Clinton is the first U.S. unanimously, confirm Breyer's national health insurance that With North Korea, Kim II Sung appointment to a lifetime job on want to completely rip up the president ... to be more popular helped propel Sen. Harris Wof currrent system. They want it with the Russian army than he is Gains Psychological Edge." Packwoodrohabbod? the Supreme Court ford into the Senate in 1991 and "Many analysts predict Breyer patched up." with the American Army." Sen. Bob Packwood has been will find a home in left-center The GOP thrust shrewdly rebuilding support to field, somewhere in the vicinity ward that day when his Senate Columnist Michael Barone of [Justice David H ] Souter and colleagues may sit in judgment [Justice Ruth Bader] Ginsburg. says in US. News & World Report on the charges of sexual miscon that "there are new signs of deep, "All of which means that the duct that once seemed certain to Breyer-for-Blackmun transition deep trouble for Democrats, end his career. enough for a 30-seat loss" in the might be a rare instance of a "He has successfully diverted Democratic president's nominee House and perhaps even the 40 attention from the accusations MONDAY. JULY II. /VW is that would relinquish con actually moving the court to the 8MK MtooljiiifltoiiSTmico against him," writes Katharine Q. right." trol to the Republicans. Seelye in the New York Times. He notes five Democratic in "There is no denying that Mr. Today's quote cumbents in difficulty: Rep. Mar Packwood has shed a heavy shell jorie Margolies-Mezvinsky of that encased and isolated him." The Los Angeles Times reports Pennsylvania, Rep. Peter Hoag- The Oregon Republican, em a White House official was taken d of Nebraska, Rep. Larry bracing the view that Americans aback last week when asked LaRocco of Idaho, Rep. Neal love a fighter and hate the press, how the twists of U.S. policy on Smith of Iowa and Rep. Lealie cast himself as a media victim. Haiti fit into an overall American Byrne of Virginia. He was also helped by the pas strategy: "We aren't answering Things may change, Mr. sage of time, Paula Corbin Jones questions about strategy today," Barone said, but there is evi and the health care debate. the official snapped. dence that their problems are Time muddles emotions, part of a national swine, against Democrats no longer view sexual Thomas' big opinion Democrats — and against BiU Clinton, who has been unable to misconduct as a promising vehi Columnist Paul A. Gigot in the enlarge his support since being cle for full-scale political ex Wall Street Journal notes Su elected. ploitation, and he was recognized preme Court Justice Clarence as knowledgeable about health Thomas' recent "tour de force" in One reason for declining care. Holder vs. Hall, in which he Democratic prospects: "Incum Ms. Seelye concludes, "Caught quotes liberal icons in his warn bency is increasingly a liability for so long in the nether region ing about the politics of race. Barbour, who will be keynote speaker at Saturday's state GOP convention in Lincoln. Barbour noted that neither Rep. Peter Hoagland nor Sen. Bob Kerrey, two Democrats seeking re-election this year, has asked Clinton to visit Nebraska, but neither can escape ties to Clinton. Hoagland cast the key vote for employer mandates in the House Ways and Means Committee's debate on health-care reform, a major Clinton initiative, Barbour said. He also predicted Nebraska voters would not forget Kerrey's decisive vote in enacting Clinton's 1994 budget bill with its combination of tax increases and spending cuts. Both Hoagland and Kerrey broke with Clinton on health care. They have tried to portray themselves as moderates seeking a bipartisan solution. If the pattern of Republican victories carries over to November, 1994 will be a referendum on Clinton's policies, Barbour said. xxIf all politics is local, Bill Clinton is unpopular in all localities,'' he said. think the Clinton policies will be at issue in Nebraska whether he shows up there in Air Force One or not.'' Barbour said he believes most people don't give Clinton or Democrats credit for an upswing in the national economy and he believes the Democratic leadership attack on the conservative Christian movement in the Republican Party would backfire with more support for the GOP. BC-HAITI-PANAMA URGENT PANAMA REFUSES TO ACCEPT HAITIAN REFUGEES PANAMA CITY (Reuter) - Panamanian President Guillermo Endara said Thursday he had withdrawn his agreement to take in up to 10,000 Haitian refugees, saying the United States had changed the terms of an accord made earlier this week. REUTER Distribution: TO: Kimberly S. Anderson TO: Catherine Balsam-Schwaber TO: Robert 0. Boorstin TO: Thomas I. Burke TO: Kenneth R Chitester TO: Gary Cohen Barbour, who will be keynote speaker at Saturday's state GOP convention in Lincoln. Barbour noted that neither Rep. Peter Hoagland nor Sen. Bob Kerrey, two Democrats seeking re-election this year, has asked Clinton to visit Nebraska, but neither can escape ties to Clinton. Hoagland cast the key vote for employer mandates in the House Ways and Means Committee's debate on health-care reform, a major Clinton initiative, Barbour said. He also predicted Nebraska voters would not forget Kerrey's decisive vote in enacting Clinton's 1994 budget bill with its combination of tax increases and spending cuts. Both Hoagland and Kerrey broke with Clinton on health care. They have tried to portray themselves as moderates seeking a bipartisan solution. If the pattern of Republican victories carries over to November, 1994 will be a referendum on Clinton's policies, Barbour said. xxIf all politics is local. Bill Clinton is unpopular in all localities," he said. "I think the Clinton policies will be at issue in Nebraska whether he shows up there in Air Force One or not.'' Barbour said he believes most people don't give Clinton or Democrats credit for an upswing in the national economy and he believes the Democratic leadership attack on the conservative Christian movement in the Republican Party would backfire with more support for the GOP. BC-HAITI-PANAMA URGENT PANAMA REFUSES TO ACCEPT HAITIAN REFUGEES PANAMA CITY (Reuter) - Panamanian President Guillermo Endara said Thursday he had withdrawn his agreement to take in up to 10,000 Haitian refugees, saying the United States had changed the terms of an accord made earlier this week. REUTER Distribution: TO: Kimberly S. Anderson TO: Catherine Balsam-Schwaber TO: Robert 0. Boorstin TO: Thomas I. Burke TO: Kenneth R Chitester TO: Gary Cohen PM-The Targeted Ones,690 Lawmakers Stuck in Crossfire of Heavily Lobbied Health Refonn With PM-Managed Care Eds: Also in Monday AMs report By JIM DRINKARD= Associated Press Writer= WASHINGTON (AP) Peter Hoagland is a Democrat, he's from a Nebraska district that makes re-election a constant battle, he's undecided on which health care bill to support and he's on virtually everybody's target list. "I guess they think, "Here's a guy we can really whip,1'1 Hoagland says. '"There are so many lobby groups out there it's incomprehensible. You can't keep track of them.'• In recent weeks, he's heard from the hospitals, the doctors, the insurance companies, small business and retailers. The airwaves in Omaha have been alive with radio and television ads from the National Restaurant Association, the Christian Coalition and the American Association of Retired Persons. The Democratic and Republican parties also have weighed in. ""It's been pretty much a mortar barrage,1' says an aide. One intern was almost in tears last week after several hours of being yelled at on the telephone by people calling about health care. Such is life in the crossfire of the biggest legislative issue to hit Congress in decades, and the most heavily lobbied ever. Every interest group has laid its battle plans as competing health care proposals go to House and Senate floor debate this week. Every group has made its target list of key swing votes, and for the most part they are the same: about 50 to 60 House members, and about 20 or so senators, mostly Democrats, heavily concentrated in the South and the border states. "They are beating down our doors,•• Hoagland said. ""To the degree it's honest input, it's helpful. To the degree that it's major interest groups putting TV ads on in Omaha, it's not helpful.•' ""Everybody who ever said hello to you wants to bring in their vice president,•' said Rep. Charles Wilson, D-T^xas, who's on some of the lists. ""Every labor union that ever made a contribution, every corporation that ever gave you a quarter. There aren't that many hours in the day.'1 In addition to hearing from outside groups such as auto dealers and restaurant owners, Wilson said, he is also being lobbied by his own colleagues to join a ""mainstream'• group seeking to assemble a more conservative bill than the one put together by House Democratic leaders. House Majority Leader Richard Gephardt, D-Mo., and Senate Majority Leader George Mitchell, D-Maine, have been involved in endless meetings aimed at crafting bills that can attract majority support. In the days ahead, they will cut whatever deals they can in an effort to bring vote totals up to the magic number that means passage. At the same time, Republicans are seeking to pick off the same swing votes by drafting bills that play to the lawmakers' concerns: A dicey political situation, like Hoagland's; worries over a tobacco tax for members from Virginia, North Carolina and Kentucky; or problems with including abortion services in the package. Last week, Sen. Kent Conrad, D-N.D., and four colleagues had lunch with Treasury Secretary Lloyd Bentsen and four other top Clinton administration officials. They were seeking Conrad's support and that of Sens. Charles Robb, D-Va., Max Baucus, D-Mont., Dianne Feinstein, D-Calif., and James Exon, D-Neb. ""I talk to the majority leader (Mitchell) almost every day,'' Conrad said. North Dakota's other senator, Byron Dorgan, is also feeling the heat. ""Because I've kept an open mind, I have literally been bombarded by everybody,•' he said. Clinton invited him to an Oval Office meeting. His telephones have been constantly busy. Faxes pile up daily. At some point, lawmakers say, all the messages blend into a wall of noise. The names of competing groups and coalitions and associations become indistinguishable in the cacophony. "It's about every single group in the country ... They're wallpapering Capitol Hill with an enormous amount of information,'1 Dorgan said. "At some point you say, "I've got to separate myself from the crowd noise here and think through what's best for the country.' Otherwise you're like a puppy trying to follow six kids home from school.'• **** filed by:APE-(—) on 08/01/94 at 02:06EDT **** **** printed by:WHPR(160) on 08/01/94 at 06:59EDT **** Top Ho ise Democra s Urge Universal Coverage by 1999 7 G^J Al been discussing \\,i>s ;.i tr\p.ind the "conscience clause" already in the Pes Wtxrti If 95 percent of the population in a bill in a way thai would allow those state was not insured in the early who oppose abortion to obtain poli years after the new century, the fed cies omitting it. "There is a real de eral government would require em sire on both sides to work this out," ployers to pay half of their workers' Fazio said, "but we're not there yet." msurance bill, with employees pay ing the rest. Other controversial questions "That's where [Mitchell's] coming were settled in the final hours before down," Sen. Dennis DeConcini (D- yesterday's caucus. Large multi- Anz.) said. state employers lost their bid to be Mitchell said he would introduce exempted from state laws creating a his plan Tuesday and begin debate single-payer, tax-financed health as early as Aug. 8. Differences be system, an option that Gephardt's tween bills ultimately passed by the bill provides to every state. Big busi Hou>e md Senate would have to be ness, including auto and steel com reconciled m conference, returned panies, would have the health insur to both chambers for final passage ance cost of their current early and then go to the president for his BY LAIWY MOOmS— THt WASHINGTON »OST retirees—55 to 64 years old—taken signature. Majority Leader Richard A. Gephardt, over by the government, but would offering leatters' legislation, says not have the same benefit in future Mitchell, struggling to meld a "this (• not the CHnton WH." measure much like that announced years. Hospitals gained some relief, by the House leadership with a more Those taxes were an immediate apparently at a cost to doctors, from modest proposal passed by the Sen target for Republican leaders, who the Medicare cutbacks they had ate Finance Committee, received dismissed the Democrats' claim to been protesting. bad news yesterday when the Con have scrapped the Clinton plan as a Gephardt produced charts show gressional Budget Office said the Fi "cellophane-wrapped deception." in ing that the mandate would cost nance Committee bill would be the words of House GOP Conference small firms with low-wage workers largely unworkable. Chairman Richard K. Armey (R- only 16 cents an hour (after their tax The CBO analysis showed that the Tex.). House Minonty Whip Newt Gin credit) and that big firms with high bill could bnng coverage to 20 mil wages would pay only $1.26 an hour. lion of the estimated 37 million unin gnch (R-Ga.) said there would be no Republican votes for the Gephardt He argued that this is in the range of sured by the year 2000 and reduce the 90-cents-an-hour minimum wage the deficit by $5 billion. It found that bill, which leaves its fate largely in the hands of the moderate-to-con- increase approved in 1990 and the bill would cost the government promised that if it were accepted, no $124 billion to help low-income peo servative Democrats, 52 of whom signed a petition two weeks ago ask minimum-wage boost would be ple buy msurance, a pnce tag that sought m the next few years. might go up further to cover work ing for assurances of a floor-vote on ers dumped into new small firms ., AhigarUiaa altjeaiauve, now neanng Gephardt announced that his bill created expressly to qualify for the pcompietion, that wonld omit employ and all substitutes for it must be filed subsidies. Its fmancmg and adminis er mandafcs.,. -, by Wednesday night, a tough dead trative features would be "difficult to • Gephardt must convert at least line for the bipartisan group seeking implement," the CBO §aig, adding some of tliose cent^sts to his aide to a middle-road alternative. House de that "it seems doubtflil^jfirt "states ! bate is scheduled to begin oajtag. 8 would be prepare^ ty>ijMHb$$«ti}eF win, and comments from that quar votes are setflpr^g. responsibilities undcMSBtt*^; ' ^ ter were largely skeptical yesterday. :o The Finance CbrTB&jR ty^itts ' Rep. Calvin M. Dooley (D-Calif.) no employer mahdaU^j^Tfl)#3u- said, "I think a lot of us ... see very Senate stead otr a $1 boost in tbe <;gajett£ . little in the leadership bill that ad dresses our concerns about the very t holi- tax and a novel 25 perceA tax! ofc t and the high-pnced insurance plaas. .f ^ strong employer mandate and back up pnce controls." e Finance Tlie most striking feature of the j problems, rhetonc surrounding the House > Rep. Timothy J. Penny (D-Minn.) that Democrats' introduction of their biH"..^ said, 'Tm not encouraged by what I iplicat- was their insistence that the meas-r ' see. ... I don't think voters will ure "is not the Clinton bill," as Ma trust something partisan on some-, ubsidy scheme and Medicaid program, regulate and; jority Whip David E. Bonior (D- thing this important." Rep. Peter 1 Mich.) put it. Hoagland (D-Neb.), expressing monitor the health insurance HKAIS- try region by'region, provide con-, The briefing material given law strong concern about the expansion of Medicare, said the bill "has moved sumer information and set up a so^' makers and the press included a pfaaticated alectronic data collection* chart of "key differences from the slightly in the way of the changes I want, but it has quite a way to go."•> system', AsffiSjjfl for by theFlhancef Clinton plan," noting that there are Committelfcs* ^5.?.^ ' j" "no mandatory alhances" but only 8ep. Michael A. Andrews (DJex.) voluntary purchasing cooperatives and. "no neww,, large government bq- h J^3* c^tyS*<*%** reaucrades . Chnton issued a statemen...'T_'...t , QCM_ K jonty voteintheHousfi^^- - » Rep. Glenn Poshard,' tng the bin as "a step doser to v health security" and ptifltu[$ ii$ would "take pencil to . _ _. thatJt maintained the einqtoyM; £0 figure out if enbughTttW" miitdatc as the principal tehicte ife "".be created in his $ expansion offset thtf'i _ expects in Mftflj Ms snd ffcdtors ibr. cmf ent ftMc**, irfth^/equire patnH by $85 billioo over five yaari, tfanaferring funds prevkws^ tSed tar like several others, said he Medicaid benefits to the poor nid tta •raa bothered that abortion was in Mv Medicare "Put £" puttfag tJ cluded io the standard Ksefits pack percent surtax pdvate btath age, but Gephardt sa^tlot larifeuuK ance premiums and the' expefises of couid change next week 4 BouSr firms that self-insure their employeea and Rep. Vic Fazio (D-Calift sfc- and boosting cigarette taxes 45 cents ceed in the negotiations with oppos rpack over the next few years. ing sides on that issue. The two have Comparing three health-care approaches Three approaches to heatth-care reform are being debated in Congress. One approach is reflected in the Democratic plans of House Maionty Leader Richard Gepnardt and Senate Maionty Leader George Mitchell. Another is seen in tne Republican plans of Senate Minonty Leader Robert Dole and House Minority Leader Bob Michel. The third is a bipartisan aoproach trom a group led by Rep. Jim Cooper. D-Tenn. All contain basic insurance reforms — bamng denial of coverage tor pre-existrng conditions, guaranteeing portability of insurance from one job to another, ana some effort to even-out premium differences. Democrats Bipartisan Republicans am GEPHARDT MITCHELL COOPER MICHEL COVERAGE Airm to (rwrease hMltfrtasurance Hope to cover 90% of Americans No specific coverage goals. Insur coverage from 85% to at least 96% of through insurance law changes and ance-market reforms and smaller sub Americana by 2000, and uttmatefy to less generous subsidies, phased in sides than Democratic or bipartisan nearty aU Method: subsfctiea, changes through 2004. Expands community approaches. No mandates. in insurance law and possftfy requiring health centers. No mandates on em employers topa y from 50% (Mitchefl) to ployers. 80% (Gephardt) of workers'premiums. COST CONTAINMENT OwMIti tifiheaatvcarrmnaflon by Would permit voluntary purchasing WouldL pemfrvoiuntary purchasing PPoflO praraunwon wyyooat pwns or cooperatives and tax-free medical sav oooperatives and tax-free medicai sav attrscttngmore people new Metf- ings accounts. Prohibits employers ings accounts.. cankpnoEHRri CS^lRillnQ^doctor from contributing above a standard lev and^oapWJ^Onaapproachaoould el to pay for high-priced insurance BlJUOBKSMMf WeSraCTvwttM^^Jiwtttn plans. *c>:.-—: POOpefBINWpMHi VOr BENEFITS Comprahensivs standwd bene fits, Benefits plan equal to standard Blue NO specflic peoents. inc>u