Skip banner
HomeSourcesHow Do I?Site MapHelp
Return To Search FormFOCUS
Search Terms: managed care reform

Document ListExpanded ListKWICFULL format currently displayed

Previous Document Document 4 of 19. Next Document

Copyright 1999 The National Journal, Inc.  
The National Journal

October 16, 1999

SECTION: POLITICS; Pg. 3018; Vol. 31, No. 42

LENGTH: 1521 words

HEADLINE: Why Health Care's Back

BYLINE: William Schneider


The many, many Americans who have moved into managed care are
worried about their loss of rights.


     The House and Senate have now passed separate versions of
health care reform legislation. Meanwhile, on the campaign trail,
Al Gore and Bill Bradley have laid out their own proposals. All
the recent attention ensures that health care has emerged as a
major issue in the 2000 presidential race, which raises a key
question: Haven't we been here before? The answer is yes--and no.
Yes, the problem is the same--millions of Americans who don't
have health coverage. In fact, the problem's gotten worse. The
Census Bureau has just reported that the number of Americans
without health insurance has grown by 4.5 million since Bill
Clinton was sworn in as President. One in six Americans now lack
coverage.      But no, the debate is different from six years ago. Then,
the country was just coming out of a painful recession. Middle-
class Americans were terrified at the possibility of losing their
health insurance. Hillary Clinton told a Pennsylvania town
meeting in November 1993: ''Every one of us in this room, even if
we have health insurance today, because our country cannot
guarantee us health care coverage, we cannot know that we will
have health insurance this time next year.''

     The Administration came up with a bold program to
guarantee coverage for all Americans--''a system of comprehensive
benefits that are always there, that can never be taken away,''
as the President described it. But the economy started to
improve, so middle-class Americans felt less threatened. And
opponents depicted the plan as a bureaucratic nightmare. That was
the point of the Health Insurance Association of America's now-
legendary ''Harry and Louise'' ads. Polls showed that Americans
were overwhelmingly satisfied with their medical care and their
health insurance. What they were afraid of was losing it. People
became worried that the government wasn't just trying to protect
their health coverage. It was trying to take it over.

     By the time the issue came before Congress in 1994, more
Americans were concerned about what would happen if the plan
passed (54 percent) than about losing their health insurance if
it failed (30 percent), according to a Gallup Poll. And as the
economy continued to pick up speed, the health care crisis seemed
to go away. When Clinton took office in 1993, only 23 percent of
Americans said they were satisfied with the availability and
affordability of health care in this country. By the beginning of
his second term in 1997, that number had risen to 41 percent.

     So now, with the economy booming, inflation low, and job
creation at a record high, why is health care back on the front
burner? Because more and more Americans have moved into managed
care. The issue now is not loss of coverage. It's loss of rights.

     Back in 1994, Americans in managed care plans and in
traditional fee-for-service plans were about equally likely to
rate their health insurance coverage as ''very good.'' By 1998,
those in traditional plans were still satisfied (51 percent). But
not the people in managed care plans. Their confidence had
dropped to 29 percent.

     Today, managed care accounts for almost nine in 10 people
whose health care is covered by their employers. They're unhappy.
That's the crisis. It's a middle-class problem--a crisis of the
insured. But wait a minute. What about the growing number of
Americans who don't have any health insurance? Many of them are
poor; others are women coming off welfare, children, and
noncitizens--people who don't have much of a voice politically.
Which is why politicians have learned to be cautious.

     In his reform proposal, Gore talked first about the
rights of those who are already covered, then about covering
children, and finally about making ''progress'' toward coverage
for all. ''As President,'' Gore said on Sept. 7, ''I will commit
our nation to the goals of universal rights for those who have
health coverage; universal access for all American children; and
real progress toward access to quality, affordable health care
for every American family.''

     The difficulty now is the same as it was in 1994:
Opponents will be able to depict the reforms not as protecting
what the middle class already has, but as taking rights away.
After the House bill passed last week, Assistant Senate Majority
Leader Don Nickles, R-Okla., promised he would ''work very
aggressively to make sure we don't pass a bill which increases
costs or increases the number of uninsured.''

     Before the managed care reform bill passed, House
Republican leaders tacked on a provision creating tax breaks to
help the uninsured buy coverage. Speaker J. Dennis Hastert, R-
Ill., defended the provision saying: ''The most important patient
protection is to provide health care coverage for people who do
not now have it.'' But the real motive was to try to kill the
bill, which allows patients to sue HMOs and grants more choice in
selecting doctors, by peeling off Democratic supporters who
oppose what they regard as tax breaks for the affluent.

     It's the same story now as in 1994. Middle-class concerns
over managed care are driving the issue politically. But the
crisis of the uninsured exists largely outside the middle class.
Candidates like Gore and Bradley are trying to package them
together, as one crisis. But as the President and the first lady
learned five years ago, and as GOP leaders in Congress are fully
aware, the insured and the uninsured have very different

LOAD-DATE: October 19, 1999

Previous Document Document 4 of 19. Next Document


Search Terms: managed care reform
To narrow your search, please enter a word or phrase:
About LEXIS-NEXIS® Academic Universe Terms and Conditions Top of Page
Copyright © 2001, LEXIS-NEXIS®, a division of Reed Elsevier Inc. All Rights Reserved.