WASHINGTON -- President Clinton's health care plan will cover the cost of treating people injured on the job or in automobile accidents, merging workers' compensation and the medical portion of auto insurance with standard health insurance in one big system, Hillary Rodham Clinton said yesterday.
The plan would move toward eliminating the sprawling workers' compensation system, which has become a headache for employers. Medical costs paid by workers' compensation and auto insurance have risen faster than health care expenses in general, as have the mandatory workers' compensation premiums paid by employers.
Health care provided under the newly unified system would include
the same incentives for cost control that the president hopes to introduce throughout the health care system.
But the proposed changes, if they are included in the final plan and approved by Congress, would greatly affect the interests of lawyers, doctors, labor unions and insurers involved in the workers' compensation and auto insurance systems, and the details of such a shift are certain to provoke intense debate.
Congressional action on this issue would also move the federal government into an arena now regulated by the states.
Mrs. Clinton's brief remarks yesterday left many questions unanswered. It is not clear, for example, how fast the changes would take effect or whether the new system would retain incentives for motorists to drive safely and for employers to eliminate occupational hazards. Nor is it clear how the proposal would affect liability for injuries in auto accidents.
Some advisers to Mrs. Clinton's Task Force on National Health Care Reform had previously raised the possibility of incorporating these historically separate forms of medical insurance into the system they are proposing for medical care generally.
Mrs. Clinton's comments yesterday at a conference of business executives in Williamsburg, Va., were the clearest signal yet that the president would propose such changes as part of his health care plan, to be sent to Congress next month.
Administration officials said it would greatly simplify life for consumers if the standard medical insurance policies contemplated under the Clinton health care plan covered injuries suffered on the road and on the job. Consumers would then have the same protection against illness and injury, whether they were working, driving or simply spending time at home, the officials said.
But efforts to fold workers' compensation into a national health care program will complicate the Clinton plan, create new political problems and increase the difficulty of pushing legislation through Congress.
Mrs. Clinton's audience yesterday consisted of business executives, many of whom are wary of the emerging health care plan because they fear it will include new taxes.
Mr. Clinton is expected to propose a law requiring all employers to provide or arrange health insurance coverage for their workers. Owners of small businesses oppose such a requirement.
Mrs. Clinton addressed these fears after meeting with members of the Business Council, declaring, "We believe, based on everything we know, that for the vast majority of businesses, health care reform will be a net winner. Their costs will stabilize and go down."
She said, "For many small businesses, the same will be true because we intend to move to incorporate workers' compensation and auto insurance in health care coverage and comprehensive health care reform."
Workers' compensation and automobile insurance pay $40 billion health-care bills each year. Workers' compensation helps cover the cost of medical care, lost wages and rehabilitative services for people who suffer work-related injuries or illnesses.
Robert O. Boorstin, a spokesman for the task force, said the goal of this proposal was to "reduce duplicative insurance policies, reduce administrative paperwork and save money in the health care system overall."
He added, "One of the keys to our plan is to protect small business. One of the top complaints of small business is the workers' compensation system. We are trying to design a sensible system. Folding in these other kinds of coverage makes sense."
But Amy J. Biderman, a spokeswoman for the American Insurance Association, a trade group for 250 property and casualty insurers who could lose substantial business if the plan is adopted, said, "This is not an approach that we favor. We have suggested an alternative that is more cost-effective, coordinating rather than merging these programs."
Ms. Biderman said the president's proposal could lead to an increase in health costs because health maintenance organizations and other health plans providing managed care did not have "the capability to effectively treat occupational illnesses and injuries."
By contrast, she said, insurers that specialize in workers' compensation "help employers hold down costs by providing appropriate care to get the workers back to work."
Mr. Clinton is expected to propose that most people, including individuals and employees of smaller companies, buy health coverage through new, large purchasing cooperatives.
These purchasing groups would bargain with competing providers and offer a selection of prepaid health plans, many resembling health maintenance organizations that strive to hold down medical costs. One longtime complaint about workers' compensation and automobile insurance systems is that they lack such cost controls.
But from the employees' point of view, workers' compensation is more generous than standard health insurance policies. It provides broader benefits, including rehabilitation and occupational therapy to help employees return to work.
The worker does not pay premiums or any part of medical bills for the treatment of work-related illnesses and injuries. Depending on how the new health plans are structured, merging the systems could mean that injured workers would have to pay more themselves for care for job-related injuries and illnesses.
Karen M. Ignagni, director of employee benefits at the AFL-CIO, said yesterday, "We support the integration of workers' compensation with overall health care reform. It does not make any sense to have two separate systems, one for people injured on the job and one for people who suffer from other health conditions."
But labor officials say their members must not be forced to give up any of the benefits they have under workers' compensation.
"Workers injured on the job should not be required to bear the cost of treating those injuries through co-payments and deductibles, if such cost-sharing is in the new health care system," Ms. Ignagni said.
Spokesmen for the property and casualty insurance industry, which sells workers' compensation and auto insurance, said they didn't have enough details to assess the plan.