Many to pay a tiny bit more for health Clinton plan may up cost as little as $1


WASHINGTON -- Administration officials scrambled yesterday to contain the political damage caused by reports that 40 percent of insured Americans would pay more for health coverage under the president's health reform legislation.

Although that figure is "technically" accurate, the officials said, it does not reflect a complete picture of the benefits and savings Americans would experience over time under the president's plan.

Many of the people who would pay higher premiums would receive more benefits than they have now, and many would pay lower deductibles and co-payment charges than they do now, the officials said. The reductions in deductibles and other out-of-pocket charges could more than offset any increase in premiums, they said.

While this issue occupied the administration in Washington, Hillary Rodham Clinton sought to sell health care reform in Kansas City, Kan., reaching out to Republicans who have offered alternative plans.

She praised those Republicans who want to "move beyond partisan bickering and gridlock" and said the lead GOP alternative bill, sponsored by Sen. John H. Chafee of Rhode Island, was "far superior" to most other plans because it moves the nation toward universal coverage and emphasizes personal responsibility.

Mr. Chafee, however, reiterated doubts about the financing of the Clinton plan, saying the cost "is just not calculated carefully enough."

His own plan would rely on individuals buying insurance and would not compel employers to provide it, a key financing feature of the Clinton plan. Both plans would have the government determine a standardized set of benefits.

Mrs. Clinton, Mr. Chafee and others addressed about 2,000 insurers, health care providers and citizens at a forum arranged by one of the Clinton plan's major critics, Sen. Bob Dole of Kansas, the Senate Republican leader.

Mr. Dole was among those who made an issue Thursday of the estimate that 40 percent of insured Americans would pay more for coverage.

Administration officials said they were surprised by the attention given to the estimate, which Health and Human Services Secretary Donna E. Shalala discussed before the Senate Finance Committee. It had been reported previously by the White House, although with a positive twist: 60 percent of Americans would pay the same or less than they do now for insurance.

Sen. Daniel Patrick Moynihan, the New York Democrat who chairs the Finance Committee, pounced on the 40 percent figure, warning that it would make it more difficult to sell the legislation presented to Congress Wednesday.

The 40 percent estimate is "technically true," said Ken Thorpe, a Human Services economist. But, "when the picture is really out there . . . I think it's a completely different characterization. Out-of-pocket spending for most of those people is going to fall."

Although Ms. Shalala told the committee that the premium increases for the 40 percent would range up to $500, in fact for many people the increase would be small, said Mr. Thorpe, who also testified before the committee Thursday.

For 5 million people, the increase would be a dollar a month, or $12 a year, he said.

A White House official who asked not to be identified offered these calculations:

* About 109 million people would pay less for the same or better benefits than they receive at present.

* About 40 million people would pay more, but receive more benefits. "These are people who have bare-bones" coverage today "and probably have high out-of-pocket costs, with high deductibles," the official said.

* About 31 million would pay more for roughly the same benefits. "Those are mostly young people who right now get very good discounts because they're the people everyone wants to insure," the official said. "They're young, they're healthy, and they're low risk."

These figures encompass Americans who have private insurance, not people who participate in the government-paid Medicaid and Medicare programs for the poor and elderly, the official said.

Medicare would continue as a separate program under the Clinton plan, with additional prescription drug and long-term care benefits, while Medicaid would be folded into the new system.

Mr. Thorpe emphasized that the premium increases people experience would occur at the outset of the Clinton plan. Over time, however, the administration projects that premiums would rise more slowly.

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