WASHINGTON — WASHINGTON -- Moving to correct glaring shortcomings of American health insurance, the Senate voted unanimously yesterday to prevent insurers from dropping workers who get sick, or change or lose jobs.
The 100-0 vote advances toward almost certain enactment legislation that would represent the first health insurance reform in decades and one of the leading achievements of the Republican-led Congress.
A conference committee will shortly begin meeting to reconcile differences with a House-passed version of the measure to produce a final bill that can be sent to President Clinton, who is eager to sign it into law.
"This was virtual shut-out; I can't think of a more important piece of legislation that this has happened on," Sen. Edward M. Kennedy, a Massachusetts Democrat and leading sponsor of the bill, said of the unanimous vote. He said the measure would provide families with "peace of mind and a sense of security."
Unlike a far more sweeping proposal offered by Mr. Clinton three years ago, this measure would not revamp the health insurance system or guarantee health insurance coverage to the 40 million Americans who are without it.
Instead, Mr. Kennedy and his Republican co-sponsor, Nancy Kassebaum of Kansas, tried to limit their effort to modest reforms aimed at changes on which all their colleagues could agree.
In addition to protecting those currently insured, the measure would lift barriers that now prevent ailing people from obtaining medical insurance and grant new tax breaks to help small businesses and individuals bear the cost of health care.
"Over 1 million working Americans have lost health insurance in the last two years alone, and over 80 million Americans have pre-existing conditions that could make it difficult for them to maintain health coverage when they change jobs," Mrs. Kassebaum said.
At a news conference, Senate Majority Leader Bob Dole contrasted yesterday's relatively narrow bill with the earlier Clinton proposal that never came to a vote.
"We have been trying to pass some of these common-sense measures for a decade," said Mr. Dole, the likely Republican presidential nominee. "This shows the Clinton era of big government health care is over."
During the course of Senate consideration, Mr. Dole managed to add several key provisions to the measure. They include:
An increase to 80 percent from the current 30 percent in the amount of health insurance cost that self-employed people may deduct from taxes.
Tax breaks for the purchase of long-term care insurance and for direct costs of long-term care.
Another tax break permitting chronically or terminally ill individuals to draw on life insurance benefits without tax penalties within two years of their death.
Some potential stumbling blocks remain, however.
Mr. Clinton and many Democrats oppose a provision in the House bill that would grant tax breaks for individuals who chose an option known as Medical Savings Accounts.
Similar to IRAs, these accounts would be used as a supplement to high-deductible insurance policies that cover only catastrophic injuries or illness.
Opponents fear they will draw young, healthy people away from traditional insurance, raising the cost of premiums for everyone who remains.
The president has threatened to veto the measure if it contains the MSA provision in its current form, but Vice President Al Gore as well as many Republicans have hinted there may be room for some kind of compromise.
Various segments of the business community, which had previously endorsed the Kennedy-Kassebaum bill, are also raising concerns about an amendment added in the Senate last week that would require insurance companies to treat mental illness the same as physical illness.
Currently, most insurance companies provide more limited benefits for mental illness.
House Majority Leader Dick Armey said yesterday that House negotiators might be willing to accept the mental health amendment. But Mr. Kennedy and Mrs. Kassebaum said they will resist it unless it has unanimous support.
Senate Majority Whip Trent Lott, a Mississippi Republican, flatly predicted yesterday that the health care reform measure will be enacted and signed into law "because everyone wants to get something through."
But work on the measure, which last week included a sharp rebuff to Mr. Dole on medical savings accounts, provided him with a painful learning experience about the difference between being Senate leader, and being a Senate leader who is running for president.
Mr. Dole decided to lead the fight for the MSAs himself, knowing he lacked the votes to win when he offered an amendment to add them to the bill. The 52-46 tally helped demonstrate strength for the proposal in conference and to highlight Mr. Dole's differences with Mr. Clinton, said Sen. John McCain, an Arizona Republican and Dole ally.
But after headlines reported the Dole defeat, other Dole advisers said it had been a mistake for a presidential candidate trying to demonstrate his leadership skills to back a loser.
Pub Date: 4/24/96