Substance abuse and the Health Security Act: a case study of a benefit under the Clinton health plan.
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Health Care Reform↗
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Consensus paper on the Health Security Act (HR3600/S1757) Medical Society of Delaware Ad Hoc Committee to review the Clinton Health Care Reform Plan.
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Delaware↗
Advanced nursing practice.
The focus on advanced practice is now critical, as the nation begins to reform our health care system. President Clinton has called for a plan that incorporates "security, simplicity, savings, choice, quality, and responsibility". These are major efforts for health care providers, including nurses who deliver direct care and designers of these health care systems. The future work of the advanced nurse practitioner evolves from today's practitioners and their vision. Now, nurses in advanced practice can help design and implement systems of the future. The author highlights some of the issues involved in advanced practice, remarking on how advanced practice might be implemented in the critical care setting. The specifics of implementation is the responsibility of specialists in acute care. As a primary care nurse practitioner, the author provides ideas of application and examines some of the barriers to the continuing growth of nursing practice.
Certification↗
Centralized automated quality assurance for large scale health care systems. A pilot method for some aspects of dental radiography.
President Clinton's Health Security Act proposes the formation of large scale health plans with improved quality assurance. Dental radiography consumes 4% ($1.2 billion in 1990) of total dental expenditure yet regular systematic office quality assurance is not performed. A pilot automated method is described for assessing density of exposed film and fogging of unexposed processed film. A workstation and camera were used to input intraoral radiographs. Test images were produced from a phantom jaw with increasing exposure times. Two radiologists subjectively classified the images as too light, acceptable, or too dark. A computer program automatically classified global grey level histograms from the test images as too light, acceptable, or too dark. The program correctly classified 95% of 88 clinical films. Optical density of unexposed film in the range 0.15 to 0.52 measured by computer was reliable to better than 0.01. Further work is needed to see if comprehensive centralized automated radiographic quality assurance systems with feedback to dentists are feasible, are able to improve quality, and are significantly cheaper than conventional clerical methods.
Absorptiometry, Photon↗
Meeting the needs of the poor and underserved under health care reform.
President Clinton's health care reform plan is premised on six principles: security, simplicity, savings, choice, quality, and responsibility. To the extent that negotiations with Congress and others to arrive at the final reform package respects the primary of these principles, the President's plan will meet the needs of America's poor and underserved.
Health Care Reform↗
How Clinton's health benefit package compares to today's employer-sponsored plans.
Will you and your employees be better or worse off under the Clinton Health Security Act? A national survey of nearly 2,000 large and small businesses finds that a few workers will pay a lot less and receive a lot more insurance coverage than they receive today, while those who lose ground will just be a little worse off.
Cost Sharing↗
Rekindling reform--how goes business?
Employers were a major cause of the failure of President Clinton's Health Security bill. This did not have to be so. The substantive and political factors that caused employers to turn against the Clinton Plan could prove instructive in the next reform effort. The unwillingness of employers who do provide benefits to engage seriously in the struggle over health care reform contributes to maintaining the status quo that penalizes them while rewarding employers who fail to provide coverage. The lessons that can be learned from the Clinton Plan debate, if heeded by both employers and health reform advocates, raise hope that key elements of the business community can play a positive role in the next comprehensive health reform effort.
Commerce↗
Impact of the American Health Security Act of 1993.
In the months to come, opponents of President Clinton's proposal will focus on issues of choice among physicians and health plans and on estimates of the economic impact of reform. Others will raise the issue of the efficiency of the administrative structures necessary to implement the Act. These important concerns notwithstanding, people with rheumatic diseases stand to gain much from the passage of the American Health Security Act of 1993, principally the knowledge that they always will have insurance, that their out-of-pocket costs will be limited, that they will have access to a standard set of benefits, and that these benefits are more comprehensive than the current Medicare and Medicaid programs and all but a small percentage of private health insurance plans.
Health Care Reform↗
Clinton, health care, and the crystal ball. With the Democrats back in power, where do we go from here?
Although Clinton's Health Security Act was unsuccessful, the President's first term did see considerable headway in health care policy, including the Health Insurance Reform Act, the Family and Medical leave Act, and improvements to both Medicare and Medicaid programs. Whether the result of a federal reform plan or free-market forces, efforts to control health care costs hinge on continued growth of managed care. Capitation is the wave of the future, according to some experts. America's aging population is rapidly overwhelming the Medicare Hospital Insurance Trust Fund. Clinton's balanced-budget proposal would keep Medicare solvent until 2006, while a bipartisan committee devises a long-term plan. Options for relief, however, are limited to increasing revenues by raising premiums and copayments or by decreasing spending.
Delivery of Health Care↗
Health education: what can it look like after health care reform? 1993 SOPHE presidential address.
In the fall of 1993 the plans for the Health Security Act were unveiled: health education was referenced no fewer than 18 times. This 1993 SOPHE Presidential Address examines the role of health education under the plans for and principles of health care reform. As Bill Clinton stated, "an intensified health education system must be designed to educate and encourage the American people to change behavior that results in ill health and high costs." It is argued that health education has been demonstrated to be effective at reducing risk behaviors associated with each of the leading causes of death. Likewise health education should, can, and does play a role in each of the health goals and objectives for the year 2000. Health reform provides new opportunities to invest in prevention, public health and health education--not only in medical care settings--but in schools, at worksites, and in the community. Health education in these settings can help create supportive environments that make healthy choices the easy choices, ensuring that health reform can succeed.
Cost Savings↗
President Clinton's proposal for health care reform: key provisions and issues.
Shortly after his election in 1992, President Clinton appointed a health care reform task force to develop a proposal for providing health care benefits for all American citizens and legal residents. Between February and May 1993 the Interdepartmental Working Group, composed of more than 30 working groups addressing specific health care issues, prepared options for the task force. The Health Security Act was introduced in November 1993. Besides universal coverage and a basic benefit package, provisions included health insurance reform, regional alliances for structuring competition among health insurance plans, consumer choice of health plans, and provisions for Medicaid beneficiaries. Proposed mental health and substance abuse provisions included coverage of intensive nonresidential services, medical management, evaluation and assessment services, and case management. Initial limitations on coverage of inpatient mental health services and psychotherapy would be removed by 2001. The Clinton plan also called for integration of public mental health and substance abuse services into the full range of health services offered by local health plans. Major issues that will have to be resolved if health care legislation is to be enacted include whether regional alliances should be mandatory and whether employers should be required to contribute to insurance premiums.
Health Care Reform↗
Implications of the Health Security Act for mental health services for children and adolescents.
Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.
Adolescent↗
U.S. health care in transition: a response to the Health Security Act of 1993.
Although the President and Mrs. Clinton are to be commended for their courage and commitment in bringing the issue of health care reform to the forefront of national concern, their proposal has "too much regulation and too much government." The author fears that the plan will not work due to its emphasis on global budgeting, price controls, and the regulatory nature of the regional health alliances. He advocates a reform system based on the American values of innovation, entrepreneurship, and the spirit of free enterprise.
Budgets↗
Choosing among health plans.
The health care reform system that is ultimately adopted, suggest the authors of this analysis, should rely on market forces, rather than government regulation, to reduce cost and improve quality in our health care delivery. A major portion of this paper compares the Health Security act (the Clinton proposal), the American Health Security Act (the McDermott bill), the Health Equity and Access Reform Today, HEART (the Chafee proposal), and the Managed Competition Act (the Cooper bill). The article focuses on the major areas of difference between these alternative proposals in the extent to which they would achieve true market-based reform, small group reform, universal coverage, and financing mechanisms.
Evaluation Studies as Topic↗
The Health Security Act: a complex and costly prescription for healthcare reform.
The crafters of the Administration's Health Security Act recognize the need for "fresh approaches" to measuring and improving the quality of the American healthcare system, believes David Sundwall, MD, Vice President and Medical Director of American Healthcare Systems, an alliance of 40 multihospital healthcare systems. He has concerns, however, about the complexity of the Clinton proposal--especially with regard to its data requirements--and the significant financial investments that will be required for the plan to succeed.
Costs and Cost Analysis↗
The critical role of ERISA in state health reform.
Despite prominent roles for employers and state regulation in the Clinton administration's Health Security Act, relatively little attention has been accorded to the impact of federal preemption of state legislation through the Employee Retirement Income Security Act (ERISA). As interpreted by the U.S. Supreme Court, ERISA permits state regulation of insured employee health plans but otherwise preempts analogous regulation relating to self-insured benefit plans. This has prompted lower courts to find that hospital rate-setting legislation, regulation of preferred provider organizations (PPOs), and medical malpractice suits for utilization review decisions are preempted by ERISA. Several issues with major implications for health reform remain unresolved, such as the availability of ERISA preemption to self-insured health alliances and health maintenance organizations (HMOs).
Health Benefit Plans, Employee↗
Elements of the American Health Security Act of 1993.
Over the past several decades, there has been a plethora of proposals that were developed in response to the ongoing debate on how best to solve the problems of the American health care delivery system. In the past decade, calls for modification of our health system have become even more resonant, as measures to control rising costs were unsuccessful and access to basic services was diminished for many Americans. The most recent addition to the list of proposals for modifying the health care system is the American Health Security Act of 1993, introduced by President Clinton in September 1993. This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package.
Competitive Medical Plans↗
Jury still out on extent of employers' cost savings under managed care. An AMA policy research perspective.
President Clinton's Health Security Act as well as other proposals for national health system reform and state-level reform call for greater use of managed care to control employers' health care costs. Even without government intervention, the trend is for increased enrollment of employees into managed care plans as opposed to traditional indemnity plans. In fact, the proportion of private employees enrolled in managed care plans grew from 5% in 1980 to 55% (90 million persons) in 1992. Despite the increased reliance on managed care plans, little is known about their ability to limit costs and whether they pass any savings on to employers. This American Medical Association Policy Research Perspectives summarizes a recent report by the General Accounting Office (GAO) that discusses their review of the literature on managed care and interviews with insurers and more than 60 private employers between March 1992 and March 1993.
Costs and Cost Analysis↗