After President Clinton and several members of Congress spent an entire year of virtually nonstop haranguing about the problems of managed care, Congress failed to pass any reform legislation.
Now for the bad news: they'll be back with the same complaints and reform proposals next year.
The argument is that "patient protection" legislation would make the health care system safer for the 160 million or so Americans under age 65 enrolled in managed care. But the true reason behind the push to regulate managed care is a desire — openly expressed during the debate over the Clinton health care plan, but covertly being implemented now — to slowly but surely take over the health care system.
The method being used to achieve that goal is subtle, and many conservatives have missed it entirely. First, pass legislation that drives up the cost of health insurance. Then, as people and employers begin to cancel their coverage because it is too expensive, the number of uninsured will go up — the U.S. Census Bureau just reported it has increased to 43.4 million people — creating the impression of a crisis of the uninsured. In addition, those who remain insured will cry out that insurance premiums are rising too quickly and ask the federal or state governments to intervene (i.e., impose price controls).
When the government responds by intervening, prices will go up even more, more people will cancel their coverage, and the crisis will be exacerbated. Eventually the American people will be fed up with the whole process and simply ask the government to take over the health care system, thus giving President Clinton in steps what he was unable to achieve in one leap.
Now that you know the battle plan, maybe the maneuvers make more sense.
For example, the Kassebaum-Kennedy legislation of 1996 was meant to make health insurance more portable, so that people who had coverage wouldn't lose it when they changed jobs. The goal was laudable, but Democrats pushed to include some measures that would force premiums much higher. As a result, some people are experiencing premiums five times what the average person would pay. Since most can't afford that much, they cancel their coverage — and let Congress know about the problem.
This year's "patient protection" legislation could have a similar impact. The actuarial firm Milliman & Robertson did a cost analysis of an earlier version of the bill and concluded it could increase the cost of health insurance by 23 percent, on average. That would increase the cost of a standard HMO policy — which currently runs about $5,000 a year — to $6,250 a year. While some individuals and employers could afford that increase, many could not. Those who lost their policies would then join the chorus that Congress must do something to fix the problem.
And we're not done yet. As part of the budget deal, Congress will require insurers and health plans that cover federal employees to pay for the five most common types of contraceptives (birth control pills, Depo Provera, Norplant, diaphragms and intrauterine devices). And Sen. Olympia Snowe (R-Maine) and Rep. Jim Greenwood (R-Pa.) have introduced legislation that would require any insurer or employer who covers prescriptions to do the same for the rest of the population.
Is such legislation necessary? A recent survey from the Alan Guttmacher Institute, which specializes in women's reproductive health issues, found that 94 percent of managed care plans cover some form of contraception, and 72 percent cover all five forms.
Moreover, 74 percent of U.S. women who are between the childbearing ages of 15 and 44 have some form of private employment-related coverage for contraception, and another 16 percent of women in that age range have contraceptive coverage under Medicaid. That's a total of 90 percent of women in their reproductive years with some contraceptive coverage, not counting the easy availability of contraceptives to those in need through places like Planned Parenthood.
But any legislation requiring health plans to include contraceptive services won't cover those most in need — low-income women who don't have insurance. Of course, people with insurance are usually working and can afford to pay out-of- pocket for most contraceptives, which are relatively inexpensive.
So by adding this additional burden to the cost of a health insurance policy, premiums will go up — for the 74% of women who have contraceptive services, and the 10% who don't won't get them. The premium increase may not be large, but regulations have made insurance so costly that even a small increase is prohibitively high for some. If some women have to drop their coverage, then all the insurance mandates in the world won't help them.
They, too, would then likely join the group claiming that Congress must do something — leaving President Clinton little to do but smile.
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The National Center for Policy Analysis is a public policy research institute founded in 1983 and internationally known for its studies on public policy issues.