States Are Wary Partners In President’s Big Venture
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President Clinton’s health plan creates a mind-boggling array of new duties for the 50 states, which would be responsible for carrying out Mr. Clinton’s promise to guarantee insurance coverage for all Americans. Health care experts say a handful of states, like New York, New Jersey, Hawaii, Minnesota, Vermont and Washington, have established innovative programs to control costs and expand insurance coverage. But, they say, it is unclear whether other states have the political commitment or technical expertise to arrange insurance for all their residents by July 1997, as Mr. Clinton would require. Under the President’s plan, all Americans would be entitled to a comprehensive package of health benefits, one that states could not reduce. ‘They Will Kick and Scream’ Toby S. Edelman, a lawyer at the National Senior Citizens Law Center, said: “Our experience is that states are not eager to be in the forefront of any health program that costs them money. They will kick and scream about Federal regulation, but many do not act until forced to do so by the Federal Government.” While states would take on much responsibility and be given many new powers over medicine and business, state officials say they will not have all the authority or flexibility they need. States could provide benefits beyond those in the standard package, but state officials say most states will stay with this package. As a result, there would be much more uniformity in the nation than in the current patchwork of private health insurance and Medicaid programs, which vary widely. James D. Bentley, senior vice president of the American Hospital Association, said today that hospital executives were worried about some of the new powers Mr. Clinton’s plan would give to the states. For example, he said, only state-certified health plans could care for large numbers of patients. States would set the criteria that health plans must meet to be certified, and the states would appear to have complete freedom in setting these criteria. Under the Clinton plan, Mr. Bentley said, “there is no constraint on what a state can require” of health plans. Stan Dorn, who has represented poor people as a lawyer at the National Health Law Program, said he feared that “under the President’s plan, states may be given freedom to terminate Medicaid benefits beyond those covered in the standard package.” For example, he said, many states now cover dental care and eyeglasses for adults and would apparently not be required to continue doing so. Specifically, the Clinton plan, as described by Administration officials and White House documents, would give states these expanded responsibilities: *To establish one or more regional health alliances, which could be state agencies or private nonprofit corporations, to buy insurance coverage for their residents. The states would draw the boundaries of the alliances and would have to make sure that “all eligible individuals,” including homeless people, drug addicts and residents of remote areas, enroll in a regional alliance. Mr. Clinton does not say how states are to accomplish this. *To certify health plans, the networks of doctors, hospitals and insurance companies that care for most Americans. Only state-certified health plans would be allowed to provide insurance and benefits to members of the regional alliances. States must guarantee that at least one health plan is available in every part of every state, even where no health plan applies for this privilege. *To set and enforce financial standards for health plans to make sure they do not run out of money. If a health plan goes bankrupt, the state would take control of its assets, provide continuous coverage for consumers and pay claims with money from a state guaranty fund. The Federal Government would enforce a national budget for all health spending, but states would bear the financial risk if the limits are so tight that health plans fail. *To regulate private health insurance premiums “when necessary to meet budget requirements” or to guarantee the solvency of a health plan. More : query.nytimes.com |