The administration s standard benefit package is designed to be as good as or better than what most Americans have now, though it could become less generous if Congress trims it back to save money. Still, it will be “portable”–guaranteed even if you changed jobs, lost your job or came down with a serious disease requiring costly treatment. No one may opt out to avoid paying any premiums.
Clinton estimates that the average premium in 1994 will be $1,800 per individual and $4,200 per family, though exact price tags would vary by region. Of this, your employer would pay at least 80 percent. Companies could continue to pick up the entire cost, but many would not, and workers accustomed to free health benefits may suddenly find themselves out hundreds of dollars. If you are unemployed or self-employed, you’ll have to pay the entire premium, unless your income is so low you qualify for a subsidy.
Yes, but it might cost you. HMOs are more efficient health-care providers, so Clinton has made them cheaper than the “fee for service” model, in which you choose any doctor you want. If you join an HMO, you would pay $10 per doctor’s visit, $5 per prescription and $25 per psychotherapy session, with no deductible. If you choose fee for service, you would pay 20 percent of the cost of most services, from doctor visit to ambulance pickup, and 20 percent of drug charges. And you’d have a $200 deductible ($400 per family) plus a separate $250 deductible on drugs. Because this could add up, Clinton would cap out-of-pocket costs at $1,500 per person and $3,000 per family.
Studies suggest that as much as 35 percent of medical care is unnecessary, so there’s plenty of room to squeeze costs without sacrificing quality. Still, you may be faced with longer waits, and some expensive treatments could be rationed. Every health-care program will be rated for quality; if you don’t like yours, you can switch.
In order to win support from the powerful senior citizens’ lobby, Clinton in effect offered seniors a bribe: under the plan, Medicare will now help pay for prescription drugs. And if you need long-term care at home, Medicare will now help pay for it. Beyond that, Medicare is not part of the plan–with one big catch. Clinton wants to hold down the annual growth of Medicare, now running at 13 percent, to about 5 percent by 1997. The squeeze may force cutbacks on treatment.
You’ll join the Clinton plan like everyone else, with the same benefits. You may be asked to pay a small fee for each doctor visit, but you may qualify for subsidies to help pay for it. Medicaid will continue to pay nursing-home bills for the poor.
The A word is not mentioned in Clinton’s plan. But the benefits package would cover “pregnancy related” and “family planning” services. As the White House sees it, these could include abortions but wouldn’t be required to. Doctors or hospitals who are affiliated with a plan that offers abortions could opt out under a “conscience clause.”
No employer would be required to pay more than 7.9 percent of its payroll toward health insurance. Small businesses with low-wage workers may pay less. For example, a business with fewer than 50 employees who earn on average $12,000 a year would have health-insurance costs capped at 3.5 percent of payroll. Still, if you now pay for no medical benefits, you’ll feel the pinch.
Yes, just the way you’re supposed to pay social-security taxes. You’ll be required to pay a prorated share of the premium for anyone who works for you 10 hours a week or more. If your employee earns $12,000 a year, you would pay 3.5 percent of their wages, or $420.
