After 4 long years of congressional debate, which generated thousands of pages of hearing records and dozens of healthcare reform proposals (some so comprehensive they would have provided “single-payer” universal coverage), Congress passed a new law simply addressing medical insurance coverage. This August, President Clinton signed into law the Health Insurance Reform Act of 1996.
Although it was limited in scope, the bipartisan initiative barely survived months of political infighting over a number of its provisions. With negotiators bogged down in details and passage appearing extremely doubtful, early this past summer a group of voluntary health organizations, including the American Heart Association, came forward to help jump start the process. In a letter to key congressional negotiators the group stated, “. . . on behalf of the millions of men, women and children with chronic disease and/or disabilities, [we] urge Congress not to let the window of opportunity close on health insurance reform . . . .” (written communication to congressional negotiators from health groups regarding healthcare reform, July 30, 1996).
Under current insurance practices, many Americans are denied coverage if they change or lose their jobs or are dropped from their existing plans because of preexisting health conditions. Compared with the insured, the uninsured use the nation's healthcare system less frequently, are more likely to be without a regular source of basic health care, are less likely to engage in preventive measures, and are more likely to delay seeking medical care. Because the uninsured are less likely to seek basic medical care, they probably are less likely to receive basic cardiovascular care. When this care is not provided, in many cases people are more likely to suffer from preventable cardiovascular diseases and the nation's healthcare system incurs treatment costs that far exceed those that would be incurred with preventive care.
The new law guarantees portability of insurance for those leaving or losing jobs, requires renewability of group health plans, and prohibits the denial of access to quality medical care for those with preexisting conditions. Such incremental measures go a long way toward guaranteeing universal access and coverage for basic medical care for Americans. AHA holds the position that regardless of preexisting conditions all US residents must have access to quality medical care, including appropriate medications and prevention programs.
Specifically, the new statute limits the ability of insurance companies to deny policies to Americans with preexisting medical conditions. Group insurance plans must cover new employees with preexisting conditions within 12 months, and the waiting period may be reduced by an amount equal to the period of previous creditable coverage. The law guarantees the availability of comparable coverage for people moving from group to individual plans, guarantees renewability of group insurance plans except in cases of nonpayment or fraud, and makes long-term health insurance taxes deductible. It establishes a demonstration medical savings account (MSA) program, allowing certain individuals to create high-deductible, tax-free medical accounts to pay routine medical bills.
During the long healthcare debate, AHA continued to support a series of principles, including prompt access to appropriate quality medical care, particularly for cardiovascular diseases and stroke; the allocation of funds for biomedical research, education, and clinical training, to ensure optimal health care and healthcare delivery; universal coverage for basic medical care; coverage for preventive care; and the development of guidelines and support for research into methods to measure quality, outcomes, and cost-effectiveness.
AHA will continue to support these principles as they relate to health care delivered by managed care or point-of-service options via group health insurance, individual policies, or Medicare. Managed-care issues garnered much attention during the 104th Congress.
President Clinton has authorized the establishment of a healthcare quality advisory panel that will make recommendations concerning delivery of health care, including managed care. Issues that might be addressed during the 105th Congress include the following:
•allowing point-of-service options for patients to see specialists, when necessary.
•prohibiting financial incentives for denying referrals.
•prohibiting “gag” clauses in physician contracts that restrict or interfere with medical judgment.
•preventing HMOs from requiring prior authorization in emergency situations while requiring them to pay for emergency care services provided to prudent laypersons seeking emergency care.
•addressing the coverage needs of small businesses.
•providing additional incremental insurance reforms.
AHA will continue to monitor and address these important healthcare issues during the upcoming session of Congress.
- Copyright © 1996 by American Heart Association