Negotiators Reach Accord on Health Reform

Congressional negotiators reached final agreement Wednesday on broad health reform legislation that would permit workers to carry their health insurance from job to job and make it more difficult for insurers to refuse coverage to people with existing medical problems.

House and Senate conferees, however, eliminated provisions that would require the same level of coverage for mental health treatment as for other health problems.

The agreement clears the way for final congressional approval this week. The White House indicated that President Clinton will sign the bill.

In a statement issued late Wednesday, Clinton said: “Today we have apparently achieved a long overdue victory for the millions of Americans who live in fear of losing their health insurance when they change or lose their jobs or because of preexisting conditions.”

Clinton said that he hopes Congress will send him the bill before adjourning at the end of this week for its August recess.

Senate Majority Leader Trent Lott (R-Miss.) called the agreement “a remarkable achievement” and said that the Senate hopes to act on the bill Friday.

On the House side, Rep. Bill Archer (R-Texas), chairman of the Ways and Means Committee and a central figure in the health debate, said that the agreement “is truly momentous. This is what the American people want out of their Congress.”

The legislation is far less ambitious than the monumental health reform plan that the Clinton administration unsuccessfully proposed early in Clinton’s term. But enactment of the pending bill nonetheless would be a significant bipartisan accomplishment for Congress, because the reforms would affect so many Americans and the insurance industry.

Some analysts have estimated that 25 million people a year could benefit from having “portable” health insurance, while as many as 80 million have ailments that could subject them to exclusion from coverage because of preexisting conditions.

Before reaching agreement, House and Senate conferees wrestled with versions of the plan that diverged in critical areas. The Senate version would have provided workers with a wide choice of health plans after leaving or switching jobs, while the House measure envisioned a narrower list of options.

The final legislation, which would take effect next July 1, more closely resembles the Senate-backed bill. It would provide that all plans currently offered by insurers would be available to any person who shifts from a group plan when leaving a job to an individual plan.

If an insurer were to limit individual coverage to a smaller range of plans, those plans would have to be the insurer’s most popular ones. If not, the insurer would be required to provide coverage comparable to its popular plans and include subsidies to offset the high costs for high-risk individuals.

The bill also would permit insurers to deny health coverage for only 12 months for a medical condition diagnosed or treated in the previous six months.

Sen. Nancy Landon Kassebaum (R-Kan.), chief Republican sponsor of the Senate version, said that she was “just thrilled” by the agreement. “Over the past year we have worked hard to put together a bill that provides assurances that individuals will not be excluded from health coverage due to preexisting conditions and that those who have played by the rules will not lose access to coverage if they change or lose their jobs,” she said.

Sen. Edward M. Kennedy (D-Mass.), the chief Democratic sponsor in the Senate, said: “Help is now on the way for 25 million Americans. If you change your job or lose your job, it should not mean that you lose your health insurance too.”

Conferees eliminated provisions that would have required insurers to provide the same level of coverage for mental disorders as they do for other health problems. The decision means that insurers can continue their current practice of providing a much narrower range of mental health benefits.

Insurance companies and House Republicans who vehemently opposed the mental health provision argued that it would drive health costs up sharply. But in the Senate, Republican Sen. Pete V. Domenici of New Mexico, who crafted the mental health provision, angrily objected.

“I would like to say publicly to the business community. . . . Shame, shame on you. Shame on you,” Domenici said.

Dr. Laura Lee Hall, deputy director for policy and research of the National Alliance for the Mentally Ill, said: “Millions of Americans suffering from brain disorders and the discrimination that accompanies them are outraged that congressional leaders have rejected a modest step towards ending this injustice.”

Wednesday’s final agreement came after partisan wrangling broke out earlier in the week, as Republicans accused Democrats of attempting to delay enactment until after the recess to prevent GOP lawmakers from telling their constituents that a health reform bill had been passed by a Republican-led Congress.

Last week, negotiators overcame serious differences over medical savings accounts, the most contentious issue involved in the legislation, which had stalled it for months.

The proposal to create such medical accounts was supported by the GOP but opposed by Democrats and the administration. It would allow individuals to put money aside, tax free, to pay most medical costs and buy insurance policies with high deductibles to cover serious illness.

The compromise on the medical savings accounts, struck by Kennedy and Archer, provides for a limited trial of the system in which up to 750,000 policies would be made available to the self-employed and to workers in businesses with fewer than 50 employees.

After four years, the results would be evaluated and Congress then could vote to extend the program to the entire country. People involved in the experiment, however, would be allowed to continue with the accounts regardless of the congressional action.

Republicans pushed the accounts idea as a way to give people a new option and argued that it would make consumers more cost conscious.

Democrats and other critics argued that medical accounts primarily would benefit wealthy and healthy people and draw them away from traditional insurance plans--making those plans more expensive for those who remain.