A top administration health official said last week that he is "optimistic" the reform plan Congress enacts this year will include a mandate requiring employers to provide health coverage.
In an interview with MODERN HEALTHCARE, Bruce Vladeck, head of HCFA, said such a mandate is the only way to achieve universal coverage without raising taxes. That reality will become increasingly clear as lawmakers head into 1994 elections, Mr. Vladeck said.
He also predicted that arguments against a mandate would be diffused as mainstream economists conclude that it wouldn't cause a reduction in the number of jobs.
In fact, at a hearing last week of the Senate Finance subcommittee on families and the uninsured, a health economist from the Economic Policy Institute testified that if President Clinton's health plan were enacted, it would save manufacturing firms $18 billion in 1994 and create from 54,000 to 113,000 jobs in the first five years.
Mr. Vladeck said he believes that the final health plan would include a set of basic benefits and reforms of the insurance market.
"I'm hopeful that, when all of the posturing and maneuvering is done, large parts of the administration's bill will be enacted," Mr. Vladeck said.
Among the most uncertain aspects of the plan are its financing mechanisms, which include five years of Medicare spending constraints totaling $124 billion, he added.
The administration's proposed cap on private insurance premiums also will cause congressional fur to fly. But Mr. Vladeck believes there aren't many alternatives to caps. A cost-control plan that produces tangible savings is central to the administration's financing scheme and the goal of universal coverage, he said.
The only alternatives to the cap are even less palatable-stringent price controls or a more direct process for setting health budgets, which the president's plan "consciously" avoided, Mr. Vladeck said.
He suggested that differences over the premium cap could be resolved by altering how the caps were set, administered and structured.
Hospital groups, including the American Hospital Association, vehemently oppose the premium cap, charging it would impose rigid restrictions on health spend- ing. Hospitals also are battling the proposed hefty Medicare cuts. Asked how much those cuts could be reduced, Mr. Vladeck said, "Not one penny."
But providers will get a break in the fiscal 1995 budget, which won't include any additional Medicare spending reductions, Mr. Vladeck said. "We're not supporting any further savings outside of healthcare reform."
The Clinton plan is spurring the AHA to launch what it describes as the largest grass-roots lobbying effort it's ever attempted. Richard Wade, senior vice president of communications at the AHA, said the effort would have a "presidential campaign structure" and that group would spend at least $1 million on it this year.
Before deciding on the framework for the campaign, the AHA will convene focus groups composed of hospital and nurse executives as well as hospital trustees to get their feedback, Mr. Wade said. The group already has met with allied and state executives.
The push is designed to involve every AHA member in an educational and political effort to influence the healthcare reform debate by targeting members of Congress who fill key committee posts and who might be won to the AHA's position on issues that are important to the industry.
In other reform-related news, Lane Kirkland, president of the AFL-CIO, vowed that organized labor would commit "whatever it takes" to fight for Mr. Clinton's healthcare program, offering the first blanket statement of support for the plan.
A group of 560 academic economists, meanwhile, sent a letter to Mr. Clinton criticizing the premium caps and national spending targets included in the administration's health plan.
Wharton School economist John Lott Jr., who wrote the letter and collected signatures, said while the plan appears to curb health spending, "such gains are illusory. We will instead end up with lower quality medical care, reduced medical innovation and expensive new bureaucracies to monitor compliance."-Lynn Wagner with Eric Weissenstein