Number of co-sponsors Coverage approach Benefits Federal costs Federal financing Private sector cost containment Purchasing pools
Health Security Act of 1993/(President Clinton) Rep. Richard Gephardt (D-Mo.), Sen. George Mitchell (D-Maine)/100 in House, 31 in Senate. Mandatory coverage of all citizens and legal residents by 1998. Employers required to pay 80% of workers' premium costs. Unemployed individuals required to buy insurance through regional alliances, with subsidies for low-income persons. Comprehensive standard benefits package specified in statute. Includes inpatient and outpatient hospital care, physician services, prescription drugs, and mental health and substance-abuse services up to certain limits. Creates new long-term-care program. Treasury Department estimates $390 billion in federal funds over five years to pay for plan, plus $57.7 billion in deficit reduction in that time. $124 billion reductions in Medicare, $65 billion reductions in Medicaid, $89 billion from cigarette taxes and assessments on corporate alliances, $40 billion savings from other federal programs, $71 billion in new tax revenues from limiting tax-exempt spending on "cafeteria" health plans and other changes over five years. Limits on private insurance premiums; presumes price reductions from managed competition. Requires states to establish one or more regional alliances. Employers and individuals must buy insurance through alliance. Businesses with more than 5,000 employees may form their own corporate alliances.
Health Equity and Access Reform Today Act of 1993/Sen. John Chafee (R-R.I.), Rep. William Thomas (R-Calif.)/20 in Senate, four in House. Mandatory coverage of all citizens and legal residents by 2005. Employers must offer, but not pay for workers' coverage. Individuals required to buy insurance, with federal subsidies for low-income individuals. Allows individuals full tax deduction for health insurance premiums up to a specified cap. Medical savings accounts available and tax deductible. Health plans must offer standard benefits package or combination of catastrophic and medical savings accounts to small businesses. Benefit levels detailed after enactment by national benefits commission. $213 billion in low-income subsidies from 1997 to 2005. Program would be implemented only after savings are realized from Medicaid and Medicare and tax increases. $213 billion in five-year savings from curbing growth of Medicare and Medicaid. Managed competition among health plans, limits on tax deductibility of health insurance, administrative savings. Requires states to establish geographic areas in which purchasing cooperatives for individuals and small businesses with fewer than 100 workers can be formed. More than one cooperative may operate in a geographic area.
Managed Competition Act of 1993/Rep. Jim Cooper (D-Tenn.), Sen. John Breaux (D-La.)/57 in House, four in Senate. No coverage mandate. Employers must offer but not pay for health insurance. Access to health coverage expanded through insurance reforms that guarantee renewal and portability of policies, through government subsidies for low-income individuals to buy insurance and through formation of purchasing pools for small businesses and individuals. No tax deduction for premiums on benefits above standard package. Medicaid replaced with program that enables low-income individuals to buy private insurance through purchasing pools, with federal subsidies on sliding scale up to 200% of poverty. Requires all plans to offer standard benefits package of medically necessary services, which would be determined by healthcare standards commission after enactment. Must include preventive services with no cost-sharing. 25 billion annually, or $125 billion over five years. $40 billion over five years from slowing Medicare growth, $16 billion from capping employer tax deduction for healthcare at lowest-cost health plan. 1% tax on health plans to fund graduate medical education. Unspecified savings from replacing Medicaid with subsidy program. Managed competition among health plans, limits on tax deductibility, administrative savings. States must establish health plan purchasing cooperatives (HPPCs). Individuals and employers with fewer than 100 workers must buy insurance through HPPC to keep tax deduction. Large employers may form their own group purchasing arrangements.