Number of co-sponsors Coverage approach Benefits Federal costs Federal financing Private sector cost containment Purchasing pools
American Health Security Act of 1993/Rep. Jim McDermott (D-Wash.), Sen. Paul Wellstone (D-Minn.)/92 in House, five in Senate. Mandatory coverage of all U.S. citizens and legal residents by 1995. Government sponsors and finances all health insurance through employer payroll taxes and a variety of sin taxes. Private insurance eliminated. Comprehensive benefits detailed in statute, including inpatient and outpatient services, professional services from state-authorized practitioners, prescription drugs and comprehensive long-term-care services. $370 billion per year in current private spending rechanneled to federal coffers through taxes. Federal financing through employer payroll tax and sin taxes. Global health budgets, limiting expenditure growth to equal growth of GDP. Each state administers one pool.
Affordable Health Care Now Act of 1993/Rep. Robert Michel (R-Ill.), Sen. Trent Lott (R-Miss.)/139 in House, 10 in Senate. No coverage mandate. Expands access by requiring insurers to offer small businesses at least three choices of health plans: standard coverage, a more austere catastrophic plan and a medical savings account. Employers must offer but not pay for coverage. Catastrophic plans and MSAs fully tax deductible. Allows states to expand Medicaid eligibility up to 200% of the federal poverty level. No standard benefits plan. $17 billion over five years. $13 billion in revenues from raising federal retirement age from 55 to 62, $4 billion from phasing out Medicare subsidies for beneficiaries earning more than $100,000. Voluntary managed competition, administrative savings. States have option to establish voluntary insurance purchasing cooperatives for small employers.
Consumer Choice Health Security Act of 1993/Rep. Clifford Stearns (R-Fla.), Sen. Don Nickles (R-Okla.)/18 in House, 25 in Senate. No coverage mandate. Individuals must purchase catastrophic health insurance plan by 1997 or forfeit their personal tax exemption. Employers must retain current coverage until 1997. After that, businesses that discontinue health plans must pay the difference in wages to employees. Eliminates tax deductibility of health insurance and replaces with tax credits based on the portion of adjusted gross income spent on healthcare. Allows a 25% credit for medical savings accounts of up to $3,000 per individual. Broad categories that catastrophic plans must meet, including medically necessary acute and physician services, emergency hospital services and prescription drugs. Benefits package not required to include abortion services. $137 billion to finance tax changes from 1997 to 1999. $72 billion in Medicaid reductions from 1995 to 1999 by capping federal spending on acute care at CPI plus 1% and calculating payments on per-capita basis. Replaces disproportionate-share payments with federal grants to states for home healthcare for low-income individuals. $67 billion in Medicare reductions from 1995 to 1999. Price competition among insurers, limits on tax deductibility, administrative savings. Individuals act as own purchasing agents.
Comprehensive Family Health Access and Savings Act/Sen. Phil Gramm (R-Texas), not yet introduced in House/10 in Senate. No coverage mandate. Individuals must purchase a catastrophic health insurance plan. Those who don't would have wages garnisheed for seven years for unpaid medical bills. Subsidies available for high-risk individuals. Tax credits available to low-income workers up to 200% of poverty level. To continue tax exclusion for employee health costs, employers must offer three options: the current health plan, an alternative arrangement such as an HMO or PPO and a medical savings account. No minimum benefits. $144.2 billion for high-risk subsidies, low-income tax credit and health insurance tax deduction, 1995 through 1999. Programs wouldn't take effect until savings had accrued from federal programs. $112.5 billion from capitating Medicaid program and giving states more flexibility to enroll recipients in low-cost plans or provide medical savings accounts and from estimated effects of lower medical inflation and greater consumer choice. Encourage greater use of managed-care plans, administrative savings. Remove regulatory and legal restrictions impeding the formation of purchasing pools among small businesses.