Clinton to launch revised health care plan



WASHINGTON (AP)—President Clinton readied a second launch of his health care plan Monday, lifting restrictions on fee-for-service plans and adjusting other provisions in response to criticism of the original draft.

The White House tinkered with a proposed subsidy for small business to provide some help to slightly larger businesses and decided to phase in a long-term care benefit for the severely disabled over seven years instead of five, officials familiar with the plan said.

After a marathon drafting session over the weekend, Clinton’s health advisers finished the voluminous plan Monday morning.

Clinton and his wife, Hillary, were to deliver their proposed 1,600-plus page Health Security Act to Democratic congressional leaders at a ceremony in the Capitol’s Statuary Hall on Wednesday.

The Democrats may spend a week to 10 days rounding up sponsors before introducing the bill.

White House aides said Monday there have been minor changes in the health plan since Clinton outlined it in an address to Congress on Sept. 22. The changes respond both to criticism that the plan was overly regulatory and to more conservative projections of the cost of providing universal coverage by the end of 1997.

But the goals have not changed, spokeswoman Marla Romash said. ‘‘The president’s Health Security Plan is going to provide comprehensive coverage to every American that can never be taken away.’‘

After months of work by a task force led by Mrs. Clinton, a 239-page draft of Clinton’s blueprint leaked in early September. Mrs. Clinton made the case for it before five congressional committees a week after the president’s televised address to Congress.

But lawmakers grumbled about the delay in submitting detailed legislation.

Clinton’s bill faces stiff competition from both the left and right. Liberal Democrats favor letting the government pay all medical bills; conservative Republicans are backing tax-free savings accounts for health care. Conservative Democrats and moderate Republicans in both houses want to try so-called managed competition and insurance market reforms.

Clinton is sticking with his approach mixing both market reforms and government regulation.

‘‘There have been changes to make the plan less regulatory and less bureaucratic; changes to make the plan more fiscally conservative, and changes to expand consumer choices,’‘ said Christine Heenan, a White House health policy analyst.

In other developments:

_The Employee Benefit Research Institute, a research group supported by corporations, labor groups and health organizations, estimated that between 200,000 and 1.2 million workers could lose their jobs as a result of Clinton’s proposed requirement that employers provide health insurance to all workers, assuming employers do not lower wages instead.

_Citizen Action, a consumer group that favors letting the government raise taxes to pay all medical bills, said commercial health insurers spent 36.4 cents on administration, marketing and overhead for every dollar they paid in health benefits in 1991. All private insurers, including nonprofit Blue Cross plans, spent 16.8 cents on administration, it said.

Under Clinton’s plan, states would create huge insurance-purchasing pools called health alliances that would offer consumers a variety of health plans.

Consumers could reduce out-of-pocket costs by joining health maintenance organizations or other prepaid plans. But they would be free to enroll in costlier plans that do not restrict their choice of doctors.

The original draft said no more than three health plans offered by an alliance could be fee-for-service; that restriction has been scrapped.

White House officials said the alliances could still reject a health plan if its premiums were too costly. The initial draft specified that an alliance could reject a contract with a health plan that bid 20 percent more than the average charge.

The Clinton plan includes caps on health insurance premiums as a backstop to hold health costs down.

Most employers would be assured that their health insurance costs would consume no more than 7.9 percent of payroll. Some small businesses with low wages would pay from 3.5 percent to 7.9 percent of payroll, with the government subsidizing the rest. Those subsidies, originally designed to end abruptly with firms of 50 workers, now will be phased out gradually over larger businesses.

Under the initial proposal, ‘‘a company with 51 employees would have been as rare as a bald eagle,’‘ said an official who asked not to be identified.

Other changes in the original plan include providing free mammograms for women at high risk of breast cancer as well as those over 50; allowing women to designate obstetrician-gynecologists as their primary care doctors; and phasing in a government takeover of employers’ costs of providing health benefits for early retirees ages 55 to 64.