Clinton’s plan: How some families would do



WASHINGTON (AP)—If you’ve been skating by without health insurance to make payments on your BMW, the Clinton health plan could mean some big new bills. But if you’ve been unable to get coverage because your child has a serious illness, you could be in for some help.

President Clinton says ‘‘the vast majority’‘ of Americans would pay the same or less for benefits that would be as good or better than most enjoy now. And everybody would win because they would never worry again about losing health coverage, he says.

But there would be individual winners and losers by the millions if and when the nation switched to Clinton’s Health Security Plan.

Most of the 37 million uninsured Americans would be winners. A good many are workers whose employers would have to start paying most of the health premiums for them and their families.

On the other hand, Nancy Scola of Towers Perrin, a major benefits consulting company, said workers with ‘‘wonderful benefits who pay hardly anything for them now are going to be the financial losers.’‘

By forcing insurers to take all comers, without regard to their age or health, Clinton would drive up insurance rates for the young and healthy, while lowering them for older, sicker folks.

Here are some possible scenarios suggested by Marilyn Moon, a health economist for the Urban Institute. She developed the figures with support from the Kaiser Family Foundation.

The people are fictitious. The figures are based on the White House estimate that the average policy would cost $4,200 for a family and $1,800 for an individual:


Alice and Don Jones are young parents with a one-year-old infant, lots of health bills and no insurance. Jones makes $28,000 a year and works for a small business that provides no coverage. He also has a heart problem that makes insurance prohibitively expensive. She is at home with the baby.

The Joneses now pay no insurance premiums, but they spent $3,000 last year for the baby’s delivery and $1,000 for Don Jones’ medication and doctor visits. They have put off taking the baby to the doctor to save money.

Under Clinton’s plan, they would pay $840, or 20 percent of the family premium; his employer would pay the rest. They could choose a below-average cost plan with minimal out-of-pocket costs and the option to go to his heart specialist by paying 20 percent of the bill.


andy Rogers, 27, makes $32,000 a year from his own landscaping business. He is the picture of health, seldom goes to a doctor and has other uses for his disposable income than buying health insurance. He could buy a low-cost, high-deductible policy now for $1,200.

Rogers would have to pay $1,800 or close to it under the Clinton plan, even if he chose to enroll in the least expensive option, a health maintenance organization, and never darkened its door. He earns too much to qualify for discounts available to small businesses and low-wage workers.


Ann Adams, 31, and her three children get by on $9,000 a year in Aid to Families with Dependent Children and are covered under Medicaid. She has found many doctors unwilling to accept her family as patients, and has had to take one son to a hospital emergency room when he had an asthma attack. She pays no premiums or deductibles now.

The Clinton health plan would allow Adams to choose from a variety of health plans at or below the average cost. She might have to pay $10 to visit a doctor, but she would have access to far more doctors or a health maintenance organization.


Marie and Steven Smith have one child. Both parents work, earning a combined $43,000 a year. He makes $34,000 as a delivery man and she earns $9,000 from a 16-hour-a-week job in a nursery school.

His job provides good health coverage, but his employer pays only 70 percent of the premiums. The family has a choice of plans. They are in an HMO that costs them $116 a month, but leaves them with few out-of-pocket medical expenses.

The Smiths can stay in an HMO under Clinton’s plan and pay less. If the HMO charges $4,100, the Smiths’ share would be $740 a year, or less than $62 a month.

The big loser would be Mrs. Smith’s employer, who will be liable for roughly $100 a month of the family’s premium.


Barbara and Ben Boyd are lawyers in their mid-30s. Between them they earn $190,000. He works for a law firm and she is an executive of a trade association. They have no children, and each has free health insurance now through their jobs—no premiums, no deductibles.

The Boyds will have to pay 20 percent of a $3,600 policy—$720—or perhaps as much as $1,200 if they choose a high option, fee for service policy. Their employers could elect to pay the Boyds’ share of those premiums.


Dr. Peter Pratt, 43, makes $160,000 a year from his solo practice as a rheumatologist. His wife, Eleanor, 41, does not have a paid job. They have two kids.

Pratt provides coverage for himself, a nurse and three office workers. The premiums for his family alone cost $6,500 a year. He can deduct 25 percent of this from his taxes. The family has a $1,000 deductible and large co-payments to keep the costs of insurance down.

Under Clinton’s plan, the Pratts would pay $4,200 for an average family policy, or more if they choose a high-option plan.