The president's plan to reform health care, called the American Health Security Act of 1993, would establish a system of regional health alliances to ensure that all Americans are covered by health plans that provide nationally guaranteed benefits.
The 1,342-page health care bill was submitted to Congress last fall.
Besides physician and hospital services, the benefits package includes outpatient prescription drugs and biologicals, home health services (including home infusion therapy) and durable medical equipment.
Of specific concern to pharmacists, the Clinton plan would:
· Establish a prescription drug benefit for the nation's 36 million Medicare recipients, as well as the 37 million more who are currently uninsured. Medicare reimbursement for community pharmacies would be at the lower of the 90th percentile of actual charges or the estimated acquisition cost, plus a $5 dispensing fee indexed to the consumer price index.
· Eliminate so-called discriminatory pricing practices by pharmaceutical manufacturers that now permit companies to offer deep discounts to mail-order pharmacies, health maintenance organizations and other groups, but not to retail pharmacies.
· Prohibit physician self-referrals and physician ownership of pharmacies.
· Repeal the health insurance industry's exemption from antitrust laws.
· Modify antitrust laws to enable pharmacists and other health care providers to join together to negotiate with health benefit plans.
· Allow pharmacists to make a case to the alliances to be paid for their services.
Most Americans would buy health insurance through regional health alliances, which would be set up by states to oversee health plans. A network of physicians, pharmacists and hospitals would be part of a plan and would compete for business on the basis of price, quality and service.
The regional alliances would be required to offer a minimum of three health care plans for consumers to choose from, which would be funded through insurance companies. One option has to be a fee-for-service plan in which consumers can choose the doctor and pharmacy they prefer.
Under the plan, the regional health alliances could be formed as early as Jan. 1, 1995, and no later than Jan. 1, 1997. Universal coverage would be achieved by Jan. 1, 1998.
The price of the plan would vary depending on the type of provider network a patient chooses.
The White House projects that the average premium, once the system is fully phased in, would be $2,388 for an individual, and $5,388 for a family of two parents and children. An independent analysis conducted recently by Lewin-VHI, a health research firm based in Fairfax, Va., calculates that premiums would cost $2,732 and $5,975 respectively.
Most businesses would pay a 7.9% payroll tax, or 80% of average premium costs. The remaining 20% would be paid by individuals and families. Small businesses with 50 or fewer employees and an average wage of $24,000 or less would pay from 3.9% to 7.9% of payroll. Large corporations with at least 5,000 workers could maintain self-insured plans.
Overall health budget ceilings would be set for each state. A National Health Board and the regional alliances would limit how much insurance premiums could rise.
The plan would be funded by wringing savings from current public health programs, raising the excise tax on tobacco products and holding down medical costs through competition and controls on health insurance premiums.
First lady Hillary Rodham Clinton, whose Task Force on National Health Care Reform drafted the plan, has stated that universal coverage is critical both for "human reasons" and to bring health costs under control.
The president's plan is not the only one on the table.
The Cooper-Grandy plan, proposed by Reps. Jim Cooper, D-Tenn., and Fred Grandy, R-Iowa, would try to increase the number of people who receive medical coverage by increasing the muscle of health care consumers and stimulating market forces.
A proposal developed by Sen. John Chaffee, R-R.I., would require all individuals to obtain their own health coverage. This bill is co-sponsored by Senate GOP Leader Robert Dole and 21 other Senate Republicans.
A bill supporting a single-payer system was designed by Rep. Jim McDermott, D-Wash., and Sen. Paul Wellstone, D-Minn.
Three other plans have also been developed under the sponsorships of Sen. Phil Gramm, R-Texas; Sen. Robert Michel, R-Ill.; and Sens. John Breaux, D-La., and Dave Durenberger, R-Minn.