Since the defeat of President Clinton’s health care initiative in 1994, the subject of universal health care has virtually disappeared from the national agenda. For the most part, the health care legislation now offered by our national leaders has to do with prescription drug coverage under Medicare, a patients’ bill of rights, or other piecemeal approaches to the American people’s discontent with the health care system.
The bold exception in the United States Senate is the recent introduction by Minnesota Senator Paul Wellstone of the Health Security for All Americans Act, S. 2888. This bill would assure “quality, affordable health care for all Americans” by requiring every state to create its own system of universal coverage, with significant funding supplied by the federal government. The bill was introduced this past July in the Senate; companion legislation has been introduced in the House by Washington State Representative Jim McDermott and 21 co-sponsors. Although little-reported here in his home state, Wellstone believes that his bill is the first step in putting universal health care “back on the front burner where it belongs.”
In a speech on the Senate floor when the bill was introduced, Wellstone said “America’s doctors and nurses know how to cure disease better than anywhere else in the world. Well, now it is time to treat America’s worst malady-45 million uninsured Americans, and millions more underinsured Americans who are spending far too much of their monthly pay check on health care costs… All the doctors and all the nurses and all the other health care providers in America cannot solve this problem nor right this injustice, but we in the Congress can!”
Under the Wellstone bill each state would be required to provide”universal, affordable, and comprehensive” health care benefits to 100% of its residents that would be equal to the benefits provided to members of Congress. The states would have 5 years to put the plan in place.
Two provisions of the Wellstone plan will be of particular interest to readers of ACCESS PRESS. Title VI of the bill, entitled “Long-term and Home Health Care,” would mandate the Secretary of Health of Human Services to “conduct studies and demonstration projects…designed to identify model programs for the provision of long-term and home health care services,” and “report any recommendations for legislation to expand or continue such studies and projects.”
In a separate section of the bill is a requirement that any American entitled to benefits under either Part A or Part B of the Medicare program “shall be provided full mental health and substance abuse treatment parity under the medicare program.”
State Plans, Federal Funds
The Wellstone plan would be administered on the state level, with minimum standards set and funds provided by the federal government. Wellstone believes that a single-payer plan, similar to the system in Canada, might actually be the best approach for the United States to take. However, in a bow to the current political realities in this country, the Health Security for All Americans Act is not a single-payer plan. Instead, Wellstone points out that the 50 U.S. states could reach the goal of universal coverage “in a variety of ways: with an employer mandate, with a combination of public and private initiatives, with single payer, or some other method.” (For more information on the Canadian single-payer system, see the related article in this issue of ACCESS PRESS.)
There are 8 key provisions in the Health Security for All Americans Act:
1. Each state would be required to devise a way to “establish and implement State-administered systems to ensure universal health insurance coverage equal to the benefits provided” to members of Congress and other federal employees. The states would have 5 years to reach the goal of 100% coverage.
2. The federal government would provide the funding necessary for the states to assure that no citizen pays more than a small percentage of their family income for coverage under their plans (ranging from one-half of one percent for the lowest-income families to 7% for upper-income families).
3. The bill anticipates substantial “direct savings in [overall] health care expenditures resulting from the implementation of this Act,” with additional funds coming from the federal government and drawn from the projected budget surplus and from taxes raised by closing existing loopholes on wealthy individuals and large corporations.
4. Acknowledging that it would take some time for the states to implement their universal care plans, the bill would immediately enact into law a patients bill of rights (as previously submitted in the U.S. House) and the provisions of another previously-submitted bill that would “prohibit discrimination or retaliation against health care workers who report unsafe conditions and practices which impact on patient care.”
5. The bill would establish a “Health Care Quality, Patient Safety, and Workforce Standards Institute” within the federal Department of Human Services. The Institute would improve patient safety and quality of care by addressing the recently-publicized issue of workplace errors, including ongoing study of “how patient safety issues and workplace conditions are linked” to those errors and overall quality of care.
6. The Institute would also “study and report to Congress and the President legislative recommendations for adding a comprehensive, accessible, and affordable prescription drug benefit to Medicare.”
Wellstone maintains that his bill, by allowing states maximum flexibility while establishing federal responsibility for setting standards and providing funding, gives the United States the best chance at the present time to meet the goals of “universal coverage; comprehensive benefits as good as Congress gets; quality care guaranteed with patient protections; real income protections; and honoring of health care workers.”
When in his speech introducing the Health Security for All Americans Act last July, Wellstone concluded by saying that the problem of uninsured and underinsured Americans “is a problem that isn’t going away on its own, but there is a solution.” He then called on all Americans who are concerned about this issue to “join thousands of your fellow citizens who have already written to members of Congress, and call and write your Senators and Representatives and ask them to join in bringing quality, affordable health care coverage to all Americans.”