
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: THURSDAY, October 28, 1993                   TAG: 9310280168
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Associated Press
DATELINE: WASHINGTON                                LENGTH: Medium

TRADEOFFS FOUND IN PLAN

President Clinton sweetened his health reform package with discounts for more small businesses and more freedom for people to choose their own doctors. But he also alarmed liberal allies by proposing curbs on the subsidies that are to guarantee coverage for all Americans.

The pharmaceutical industry found to its dismay that Clinton was now demanding that it pay the government rebates of 17 percent on drugs sold to Medicare patients. The figure had been 15 percent in the earlier version of the plan and even that was too much, drug companies insisted.

Small-business groups sniffed at the change in subsidies for small companies with low-wage workers, saying Clinton was just cutting the same pie thinner. The original version covered companies with up to 50 workers; now it's 75.

Business and health groups scrambled Wednesday to get their hands on actual copies of the 1,342-page plan and to start sifting through the fine print of Clinton's revisions.

After weeks of leaks and speculation, there were details aplenty.

Businesses with 24 or fewer workers making less than $12,000 apiece could pay as little as 3.5 percent of payroll for health insurance. Most employers would pay up to 7.9 percent and have to pick 80 percent of their employees' premiums.

Even 3.5 percent is too much, said Stephen Elmont, president of the National Restaurant Association.

"We simply can't afford it," said Elmont, who owns Mirabelle restaurant in Boston and now splits the health insurance bills with his 30 workers, who average $18,500 a year. "What he has done is create a new entitlement program which is absolutely untenable and unacceptable."

But to meet criticism that these subsidies might break the federal bank, Clinton would limit them. If the money ran out, the president would have to go back and ask Congress for more, unlike open-ended entitlement programs such as Social Security or Medicare.

A concerned Rep. Henry Waxman, D-Calif., called that "a very serious mistake."

It "undermines the credibility of the Clinton promise of health care security that will always be there," said the liberal chairman of the House Energy and Commerce health subcommittee. Waxman is nevertheless a supporter of Clinton's bill.

"We're very concerned that the vulnerable will not be covered if the money runs out," added Linda Lipsen, legislative director for Consumers Union, which has been lobbying for government-financed health care for all.

But she praised Clinton's decision to add a "point of service" option to all health plans, including health maintenance organizations. That means patients could choose to go to a doctor outside their plan's network of physicians. They would probably have to pay 20 percent of the bill themselves, however.

The point-of-service option also pleased the American Society of Internal Medicine. Dr. Alan R. Nelson, its executive vice president, said, "Much has changed in the president's plan since his address to the nation on Sept. 22 . . . Some of these changes are for the better."

by CNB