ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, April 24, 1996 TAG: 9604240060
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: From The Houston Chronicle and The Associated Press
The Senate gave rare unanimous approval Tuesday to a health insurance bill that still faces a rocky road in a House-Senate conference committee.
The Senate bill, approved 100-0, would assure that workers would be able to buy health insurance even if they change or lose their jobs or have existing illnesses.
At a Rose Garden ceremony honoring teachers, President Clinton said the bill would ``improve access to health care for 43 million Americans.''
He also applauded the Senate version for including mental health coverage. The legislation would require corporate health plans to treat mental illnesses the same as physical ailments.
That provision and a system of medical savings accounts in the House version will be the biggest potential sticking points when a House-Senate conference committee convenes to work out differences in the two versions.
Buyers of such insurance options would get catastrophic health coverage, subject to a high deductible payment before the insurance kicked in. Part of the premium would go into a tax-exempt savings account from which routine medical expenses could be paid.
Unspent savings would earn interest, and the account could be used for non-medical expenses - but then would be subject to tax.
Opponents object to the tax shelter that medical savings accounts would create and say they would draw healthy people away from traditional insurance pools that need them to keep the cost of insurance affordable for the least healthy.
Because the House has approved the savings accounts, Dole is likely to propose them again to the House-Senate conference. Dole said one study showed the accounts would benefit mostly those with incomes of less than $100,000.
Thirteen states are trying something similar to the medical savings accounts, he said. The tax-exempt savings accounts would allow individuals to set aside money to spend on medical needs under catastrophic-illness coverage.
Business and medical groups supported the idea, but when Dole proposed the accounts last week, the Senate defeated them, 52-46. White House officials have said Clinton will veto the bill if it includes the savings accounts.
The American Conservative Union called medical savings accounts ``one of the most logical, sensible, and promising health insurance reforms ever developed.''
Some analysts contend the mental health provision could triple a patient's copayment for a doctor's visit. Current insurance plans with generous terms for periods of hospitalization for physical ailments generally have strict limits on inpatient treatment for mental problems.
A chief Senate backer of the mental health provision, Sen. Paul Wellstone, D-Wis., said it could save money by encouraging preventive treatment that avoids lost productivity.
Another difference between House and Senate versions could stir dust in the conference: The House would limit malpractice awards, and the Senate has no provision on that subject.
A spokesman for a chief Senate sponsor of the bill, Kansas Republican Nancy Kassebaum, said she is optimistic a compromise can be reached despite the big differences.
Spokesman Joel Bacon said Kassebaum will try to keep the bill from being expanded far beyond its core idea of ``portability'' of health coverage. A diverse coalition of hospital groups, business and labor supported the Senate bill and could dissolve if the conference takes the bill too far afield, he said.
The Senate bill would raise the tax deduction for health insurance bought by the self-employed and would make long-term-care insurance and expenses tax-deductible. Large medical expenses could be paid out of Individual Retirement Accounts without penalty.
Mindful of the political difficulties faced by more ambitious health insurance plans, backers of the Senate bill applauded it as realistic. ``The incremental approach [of the bill] represents a realistic pathway toward resolution of existing problems in the American health delivery system,'' the American Medical Association said.
Sen. Edward Kennedy, D-Mass., a co-sponsor of the bill with Kassebaum, said it ``will end many of the most serious health insurance abuses and provide greater protection to millions of families.
``Millions of Americans are forced to pass up jobs that would improve their standard of living or offer great opportunities, because they are afraid they will lose their health insurance,'' he said. ``Many other Americans lose their health insurance because they become sick or lose their jobs.''
LENGTH: Medium: 89 lines ILLUSTRATION: PHOTO: AP. Sens. Edward Kennedy and Nancy Kassebaum talk withby CNBreporters on Capitol Hill after the 100-0 vote. color. Graphic:
Chart by KRT.