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NATIONAL HEALTH COMMISSION WOULD CREATE BENEFITS PACKAGE UNDER REP. COOPER HEALTH CARE BILL, MEASURE CALLS FOR $40 BIL. IN MEDICARE CUTS OVER FIVE YEARS

This article was originally published in The Gray Sheet

Executive Summary

A bipartisan health care reform bill introduced Oct. 6 by Rep. Jim Cooper (D-Tenn.) would authorize a national "Health Care Standards Commission" to establish a guaranteed health benefits package, according to a summary of the proposal. The independent commission would "establish and update the standard health benefits package, which must include the full range of medically-appropriate treatments and preventive services," the summary says. The group's recommendations would "be submitted to Congress" and would "have to be approved or rejected on an up-or-down vote." The health commission also would "establish standards for reporting prices" and health outcomes. Under President Clinton's health reform plan, Congress would define the general scope of the benefits package instead of the national board. However, once health reform was enacted, the National Health Board would "interpret and update" the package without congressional oversight ("The Gray Sheet" Sept. 20, p. 15). Rep. Cooper's "pure managed competition" bill (HR 3222), which has over 40 cosponsors, seeks a middle road between the White House proposal and Republican health reform plans. Similar legislation is expected to be introduced in the Senate within the next two weeks by Sen. John Breaux (D-La.) ("The Gray Sheet" Sept. 27, p. 9). In an Oct. 6 press release, HR 3222 cosponsor Nancy Johnson (R-Conn.) says the measure will "constrain costs and increase access to health care through a market-driven" system with "far less federal control than the Clinton plan." Unlike the White House proposal, HR 3222 does not include global budgets and would not mandate that employers purchase insurance for employees. In addition, through "changes in the tax code," the Cooper bill "strongly encourages providers and insurance companies to form accountable health plans." All individuals, "except for employees of large businesses," would enroll in purchasing cooperatives, which will offer enrollees a menu of AHPs. Although the bill does not define a standard benefits package, it does identify several diagnostic procedures that would be covered through an expansion of preventive services. Medicare coverage would "be expanded to include annual mammography, certain immunizations, and colorectal screening." Medicare currently covers mammograms every other year. The initial draft of the Clinton health care reform proposal would cover biennial mammograms for women over 50 years old. However, HHS Secretary Donna Shalala stated at an Oct. 6 hearing before the Senate Labor and Human Resources Committee that mammography coverage could be expanded to cover additional screening for women over the age of 55 and other high risk groups. She added that the administration, in its health reform plan, would "adhere to" mammography guidelines under development at the National Cancer Institute. A recent letter from 14 members of the Congressional Women's Caucus urged the administration to adopt more extensive coverage for mammograms and Pap smears. The Cooper bill is projected to cost the federal government $25 bil. annually. The costs would be financed through the employer tax cap ($16 bil.); "reducing the increase in provider fees under Medicare" ($6.5 bil.); phasing out the Medicare Part B Premium subsidy for upper-income beneficiaries ($1.5 bil.) and "prefunding federal retiree health benefits" ($1 bil.). In comparison to the $8 bil. in annual Medicare cuts proposed in the Cooper bill, the White House proposal calls for spending reductions of $124 bil. over five years.
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