Tie That Binds Health-Care, Welfare Reform

THE fabled twins, Alphonse and Gaston, kept their mother in labor for years as they debated in the womb about who should enter the world first. The dialogue went something like this, ``Go ahead, you go first,'' ``No, my brother, be my guest,'' ``No, really, you deserve to go first,'' and so on.

Now, as the country awaits the arrival of both health-care reform and welfare reform, the question on many lips is, which comes first? As President Clinton said on Tuesday night, these are not separate issues; they address the common needs of Americans for security and for a society that enables people to work.

Congress and the administration can and must deal with both issues at the same time.

As a matter of social policy, health-care reform is a critical ingredient of welfare reform. That's because many people are forced to stay on welfare simply because of the failures in our health-care system. This happens in several different ways.

First, it is estimated that 1 million people are on welfare chiefly to qualify for Medicaid, the government's health-care program for the poor. Some welfare recipients have children diagnosed with chronic health problems, or they require frequent health-care services themselves.

One such person, Debra, is a graduate of a local community college in Boston. Right after she earned her degree, she began to hunt for a job. During her search, her three-year-old son was diagnosed with diabetes and asthma. Unfortunately, the part-time, low-wage, or entry-level jobs most often available to women like Debra are those least likely to provide health insurance. Because Debra's son simply cannot do without health care, she can't leave public dependency.

This situation is known as ``welfare lock,'' and by ensuring that everyone who works receives health insurance, the Health Security Act would provide the key.

Under the president's health-reform plan, all employers would provide health coverage for their workers, including low-wage earners. And no one would be locked into welfare for the Medicaid benefits.

Another reason people remain on public dependency is that a disabled or chronically-ill dependent relies on them for care. A Virginia woman named Barbara wrote to Mr. Clinton that she can't leave welfare and go to work because her disabled son requires constant attention, and she can't afford to hire someone to care for him.

The Health Security Act also offers hope for families like Barbara's. It would provide states with funds to set up home- and community-based long-term care programs, giving able-bodied people the option of working while providing full-time care for their disabled loved ones.

Finally, many people are forced to stay on welfare because of the preexisting condition clauses imposed by insurance companies.

Imagine a welfare recipient who is being considered for a job as a mail-order clerk in a small furniture outlet. However, because this individual has been diagnosed as having diabetes, his or her health benefits will cost the company hundreds of dollars more per month than another applicant's. The prospective employer can't pay the added insurance - and the applicant can't take the job without insurance. So the individual stays on welfare because of a preexisting condition.

The Health Security Act will remove this roadblock to work and independence. Under the president's plan, insurance companies no longer will be allowed to ``cherry pick'' the healthiest people and leave everyone else to fend for themselves. Businesses will no longer have a financial incentive to hire those employees who will be least expensive to insure, because the premiums will be the same for everyone. No longer will people be turned away from jobs simply because of physical conditions that don't hinder their ability to contribute.

Obviously, health-care reform is only one piece of our welfare-reform plan. The president has already dramatically expanded the Earned Income Tax Credit to ensure that people who work full-time don't have to raise their children in poverty. In the final proposal, we will strengthen the child-support system; discourage unplanned pregnancy; improve access to work-related education and training programs; and create a time-limited period of welfare eligibility followed by work.

The message is clear: We can't wait any longer for health-care reform and welfare reform. We must deliver them both right away. The Opinion/Essay Page welcomes manuscripts. Authors of articles will be notified by telephone. Authors of articles not accepted will be notified by postcard. Send manuscripts by mail to Opinions/Essays, One Norway Street, Boston, MA 02115, by fax to 617 -450-2317, or by Internet E-mail to OPED@RACHEL.CSPS.COM.