Health-Care Reform Redux: A Push for Modest Changes

GET ready for the return of health-care reform. Two years after President Clinton's broad proposals lit a nationwide debate, a low-key effort meant to make it easier for hard-pressed Americans to get health insurance coverage is gaining momentum on Capitol Hill.

If the mammoth Clinton health-care rewrite rated a 10 on a 1-to-10 scale of change, then the new legislation might perhaps be judged barely a 2. As yet, lobbyists have laid no plans to resurrect the fictional couple of Harry and Louise, whose critical ads did much to build opposition to the Clinton effort.

But the bipartisan new bill does represent the kind of incremental change in the nation's health-care delivery system that many predicted would follow the failed White House proposal. And its provisions could help solve an important problem for many American workers: the difficulty of keeping health insurance after changing jobs or becoming ill.

The reforms ''will help millions of Americans without causing any harm to the private market,'' insisted one of the measure's primary sponsors, Sen. Nancy Kassebaum (R) of Kansas, last week.

Current legislative plans call for the full Senate to debate the Kassebaum-Kennedy bill (named for its primary backers, Sens. Kassebaum and Edward Kennedy (D) of Massachusetts) sometime between April 15 and May 3. Specifically, its major ''portability'' provision would work like this: Any worker who has been covered by an employer's health plan for at least 18 months, and then loses his or her job or moves to an employer who doesn't offer health insurance, could buy an individual health policy from any firm that sells them in the worker's state.

In addition, firms would have to sell such workers individual insurance without exclusions for preexisting medical conditions.

Twenty-one million Americans currently do not have health insurance because they have a preexisting medical condition that limits their coverage options, according to a General Accounting Office estimate. The GAO also judges that 4 million workers are stuck in jobs they might wish to leave because they fear insurance loss.

Firms that sell individual health insurance aren't happy about Kassebaum-Kennedy's proposed changes. If the bill becomes law, costs of such policies will inevitably skyrocket, they say. That could set off a chain response in which healthy people drop out of the coverage pool, cost increases subsequently accelerate, and the coverage becomes too expensive for anyone to afford.

According to the Health Insurance Association of America, Kassebaum-Kennedy would cause a leap of 10 to 30 percent in individual health-insurance premiums. Such objections have stalled the bill for months - it was approved by the Senate Labor and Human Resources Committee last August, but is only coming to the floor now per an agreement hammered out between its backers and Senate majority leader Bob Dole.

The bill's prospects brightened last week when a pair of independent studies differed with the HIAA's figures. According to a report released by the American Academy of Actuaries, the new portability provision would have no impact on premium costs in most states. Similarly, the Congressional Research Service predicted that individual insurance premiums would go up less than 1 percent in the first year after passage of Kassebaum-Kennedy, and no more than 3 percent in subsequent years.

The Clinton administration, for its part, has urged that the Senate pass the bill and the House follow suit. The president called for such action in his State of the Union address last month; administration officials now worry that delay in bringing this reform to the Senate floor will allow the insurance industry to rally the opposition.

''We believe that April is a little late in the day, but apparently that was the best that could be done,'' groused White House spokesman Mike McCurry on Feb. 7.

As yet the prospects of health-insurance reform in the House aren't quite clear. GOP leaders support the concept of making it easier for workers to carry their insurance from job to job. But a number of House committees claim jurisdiction over the issue, and the leadership is currently trying to figure out how to smooth the insurance reform's path to passage.