BOTH THE Senate and House are holding hearings this week on ways to help the millions of people who have lost health insurance coverage as the result of unemployment. As evidence mounts of the hardship caused by neglected health care-- and as the financial burden increases on municipal hospitals to which the uninsured turn for help-- Congress has grown increasingly impatient with the administration's failure to propose a relief plan.
The administration's reluctance to develop a proposal is easy to understand. Guaranteeing even minimally adequate health care to people not currently served is going to be expensive. By latest count there are 14 million unemployed workers and family members without health coverage--a number that is not likely to diminish quickly. And even if you could help all the unemployed, fairness suggests that something also ought to be done for the 20 million or so additional people who can't afford health insurance coverage even in good times because their employers don't provide it or because they don't meet the criteria set for government medical aid.
Senate Finance Committee Chairman Bob Dole tried to force action on the issue by tacking an amendment on last month's Social Security reform measure. To save money, Sen. Dole's plan would have limited help to unemployed workers who previously had health coverage. This "grandfathering" approach, seeks to reduce the adjustment shock of people who have long been accustomed to adequate health care. But it's hard to buy the idea that public programs should treat people better just because they're used to it.
The administration persuaded Sen. Dole to withdraw his plan to give OMB time to come up with an alternative now promised to the Finance Committee next Tuesday. Administration planners, with their well-known aversion to anything that shows up as a budget outlay, are said to be considering requiring employers with health plans to open coverage to spouses of unemployed workers and, also, providing tax breaks to employers who continue health coverage for unemployed workers in future layoffs. These approaches wouldn't cost much because they wouldn't do much--except perhaps add to the complexity of the tax code and increase unemployment by driving up payroll costs.
Meanwhile, Rep. Henry Waxman, chairman of a House health subcommittee, has improved upon Sen. Dole's approach by proposing to extend coverage to all unemployed workers who have received unemployment benefits in the last two years. Grants to public hospitals would help them provide care to other low- income patients. To keep costs around $2.7 billion, the plan would strictly limit the number and type of services covered. It's not a perfect plan, but, given competing budget demands, it's a reasonable start toward correcting the gross imbalance in the way this nation allocates its enormous medical resources.