MEASURES TO provide health coverage for millions of jobless workers and their families are gradually working their way through Congress. Next week the Ways and Means Committee hopes to bring a $4 billion measure to the House floor. In the Senate, the Finance Committee will mark up a bill spending roughly half as much. The two bills have much in common, but some important differences.
Neither measure offers help to the 20 million or so people--including many workers--who can't afford health coverage even when the economy is booming. Benefits are focused on jobless workers who are, or were, receiving unemployment benefits. Neither measure would create a new open-ended entitlement. An earlier House Commerce Committee bill would have set up an entitlement program, but the compromise bill voted by Ways and Means --like the tentative Finance Committee plan--gives limited matching grants to states to set up insurance programs for which the jobless could qualify by paying a relatively small premium.
The Ways and Means Committee bill, however, creates a new Social Security Act title rather than adding temporarily to the existing social service title as the Finance Committee would. This is only a symbolic difference, but it could be important when the time comes to decide whether the program should be continued. The Ways and Means program is also more tightly structured. Within the funds available, states may give priority to those who have been out of work the longest (a fairer approach than the Finance Committee's priority for the relatively recently unemployed), but the state must provide an explicit, uniform set of benefits to all people covered.
The Ways and Means bill is also very insistent that, except for a small amount of discretionary state money, no means test be applied in determining eligibility for benefits. Disqualifying people with other insurance and those whose spouses have employer coverage provides a rough means test. But the absence of a direct income or asset limit is an important distinction for organized labor and others who feel that health insurance, along with unemployment insurance, ought to be a guaranteed benefit for unemployed, experienced workers.
The Finance Committee plan, as currently drafted, gives the states a good deal less money, but more flexibility in deciding what benefits to provide and how to ration them. Committee Chairman Bob Dole is also determined that the bill will carry along with it tax or budget-cutting measures to cover its costs --an obvious impediment to further expansions. By design, it is a stopgap program meant to address a recession-created problem.
Neither measure will satisfy those who feel that a nation that already spends more than 10 percent of its huge GNP on health care ought to be able to provide at least minimal coverage to all its citizens. But with the domestic budget under enormous pressure, reaching that goal won't be possible unless the society is willing to make substantial changes in the way it finances and uses health care.