WASHINGTON -- The Clinton administration's approval of Oregon's request for a Medicaid waiver to expand coverage to the poor has 'no implications' in terms of the essential benefits that will be required in the President's health care reform proposal, according to a Health Care Task Force spokesman.
'The Oregon Medicaid waiver was something they wanted to do and it has no implications whatsoever,' said Jason Solomon, assistant to Bob Boorstin, special assistant to the President for Policy Coordination.
In a related development, Mr. Solomon denied a published report that the administration's health care advisers have decided the basic package of benefits should be modeled on those required under the 1973 Health Maintenance Organization Act.
'The task force is considering a range of options for a basic benefit package,' he said, 'and the 1973 Act is not one of them.'
Health and Human Services Secretary Donna Shalala, in announcing approval of the waiver for Oregon, said special terms and conditions must be accepted by the state.
'The President believes that the federal government must give states the flexibility to design new approaches to their local problems, provided that these proposals meet the federal standards,' she said at a press briefing.
The terms of the waiver to assure that an adequate level of health services is provided eligibl Midecaid recipients are that the plan must contain federal costs and meet the requirements of the Americans with Disabilities Act, according to Ms. Shalala.
In addition, there can be no changes in covered services without prior approval by the Department of Health and Human Services.
In 1989, Oregon began a process of revising its Medicaid program to expand coverage to the uninsured poor. The state listed 688 possible categories of illness and their treatments, and ranked them by their seriousness and effectiveness of the treatment.
The state ultimately cut back the list to 568 conditions eligible for treatment. The Bush administration denied a federal Medicaid waiver to the Oregon plan because it said the plan violated the Americans with Disabilities Act.
Regarding the implications of the Oregon waiver, the Health Insurance Association of America has recognized the difficulty of defining an essential benefit package, according to Susan Van Gelder, Associate Director of Policy Development and Research. She is working closely with HIAA's Vision Committee, which is currently preparing a discussion draft of the essential benefit package.
'No one wants to talk about it,' she said, 'but everyone understands that there are limits to health care. In the Vision Committee's deliberations, it was one of the most difficult topics.'
The discussion draft paper is being prepared for the next Vision Committee monthly meeting April 8, according to Ms. Van Gelder.
'We haven't resolved whether a uniform benefit package should be based on individual and employer needs or whether states should have flexibility to determine the package,' she noted.
In an effort to spell out Vision Committee Chairman David Hurd's strong feeling that 'you can't have everything' in a health benefit package, the committee spoke about the possibility of several different approaches, Ms. Van Gelder said.
In defining approaches to health care in the future, the committee identified the Oregon plan as one possibility, she added.
Other approaches to an essential package suggested by the committee were a federally qualified HMO, a package with a specific dollar value, 'medically effective care' in general terms and a package defined by its structure, such as an indemnity policy or an HMO.
'In health care reform in the future when there is more than we can pay for, we're going to have to look at equitable approaches to see that everyone has an adequate level of protection,' Ms. Van Gelder said.
