November 1992

How Will Children and Pregnant Women Fare Under Current National Health Insurance Proposals?

Author Affiliations

From McManus Health Policy Inc, Washington, DC (Ms McManus); Fox Health Policy Consultants (Mss Fox and Wicks); and the Institute for Health Policy Studies, University of California School of Medicine, San Francisco (Dr Newacheck).

Am J Dis Child. 1992;146(11):1376-1380. doi:10.1001/archpedi.1992.02160230134034

• Objective.  —To compare the following five major national health insurance proposals and their implications for children and pregnant women: the Matsui "play or pay" bill (HR 3393); the Russo Canadian-type bill (HR 1300); the Rockefeller "play or pay" bill (S 1177); the Stark Medicare-type bill (HR 650); and the president's market reform proposal.

Research Design.  —Using an analytic framework developed by the Association of Maternal and Child Health Programs, we examine the differences among the five proposals in basic approach, eligibility and enrollment, benefits, cost-sharing requirements, provider reimbursement, and cost-control measures.

Results.  —All of the plans, except for President Bush's, would provide coverage for virtually all children and pregnant women, using a combination of private and public approaches. President Bush's market approach provides financial incentives to purchase health insurance benefit plans that states can design within actuarial limits. The remaining four plans strive for uniformity in benefits, covering physician and hospital services in a manner similar to most plans today. Preventive care benefits extend beyond what has been offered in the past. The four plans differ sharply in their coverage of extended care services, with the Matsui and Russo bills covering the most generous package of benefits. The Rockefeller and Stark plans, on the other hand, require less cost-sharing for their basically preventive and primary care plans.

Conclusions.  —Most of the health insurance proposals are aimed at extending preventive and primary care health insurance plans to more uninsured Americans. Only the Matsui bill devotes significant attention to developing a comprehensive benefit plan for children and pregnant women. Additional attention should be directed at extended care services for those with special health care needs, the future role of Medicaid, and the public health system infrastructure.(AJDC. 1992;146:1376-1380)