July 31, 1996

The best-known enemy of private medicine, Senator Edward Kennedy, has managed to neutralize what he considered the "poison pill" in his legislation, Medical Savings Accounts. In return, the Republican leadership is swallowing a number of real poison pills (and you will suffer the consequences).

TALKING POINTS:

• It is against the rules for the Conference Committee to introduce new elements into a bill. They are just supposed to reconcile the House and Senate versions. Yet critically important provisions, that no one in Congress has voted on, are being stuffed in. Is this Republican government, or imperial government?
• The anti-privacy ("administrative simplification") provisions have been amplified; a whole new title (Title XI) has been added. Section 263, "Changes in Membership and Duties of the National Committee on Vital and Health Statistics," stacks the committee with advocates of computerized medical records and directs it to report to HHS in four years on issues "related to the adoption of uniform data standards for patient medical record information and the electronic exchange of such information." Such data relates to the "past, present, or future physical or mental health or condition of an individual." "Standard unique health identifiers" are to be adopted for "each individual, employer, health plan, and health care provider."
• New provisions impose "mandatory risk adjustment" on states. Failure to comply means that HHS takes over insurance regulation within the state. (Who said the Clinton Plan was dead?)
• After guaranteeing that premiums will increase (due to guaranteed issue, mental health parity, and mandatory risk adjustment), the bill would impose federal price controls on premiums. One month of employment would qualify a person for guaranteed issue of an individual policy. The number of uninsured will increase, either because of unaffordable premiums or the unavailability of individual insurance at any price. Apologists say that "only" the self-employed or unemployed will be affected.
• The IRS will be in charge of enforcement for MSAs. A 15% penalty (on top of taxes) will be imposed for non-medical withdrawals. How will the IRS monitor this without access to medical records?
• This bill could actually reduce the number of MSAs. Despite tax discrimination, there are already some 100,000 MSAs. If no affordable catastrophic insurance product is available, the whole concept fails.

STRATEGY:

First, concentrate on the conferees. Tell them to DELETE all new provisions; DELETE the entire section on "administrative simplification"; DELETE any provisions that impose penalties without proof of specific criminal intent; DELETE the restrictive features that would make the MSAs unattractive to the sick and make accumulation of funds impossible; DELETE any new powers to the IRS; DELETE the 15% penalty. In fact, it would be best to DELETE the entire bill and start over or at least DELAY until they visit their constituents. Important legislation should not be concocted behind close doors (remember the Clinton Task Force). (We're reporting our best information about the bill but it is impossible to be sure of anything.)

Second, convey the message to your own congressional delegation.

If the Capitol Hill switchboard doesn't answer (or even if it does), call the home district offices. Tell them to watch out for an end to the Republican majority in November.

Conferees are: Sen.Trent Lott (R-MS), William Roth (R-DE), Pat Moynihan (D-NY), Nancy Kassebaum (R-KS), and Edward Kennedy (D-MA); Rep. Bill Archer (R-TX), Michael Bilirakis (R-FL), Thomas Bliley (R-VA), David Bonior (D-MI), William Clay (D-MO), John Conyers (D-MI), John Dingell (D-MI), Harris Fawell (R-IL), Sam Gibbons (D-FL), William Goodling (R-PA), Dennis Hastert (R-IL), Henry Hyde (R-IL), Bill McCollum (R-FL), Pete Stark (D-CA), William Thomas (R-CA), and Henry Waxman (D- CA).

Call Congress TODAY. The Capitol Hill switchboard is (202)224-3121 or (800)962- 3524.