Time on Capitol Hill

A CHANCE TO BE HEARD With 4 of the 5 committees involved with health-care reform voting out new bills, plus a new Senate Republican plan offered by Bob Dole, Congress is poised to narrow the options. TIME highlights the key differences among them and invites you to use the attached postcard to voice your own preferences.

COVERAGE

Three of the plans, the Senate Labor and Human Resources, House Education and Labor, and Ways and Means bills, promise universal coverage. The Dole plan is not specific, though the minority leader has said it could cover "91% or 92%" of Americans. The Senate Finance bill aims at 95% coverage by the year 2002, with the stipulation that if this goal is not met, a National Health Commission would advise Congress on how to reach that target, but without any requirement that it do so.

BENEFITS

The Senate Labor and Senate Finance bills offer a package similar to the current Federal Employees Health Benefit Plan, which Hillary Rodham Clinton describes as "the type of coverage your Congressman has." The House Labor and Education and House Ways and Means benefits packages are both modeled on Medicare and include substance-abuse treatment and coverage of abortions. Both Senate Labor and Human Resources and House Education and Labor bills cover prescription drugs. Senate Finance's provides home care for the disabled. The Dole plan, like the Clinton plan, requires that insurers offer at least 1 of 3 options: fee-for-service; a health-maintenance organization; or a hybrid of the two, known as a preferred provider plan. Dole's plan carries no drug benefits and makes no mention of abortion; his long-term-care expenses are tax deductible.

PURCHASING POOLS

The Clinton plan adopted the concept of regional health alliances, through which all companies with 5,000 or fewer employees are required to buy - insurance. The Clinton alliances would be given additional quality-control and regulatory powers. The Senate Labor and House Education and Labor bills follow the Clinton model, but their alliances are voluntary and without regulatory authority. Dole's bill neither mandates nor prohibits alliances but allows self-employed individuals and small employers to purchase the Federal Employees Health Benefit plan. The House Ways and Means and House Education and Labor bills would broaden the existing Medicare system into a national purchasing pool. Education and Labor permits states to create mandatory pools. Senate Finance offers a choice between the federal employees' plan, and, where they exist, voluntary health alliances. All plans subsidize the purcahse of insurance by poor people at varying levels.

COST CONTAINMENT

The Clinton plan proposed a cap on total national health-care spending. The Dole bill has a "fail-safe" mechanism designed to ensure that the plan would not add to the federal deficit. House Education and Labor proposes regional limits on how fast insurance premiums can rise. House Ways and Means establishes a fee structure and offers a standby cost-containment section triggered when individual states exceed a targeted expenditure level, at which point a federal rate schedule is imposed. Senate Finance would call on its National Health Commission to make nonbinding recommendations if costs got out of hand.

EMPLOYER MANDATE

The Senate Labor bill, like the Clinton plan, requires employers to pick up 80% of the cost of an individual's premiums, or 55% for a family. House Education and Labor varies requirements according to the size of the company, allowing self-insurance for companies employing more than 100, as does House Ways and Means. Neither the Dole bill nor the Senate Finance bill has any such requirement.

FINANCING

Clinton proposed a 1% tax on large (more than 5,000 employees) companies that self-insure, plus an additional 75 cents-per-pack cigarette tax. Senate Labor exacts a 1% payroll tax on companies employing more than 1,000 and a 2% tax of payrolls of firms employing fewer than six. It also takes cigarette taxes up from 24 cents to $1.24 a pack. Senate Finace also levies a $1.24 cigarette tax and means-tests premiums and co-payments for higher-income Medicare recipients. House Education and Labor places a 2% tax on health-insurance premiums and adds 69 cents more to the cigarette tax. Dole pays for reform through cuts in Medicare payments and a cap on the rate of increase in federal Medicaid payments.

SINGLE PAYER

A bill was voted out of the House Education and Labor committee "without recommendation" but will probably come to a vote on the floor anyway. The single-payer plan would make the Federal Government the nation's health- insurance manager. According to the Congressional Budget Office, its cost- containment prospects are better than that of all other plans. It would also require substantial increses in taxes on both individualas and corporations, although proponents argue that these expenses will be offset by the savings people will realize by no longer having to pay premiums to insurance companies.