Well, not again, really … it’s more like, here we go again. In the August 15, 1992, issue of American Nurseryman – 20 years ago – we find a “Legislative Watch” article entitled, “Health-Care Proposals Getting States’ Attention.” A little bit of déjàvu?

“Just 25 percent of 500 corporate chief executives surveyed by the Conference Board say they have a reasonable chance of curbing health-insurance costs over the next five year. Half want government action. And, coast to coast, they’re getting it.

According to the Wall Street Journal, 18 states – 11 this year – have passed measures that make it easier for small businesses to provide employee health-care benefits, mostly by regulating insurance premiums. An additional 15 states are likely to join the movement by the end of the year, says the Health Insurance Institute of America.

Governmental plans generally aim to slow the 12-percent-per-year escalation of heath-care costs while expanding access to medical insurance.

Among the most ambitious proposals pending are Oregon’s and Vermont’s.

Oregon’s controversial plan, some charge, amounts to rationing. It calls for ranking medical procedures and focusing government payouts on those deemed essential, while guaranteeing coverage for 120,000 residents whose incomes place them beneath the poverty line. Federal approval is required since Medicaid would be affected.

Another aspect of the Oregon plan requires employers to offer coverage to all employees who work at least 17½ hours weekly. Currently, 450,000 Oregonians, 17 percent of the state’s population, are uninsured. According to a survey conducted by the Oregon branch of the National Federation of Independent Business, 52 percent of Oregon federation members now offer health-care benefits, 9 percent less than in 1988.

Vermont, where 63,000 of 560,000 residents are without medical insurance, is considering a Canadian-style single-payer approach.

Under a single-payer approach, state government compensates health-care providers for all services rendered. Income, payroll and sales taxes finance the program, which proponents say would slash overall medical expenditures by eliminating overlapping bureaucracies.

Single-payer legislation has been introduced in 18 other states, as well as in Congress. But small, traditionally activist Vermont is viewed as most likely to take the lead, following the model of neighboring Canada.

Though 61 percent of Vermont residents support such a plan, according to a Burlington Free Press poll, a less ambitious – but still progressive – bill calling for universal coverage by late 1994 was recently signed into law.

The state had previously enacted a law forcing insurance companies to accept all applicants, regardless of age, gender or medical condition. That statute goes into effect next summer. In New York, insurers recently threatened to stop writing new policies after the state passed a bill requiring them to disregard applicants’ medical histories.

Some states are studying German-style multiple-payer plans, under which health insurers continue to sell coverage while government attempts to contain costs by overseeing the health-care system and insure the unemployed. Others are drawn to a ‘pay-or-play’ approach that’s winning converts in Iowa and is the unimplemented law in Massachusetts.

The play-or-pay [sic] method requires employers to provide insurance or, alternately, pay into a state fund to insure the uninsured.

Advocates of health-care reform say they hope to make medical care as basic a right as education and criminal defense counsel. Critics argue the proposals are idealistic and would increase the cost of doing business. Others decry anything that smacks of socialism or defies the free market.

The American Association of Nurserymen backs ‘rational reform,’ says Benjamin Bolusky, the association’s director of government affairs. The AAN is a member of the Healthcare Equity Action League, which advocates preemption of state health-insurance mandates; reform of insurance underwriting and malpractice provisions; and full deductibility of company-paid insurance premiums.”