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National Jewish Community
Relations Advisory Council Guide to Program Planning Of the Constituent Organizations |
| Equal Opportunity and Social Justice |
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The fundamental premise of the field of Jewish community relations is to foster conditions conducive to Jewish security and creative Jewish living in a free society. Such conditions require a society committed to equal rights, justice and opportunity. Their denial breeds social tensions, conflicts, and dislocations, and has led to threats to the democratic process in general, and to the Jewish community in particular. The stake of the American Jewish community in a strong, democratic society is reinforced by the moral imperative on the Jewish community to pursue social justice. This commitment flows from Jewish religious mandates, tradition, and the millennial experience of the Jewish people. Health Care Reform Changing Conditions With the introduction of his comprehensive health care reform plan in the Congress, President Bill Clinton has successfully elevated the need for reform of the nation's health care system to the forefront of the domestic policy agenda. In the national debate on health care reform there is bipartisan recognition of the basic right of all Americans to affordable and accessible health care. Given the complexities of the issues and the competing interests involved, the legislative process is likely to be protracted. Background Proclaiming that the "elevation of health care to a civil right" will be the "defining work of his presidency," President Bill Clinton presented to Congress in October 1993 the Health Security Act, a comprehensive proposal for sweeping reforms in the nation's health care system. It is the result of the work undertaken by the President's Task Force on National Health Care Reform headed by Hillary Rodham Clinton. The Health Security Act proposes a health care system which would provide affordable, comprehensive health care coverage to all Americans, regardless of income, employment status, or personal health history. It aims to reduce the cost of health care to individuals, employers and government by establishing health care alliances and by placing caps on entitlement. Caps would place a limit on the price charged for services and on annual increases in insurance premiums. Health alliances would provide individuals with the opportunity to pool their resources into large purchasing groups which could bargain with health plans (doctors, hospitals and other providers) for low cost, quality care. The general principles of health care reform outlined by the President are consistent with the NJCRAC principles on health care reform, adopted by the Executive Committee in June 1993. These principles include: security, in that coverage cannot be taken away; savings; quality of care; choice of doctor; simplicity of use; and responsibility by all for health care services. The NJCRAC has long advocated universal access to health care, in particular the urgent need to provide for the 15 percent of the American population who have no medical insurance. (See Joint Program Plans for 1989-1993) As the Health Security Act is studied, some consumer groups have identified several short falls. They include the lack of provision for health care coverage, including emergency services, for undocumented residents; gaps in treatment for children with disabilities; deficits in health care for women; and, the limited availability of mental health services, dental services and treatment for substance abuse. The Act's provision of coverage for all reproductive services, including abortion, has engendered opposition by some groups. Several alternative bills proposed by Republican members of Congress call for a health care package that would provide for an expansion of Medicaid, substantially less government intervention, and coverage for all Americans by the year 2000. In a major departure from the reforms proposed by the Clinton Administration, the Republican proposals would not require mandated coverage by employers, though employers would be required to provide access for their employees to health care alliances. The main vehicle for debate in the Congress remains the Health Security Act, which is expected to undergo many changes during that process. In his January 1994 State of the Union address President Clinton asserted that all elements of the Act are negotiable with the exception of universal coverage. He vowed to veto any legislation which failed to provide health insurance coverage for all Americans. Debate in Congress has focused primarily on issues surrounding employer mandates and health care alliances. Regarding mandates, there are concerns that increased employer costs could lead to additional layoffs. Suggested modifications of the mandate include exempting businesses with fewer than 100 employees, decreasing costs to businesses in general while raising costs to individuals, and phasing in participation by smaller businesses over a longer period of time. Alliances have been criticized as being too big, bureaucratic and needlessly regulatory, and therefore it has been suggested that they be strictly voluntary, reduced in scope, or eliminated entirely. Supporters of alliances believe that such purchasing cooperatives are essential in assuring that the chronically ill, employees of small firms, and the unemployed have access to the same high quality insurance options as employees of Fortune 500 companies. They suggest that alliances can be streamlined to address concerns regarding size and scope, while maintaining their primary function as arenas for the sale of competing health plans. Additional areas of debate involve methods of cost control and alternative financing options. A variety of other issues are likely to be challenged and revised as the bill makes its way through a number of congressional committees. With action required by three House committees and two in the Senate, any form of health care legislation is unlikely to pass until late 1994. The burgeoning costs of health care $832 billion, or one-seventh of GNP in 1993 - have led many states to make changes in their health care systems in advance of federal action. Hawaii and Minnesota provide two different examples of the kinds of programs that have been adopted by states. Since 1974, under the Prepaid Health Care Act, Hawaii has provided universal coverage to its residents. That 1974 legislation requires employers to provide insurance for all employees who work more than 20 hours per week. Those who are unemployed or have jobs where insurance is not included are covered by state medical subsidies. As a result, 98 percent of Hawaiians have some kind of medical insurance. In 1992, Minnesota began implementation of "MinnesotaCare", a health care plan that requires doctors and hospitals to either join an HMO or receive reimbursement from a system in which rates are regulated by the state. MinnesotaCare also provides publicly subsidized coverage for low-income people without insurance. How national health care reform evolves is of importance to the Jewish community as consumers, as health care providers, and as institutional employers who will be required to adhere to new legislative guidelines. The organized Jewish community provides extensive services in the areas of aging, mental health services, and services to children and families, and others. Therefore, expressing the Jewish "voice" in the national health care debate will be critical. The Jewish community relations field should
The Jewish War Veterans of the U.S.A. (JWV) believes that the VA health care system must remain a viable, operative health care system, and must not be subjugated by the proposed national health care reform. JWV will oppose any action which weakens the VA health care system or alters its operation to the point that veterans will have difficulty receiving the care they need.
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