CHICAGO -- The Clinton administration's national health-care reform plan will not lead to immediate, dramatic reevaluations and debt rating changes for health care issuers, Standard & Poor's Corp. said in a special report released yesterday.

"We're not expecting large scale reviews of ratings because what the Clinton plan is doing is accelerating the trend that is already taking place and is already incorporated in our ratings," said Michael Dorfsman, director of communications at Standard & Poor's.

However, the rating agency said the prognosis could change if global budgeting, which would cap the nation's health care spending, is implemented.

"[Standard & Poor's] analysts believe enactment of strict global budgets will either crimp revenues throughout the health care system or force providers to cut back services," the agency said.

Unveiled last Wednesday, Clinton's long-awaited plan relies in part on curbing spending growth for Medicaid and Medicare programs by $238 billion over six years, limiting insurance company premium increases, and imposing additional taxes on cigarettes and possibly alcohol, Standard & Poor's said.

The plan would establish managed care network incentives and would create regional purchasing pools called health alliances that would be able to access the tax-exempt debt market, the rating agency said.

According to the Clinton proposal, all employers would be required to pay at least 80% of the average premium for the standard package of health care benefits for each employee. The remainder would be paid by the individual employees.

The health care debate now enters Congress. While most lawmakers agree that an overhaul of the system is needed, the process of reform and the cost of financing health care coverage for all Americans are likely to be bases of disagreement, Standard & Poor's said.

Among the proposals being floated in Congress are a single-payer plan, proposed by Rep. James McDermott, D-Washington, and a Senate Republican plan that would maintain much of the current system and phase in universal health coverage by the year 2000.

Standard & Poor's said that the initial reaction from most business and trade groups to the Clinton's plan has been "mostly favorable with specific reservations."

For example, the rating agency said that the American Hospital Association supports most of the Clinton administration's plan, but is concerned that proposed cuts in Medicare funding could destabilize the nation's health care system.

Meanwhile, many states, including Florida, Minnesota, and Texas, are marching ahead with their own initiative despite national reform efforts.

"Under the Clinton plan, with its reliance on states to establish regional health alliances, those plans conforming to the federal umbrella guidelines would remain intact and serve as laboratories for the federal experience," Standard & Poor's said.

Dorfsman said that the 50-page report includes updates of previously released articles that discuss the potential impact of national reforms on health care systems, insurers and drug companies. The report also includes articles that discuss state initiatives in Florida, Kentucky, Minnesota, Ohio, Oregon, and Texas.

Standard & Poor's maintains 900 uninsured health care ratings affecting $67 billion of outstanding debt.

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