Jewish Community Center of Cleveland (Ohio), Philip Chelnick, state- Jones, Hon. Ed, a Representative in Congress from the State of North Kansas Hospital Association, Frank L. Gentry, letter with enclosure___ Kean, Hamilton, and Mrs. Max Ascoli, Citizens' Committee for Children Kelley, Charles J., Massachusetts Federation of Nursing Homes, statement.. Kelley, Verne R., and Hanna B. Weston, Mid-Eastern Iowa Community Kemper, James S., Jr., National Council on Alcoholism, Inc., statement. Leppink, Dr. Harold B., St. Louis County (Minn). Health Department, Page 3589 3567 3697 3702 3910 3662 3711 3713 3719 3702 3576 3679 3590 March of Dimes. (See National Foundation.) Lindenberg, Ruth Ellen. (See National Association of Social Workers.) 3537 3619 Marshall, Dr. Matthew, Jr., Pennsylvania Medical Care Foundation, letter with enclosure__ 3838 3537 3711 3154 Maryland, State of, Hon. Marvin Mandel, Governor, statement. Menorah Park Home, Howard Bram, book review and statement presented Mid-Eastern Iowa Community Mental Health Center, Verne R. Kelley and Hanna B. Weston, letter.. 3154 3712 3584 3713 Miller, Dorothy E., Marilyn J. and Laura R. Mehringer, and Paula M. 3712 Mink, Hon. Patsy T., a Representative in Congress from the State of 3552 Mizell, Hon. Wilmer, a Representative in Congress from the State of 3553 Mountaineer Family Health Plan, Inc., Martha Crider and Helen Powell, statement - 2164 Mrozek, John S., Denver Area Labor Federation, AFL-CIO, letter. 2115 3718 National Abortion Rights Action League, Gail Rosenberg and Karen 3718 National Association of Life Companies, statement 3714 National Association of Patients on Hemodialysis & Transplantation, Inc., 3716 National Association of Social Workers, Belle Likover, statement presented to the Northeast Ohio Congressional Council and forwarded by Congressman Charles A. Vanik. 3590 National Council on Alcoholism, Inc., James S. Kemper, Jr., statement__ 3719 2114 National Foundation-March of Dimes, Joseph F. Nee, letter....... 3721 3723 2139 National Nutrition Consortium, Inc., D. M. Hegsted, letter with enclosure. 3811 3814 National Wholesale Druggists' Association, William L. Ford, letter.. New York Chamber of Commerce & Industry, Mahlon Z. Eubank, state ment.. New York City Human Resources Administration, James R. Dumpson, New York, State of, Hon. Malcolm Wilson, Governor, statement.. Page 3814 3721 3816 3828 3543 3547 3581 Optical Wholesalers Association, Edward A. Dietz, Jr., letter. 3834 3835 Patten, Hon. Edward J., a Representative in Congress from the State of 3551 Penn Mutual Life Insurance Co., statement. 3835 Pennsylvania Medical Care Foundation, Dr. Matthew Marshall, Jr., letter with enclosure_ 3838 Pfeiffer, Edward J., Arcadia, Calif., letter with enclosure. 3885 1933 Powell, Helen, and Martha Crider, Mountaineer Family Health Plan, Inc., statement. -. 2164 Regenié, Sandra J., University of North Carolina School of Nursing, letter.. 3888 Religious Coalition for Abortion Rights, Mrs. Ray M. S. Tucker, letter with enclosure__ 3889 Rhode Island, State of, Hon. Philip W. Noel, Governor, letter. 3547 3619 Rodgers, David A., Ph. D., American Psychological Association, statement presented to the Northeast Ohio Congressional Council and forwarded by Congressman Charles A. Vanik.. 3582 Rodio, Frank, Jr., Camden County (N.J.) Planning Department, statement. 3890 Rosenberg, Gail, and Karen Mulhauser, National Abortion Rights Action 3718 Rosenthal, Hon. Benjamin S., a Representative in Congress from the 3547 Ross, E. Clarke, United Cerebral Palsy Associations, Inc., letter with enclosure__ 3892 Ross, Dr. Richard S., American Heart Association, letter__. 3618 Sacred Heart General Hospital Medical Center, Sister Monica Heeran, letter... Ryan, Hon. Leo J., a Representative in Congress from the State of California, letter with enclosure. 3561 3891 St. Louis County (Minn.) Health Department, letters forwarded by Evelyn L. Jernberg- 3577 Dr. Harold B. Leppink. 3576 Schardt, Arlie, American Civil Liberties Union, statement Schneider, Andreas G., Health Law Project. (See National Health Law Sharp, Elizabeth S., American College of Nurse-Midwives, letter. Taylor, Robert P., Arkansas Blue Cross & Blue Shield, Inc., statement. Travis, Dr. John W., and Dr. Robert E. Wise, American College of Radiology, statement_ 2106 3616 Tucker, Mrs. Ray M. S., Religious Coalition for Abortion Rights, letter with enclosure_. 3889 United Cerebral Palsy Associations, Inc., E. Clarke Ross, letter with enclosure 3892 United Methodist Church, Bishops James Armstrong and Wilbur W. Y. 3895 United States Administrators, S. X. Kaplan, statement 3910 Usera, Vincent L., and Vincent A. Wolfington, National Para-Transit 3814 36-221 74 - 2 Vanik, Hon. Charles A., a Representative in Congress from the State of Wallenberg, Ellis A., Washington Hearing & Speech Society, letter. West Virginia Committee for The Health Security Act, list of members.. Wilder, Sarah M., Cuyahoga Community College, letter forwarded by Wilson, Hon. Malcom, Governor, State of New York, statement. Page 3581 3913 3913 3914 3928 2158 2158 3715 3578 3543 3616 Woelf, Rev. Paul A., Cuyahoga County (Ohio) Health Consumers Coalition, statement presented to the Northeast Ohio Congressional Council and forwarded by Congressman Charles A. Vanik. Wolf, Fred E., Colorado Senior Action Committee, letter with enclosures. Worley, Willis, Jr., Waurika, Okla., letter. Zerfas, Drs. Charles and Phyllis, Beech Grove, Ind., letter 3593 2141 3814 3932 3932 NATIONAL HEALTH INSURANCE (Volume 5) FRIDAY, JUNE 7, 1974 HOUSE OF REPRESENTATIVES, Washington, D.C. The committee met at 10 a.m., pursuant to notice, in the committee hearing room, Longworth House Office Building, Hon. James A. Burke, presiding. Mr. BURKE. From the schedule of witnesses to appear today before the committee, we have first a group of witnesses from the American Nursing Home Association, Thomas G. Bell and Peter M. Balitsaris, legislative director. Please identify yourselves and proceed with your testimony. STATEMENT OF THOMAS G. BELL, EXECUTIVE VICE PRESIDENT, AMERICAN NURSING HOME ASSOCIATION, ACCOMPANIED BY PETER BALITSARIS, LEGISLATIVE DIRECTOR SUMMARY I. Current Problems in Long Term Care.-Consideration of what our system of long term care delivery should be may be begun by considering the problems under the current system. (a) Financial burden on the elderly.-Long term care necessarily costs more than most elderly people can afford on their own. Private insurance and Medicare do not provide coverage of long term care. Medicaid eligibility requirements force the elderly to give up the financial resources they would require to regain independent living. The elderly have a right to long term care at a cost to them that they can afford. (b) Lack of alternative modes of care.-Serious problems of availability and inflation in health costs result from overutilization of hospitals in situations which could better be met in nursing homes. Alternative modes of long term care, including nursing home care, home health and homemaker services, nutrition services, and day care, should be made available. Among these alternative modes of care, excessively costly approaches should be avoided, but to the extent possible the needs and preferences of the patient should determine the type of care provided. (c) Inefficient systems of payment.-The retrospective payment systems under existing government programs are inefficient and costly. Providers should have the alternative of payment under prospective payment systems which allow a fair return and create incentives to efficiency. II. Pending National Health Insurance Proposals.-Two pending NHI proposals, Title II of the Mills-Kennedy bill and the Long-Ribicoff-Waggonner bill, contain substantial new coverage of long term care. ANHA believes that the Mills-Kennedy proposal would establish the kind of program for long-term care benefits which American's elderly need and deserve. The Long-Ribicoff-Waggonner bill, while not as far-reaching, would be an important step in the right direction. (2053) (a) Comprehensive National Health Insurance Act (Mills-Kennedy).-While supporting the general approach set forth in this bill, ANHA recommends that it be amended as indicated below. i. Eligibility.-All groups, especially those now entitled to Medicaid coverage, should be covered under a Federal program providing the benefits set forth in Title II of Mills-Kennedy. ii. Benefits.-Long term inpatient care for the mentally ill and retarded should be added to the benefits provided. iii. Administration.-All providers of care who meet a uniform and published system of standards should be eligible to participate in this program under a contract between the providers and the State agency. The Community Long Term Care Center should concentrate its efforts on determining and reviewing the needs of beneficiaries, consumer education, and outreach. iv. Payment for Services.-Payment to providers under Title II should be made under the same formula as that which is applicable to providers under Title I. That formula set forth in Section 2042 of Title I should be amended to provide for a rate of return measured against total investment, not "equity invested". v. Skilled Nursing Facility Care Under Title I.-The prior hospital prerequisite to eligibility for Skilled Nursing facility care should be eliminated. (b) Catastrophic Health Insurance and Medical Assistance Reform Act (LongRibicoff-Waggonner).-This bill would make important improvements in government coverage of long term care, we believe that the following changes would greatly enhance its beneficial impact. i. Eligibility.-Eligibility for long term care should be extended to all Medicare beneficiaries. ii. Benefits.-Day care, nutrition services and homemaker services should be added to the nursing home and home health care which this bill would cover. iii. Administration.-We believe that the States have an important role to play in connection with any program to deliver long term care. This bill should more clearly define the role of the States. iv. Payment for Services.-This bill would provide for payment under section 249 of P.L. 92-603. This would permit, but not require, prospective payment formulas. We believe the availability of prospective formulas should be mandated by the Congress. V. Skilled Nursing Facility Care Under Catastrophic Insurance.-Days in skilled nursing facilities should be counted on a two-for-one basis as meeting the 60-day hospitalization prerequisite to obtaining catastrophic insurance benefits. Federally certified health policies under Title III should be required to offer coverage of the first 120 days in a skilled nursing facility. Mr. BELL. I am Thomas G. Bell, executive vice president of the American Nursing Home Association. With me today is Mr. Peter Balitsaris, ANHA legislative director. Mr. Chairman, I would like to make a brief oral statement this morning and request that my prepared remarks be included in the record. Mr. BURKE. Without objection, your entire statement will appear in the record. Mr. BELL. The American Nursing Home Association represents approximately 7,000 nursing homes throughout the United States with more than 500,000 patient beds. It is the Nation's largest nursing home organization with a membership made up of both proprietary and nonproprietary facilities. I am grateful for the opportunity to appear here today to discuss the vital topic of national health insurance. I will direct my remarks particularly at the proposed Comprehensive National Health Insurance Act and the proposed Catastrophic Health Insurance and Medical Assistance Reform Act since these are the two major national health insurance proposals which would provide significant new coverage for long-term care. |