TABLE OF CONTENTS COST EXPERIENCE UNDER MEDICARE FROM THE POINT OF VIEW OF AGED BENEFICIARIES ii 4. 5. B. COMPARISON OF THE COMPREHENSIVE HEALTH INSURANCE ACT 97 2. 3. 4. 5. 6. Entitlement and Duration of Entitlement The Financing of Health Care Benefits PART ONE INTRODUCTION With the prospect for enactment of national health insurance legislation in the immediate future obscured by fundamental disagreements over the extent of covered items and services, the means of financing and delivering those items and services while assuring quality control, the degree of federal involvement, the nature and extent of cost-sharing, and the nature of catastrophic protection, the National Retired Teachers Association and the American Association of Retired Persons, as their contribution toward the ultimate national goal of quality health care for all Americans, undertook a two-year effort to develop legislation responsive to the immediate health care needs of those groups for whom the need is greatest the aged and the disabled. This legislation is designed to reverse the present trend of declining Medicare protection and increasing out-of-pocket health care expenditures by reducing or eliminating the durational limitations on items and services already covered under present law, covering additionally-needed items and services, and replacing existing cost-sharing devices with a single rational system of copayments subject to a catastrophic protection feature related to income. While providing comprehensive health care protection for the needy, it would also confront directly the problem of escalating health care cost by completely reversing existing reimbursement procedures. This legislation would establish procedures 2 for prospective reimbursement to institutional providers on the basis of prospectively approved budgets and schedules of charges derived from those budgets. In the case of non-institutional providers, reimbursement would be made on the basis of negotiated rates. It is this legislation, the Medicare Amendments of 1974, which is the primary subject of this statement. While recognizing the increase in the income level of the aged over the Medicare period of 1965 to 1972, PART TWO of this statement will demonstrate statistically that a substantial percentage of the aged remain at or below the poverty level and that the aged still have far less disposable income for the purchase of health care protection than do the non-aged whose income level over the Medicare period has increased far more rapidly. That the aged, as a class, face the highest incidence of illness and disability and are therefore, most in need of adequate health care protection, will also be demonstrated. In effect, PART TWO describes statistically this nation's health care needy, who cannot afford to wait for adequate protection. PART THREE of this statement demonstrates the declining health care protection being provided by the Medicare system in the face of rapidly escalating health care costs and suggests that part of that escalation has been stimulated by the very nature of the Medicare system. It also demonstrates the obvious consequence substantial increases in out-of-pocket expenditures for health care on the part of the aged. PART THREE's conclusion is that health care legislation for this nation's health care needy must, 3 on the one hand, provide comprehensive health care protection and on the other, deal directly with the problem of rising health care costs. That the Medicare Amendments of 1974 carry out these objectives far more effectively than the present law, is the subject of PART FOUR. This PART contains, following a description of those Amendments, a detailed comparison between the provisions of current law and the provisions of the Amendments, with respect to entitlement and duration of entitlement, covered items and services and their durational limitations, cost-sharing, the conditions of and limitations on payments for services, and the financing of health care benefits. PART FIVE, after presenting a detailed description of the principal provisions and features of the Comprehensive Health Insurance Act of 1974, demonstrates how this major legislation would respond to the dimensions of the health care needs of the aged and disabled by measuring the degree of comprehensiveness of the health care protection it would provide to those groups and by evaluating its efforts with respect to health care cost restraint. The standards used in analyzing the Comprehensive Health Insurance Act of 1974 are present law and the Medicare Amendments of 1974. 34-275 (Pt. 8) O 75 |