99 of the employer portion of the payroll tax 3111 substantially devolves upon the employee) the taxable wage base revisions of the Medicare Amendments of 1974 would lessen, to some extent, the regressive impact of these taxes. In addition, the Medicare Amendments of 1974 would impose a new tax on unearned income which is neither imposed under current law nor would would be imposed under the Comprehensive Health Insurance Act of 1974. Finally, the Medicare Amendments of 1974 would provide for a Federal Government contribution to the Medicare Trust Fund out of general revenues as would the Comprehensive Health Insurance Act of 1974. However, the amount of the contribution from general revenues under the Medicare Amendments is likely to be far more substantial than the contribution under Comprehensive Health Insurance, since, in the latter case, the amount appropriated is strictly limited in accordance with specified purposes. 100 PART SIX CONCLUSION Using as a standard the Medicare Amendments of 1974, which were designed specifically to accommodate the health care needs of the aged and the disabled by providing comprehensive protection on the one hand while simultaneously confronting the problem of rising health care costs on the other, the National Health Insurance Act of 1974 is less than adequate. It fails to address itself to the nation's health care needy by providing the proper degree of protection. Moreover, it fails to come to grips with the problems of rising health care costs. In some respects, the entitlement provisions under the FHIP plans represent a contraction of eligibility in comparison with existing law. Moreover, the status of those who are disabled or deemed disabled and covered now for purposes of Medicare is obscure. Their health care protection might be jeopardized. In comparison, the eligibility provisions of the Medicare Amendments of 1974 are very liberal. With respect to health care benefits, the coverage of outpatient drugs under FHIP plans is an improvement over the benefits available under current law. However, the entire benefit package when considered in the context of durational limitations, represents at best, a slight expansion of protection. short of the comprehensive protection of the Medicare Amendments of 1974, the benefits of which would add, among other things, It falls far coverage of intermediate care facilities, greatly expanded psychiatric care including (day care and outpatient), dental services, services of optometrists and podiatrists, and outpatient drugs to services already available and with few durational limitations. - While the FHIP plans would provide catastrophic protection, the protection would be less than that available under the Medicare Amendments of 1974 because the maximum ceiling is lower and the income classes limits higher under the latter bill. Moreover, the complex system of premiums, deductibles, and coinsurance under the FHIP plans would constitute a cost burden on those administrating the plans and on those subject to the cost-sharing features. The single system of minimum copayments geared to the more expensive items of health care under the Medicare Amendments of 1974 makes better sense. With respect to the procedure for the payment for covered services, the FHIP plan idea for the establishment of an account against which a covered individual may charge the cost of obtaining items and services without regard to deductible and coinsurance requirements is commendable. Requiring a full "participating provider" (but not the "associate provider"in some cases) to accept the payment as full payment is another provision that is desirable and needed. While the Medicare Amendments of 1974 would not provide for the establishment of accounts such as is contemplated under the FHIP plans, payment under the Medicare Amendments would also have to be accepted by participating providers as full payment (without exception). 102 The complete absence of standards for the promulgation of regulations by the Secretary of HEW pursuant to which certified state reimbursement standards would be set, seems to be an unwise abdication of responsibility and likely to promote rather than restrain the rate of increase in hospital and health care costs. While the Comprehensive Health Insurance Act may with respect to FHIP plans contemplate the establishment by "certified" states of prospective budget review procedures for institutional providers and negotiated rates for non-institutional providers for payment purposes under FHIP plans, the Medicare Amendments of 1974 specifically so provide. Such reimbursement procedures should tend to promote rational and cost efficient utilization of health care facilities and personnel and thereby restrain rising health care costs. the - While inadequate in its protection for the health care needy the aged and disabled the FHIP plans have some good features. Since Medicare Amendments of 1974 and the Comprehensive Health Insurance Act of 1974 have common elements (except with respect to payment procedures where CHIA has nothing more than unqualified discretion in the Secretary of HEW to prescribe regulations), it may be possible to combine them to provide comprehensive health care protection for the aged and disabled and basic protection for the non-aged and disabled through the EHIP, AHIP and prepaid health plans. If the Comprehensive Health Insurance Act is to be given services consideration, such a fusion should be seriously considered. |