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Barriers to Health Care for Older Americans:
Part 1. Washington, D.C., March 5, 1973.
Part 2 Washington, D.C., March 6, 1973.
Part 3. Livermore Falls, Maine, April 23, 1973.
Part 4. Springfield, Ill., May 16, 1973.

Part 5. Washington, D.C., July 11, 1973.

Part 6. Washington, D.C., July 12, 1973.
Part 7. Coeur d'Alene, Idaho, August 4, 1973.
Part 8. Washington, D.C., March 12, 1974.
Part 9. Washington, D.C., March 13, 1974.
Part 10. Price, Utah, April 20, 1974.

Part 11. Albuquerque, N. Mex., May 25, 1974.
Part 12. Santa Fe, N. Mex., May 25, 1974.
Part 13. Washington, D.C., June 25, 1974.
Part 14. Washington, D.C., June 26, 1974.
Part 15. Washington, D.C., July 9, 1974.
Part 16. Washington, D.C., July 17, 1974.

(Additional hearings anticipated but not scheduled at time of this printing.)

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APPENDIXES

BARRIERS TO HEALTH CARE FOR OLDER AMERICANS

WEDNESDAY, MARCH 13, 1974

U.S. SENATE,

SUBCOMMITTEE ON HEALTH OF THE ELDERLY OF THE

SPECIAL COMMITTEE ON AGING,
Washington, D.C.

The committee met, pursuant to recess, at 10 a.m. in room 5110, Dirksen Office Building, Hon. Edmund S. Muskie, chairman, presiding.

Present: Senators Muskie, Stafford, Mondale, and Percy.

Also present: William E. Oriol, staff director; Elizabeth Heidbreder, professional staff member: Reid Feldman, legislative assistant to Senator Muskie; John Guy Miller, minority staff director; Margaret Fayé, minority professional staff member; Patricia Oriol, chief clerk; Gerald Strickler, printing assistant; Yvonne McCoy, assistant chief clerk; and Dorothy McCamman and Herman Brotman, consultants.

OPENING STATEMENT BY SENATOR EDMUND S. MUSKIE,

CHAIRMAN

Senator MUSKIE. The committee will be in order. I have a brief opening statement, designed to summarize somewhat, yesterday's hearing as a prelude to today's hearing.

Yesterday, this subcommittee began 2 days of hearings specifically to examine the effect that the administration's proposed new comprehensive health insurance plan would have upon health care for older Americans. To fashion the comprehensive health insurance plan most Americans now agree is needed will require a process of careful scrutiny and cooperation by all parties. I believe that the administration's proposal is a step forward in this cooperative process.

The testimony in yesterday's hearings, however, raised serious questions about the adequacy of the administration's proposal in meeting the health needs of the elderly.

The administration plan does offer some improvements over earlier proposals. But the evidence we have heard so far indicates that it would create an unwieldy and perhaps unworkable apparatus which would impose increased health care costs on most elderly Americans while failing to guarantee needed improvements in kinds of health care they can receive.

This subcommittee's hearings, of course, are not focusing on all the provisions of the administration's plan-other congressional units will take on that task in the months ahead.

To the Committee on Aging, however, the administration's planCHIP-is of immediate concern because it would considerably alter the Medicare system, and-in the opinion of the witnesses yesterday— it would alter Medicare for the worse.

They were concerned, as am I, about the "cost-sharing" provisions in CHIP. They testified that the administration proposal could add hundreds of dollars to an average hospital bill, and significantly more to a doctor's bill.

Later on, in questioning, I'll give examples showing that the CHIP bill would clearly result in much higher out-of-pocket expenses for older patients.

"COST-SHARING" "OVERUTILIZATION”

For now I will say only that Secretary Weinberger and I had a conversation in hearings before this subcommittee about 1 year ago about the pros and cons of "cost-sharing." He maintained that higher costs to the Medicare enrollees would prevent what he called "overutilization" of medical facilities. But the evidence we heard showed that "cost-sharing" would not change utilization patterns except when it put needed care beyond the patient's financial reach. I invite whatever new evidence he may have on this crucial issue.

The Secretary may also argue, as he did last year, that the elderly patient with a long-term hospital stay will benefit from the administration plan. Most Medicare patients, however, come nowhere near the length of stay required to receive such advantages.

The Secretary should also know that yesterday's hearing produced other testimony questioning the usefulness of CHIP to the elderly: Nelson Cruikshank said that CHIP seems to "take a lot from a great many in order to give a few people very little." He pointed out that it violates the social insurance principles on which Medicare is based, and that "the biggest beneficiaries would not be the sick, but the health insurance industry."

Melvin Glasser said that CHIP nowhere assures that access to decent health services is a right for all Americans. "Rather," he said, "it continues to be a privilege for those who can meet the requirements of out-of-pocket payments, State legislation, and Federal strictures."

One point emphatically made by two witnesses is that Medicare benefits under CHIP could vary widely from State to State—a concept resisted by Medicare supporters and the Congress in the early 1960's. Surely there is no good rationale for retrogression now.

The American Association of Retired Persons also questioned the usefulness of the "cost-sharing" provisions for controlling health costs. They questioned whether the States could be expected to take upon themselves the responsibilities which the overall CHIP plan would require. And they said that if benefits were to vary sharply among the States, CHIP could even be challenged on constitutional grounds.

Such questions, to my mind, warrant careful consideration by the administration, just as the CHIP proposal warrants careful attention by the Congress.

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