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Senior Citizens of Manville, Ine.

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835

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ttee, currently charged with this task, review these recommendations and

propose

action on those with beneficial merit.

Encourage families to maintain elderly relations (pa rents, in-laws, etc.) in their

homes and allow them meaningful tax credits.

Establish a National Health Insurano o Policy, through Public or Private Insurance

Plans.

Establish a Schedule of surgery charges

Hospital charges, etc.

Compel more

Doctors to accept those charges. Payment to Hospitals, only for the amount of necessary

cost incurred.

Doctor and Hospital charges should be so devised, as to eliminate the

incentive to perform more services than required. Eliminate the cost-plus fee for

service plan.

Institute an across-the-board limit on increases in Medicaid reimbursement to

Hospitals by all Third Party payers, inoluding Medicare and Medicaid.

Hospitals, thereby

would not be able to shift their costs onto private-pay patients. Thus, they would have

to initiate economios.

All Plans and payments, should be subject to more thorough audit.

Congress should

enaot strong Foderally man dated penalties and enforcement against fraud in the Medicare

Medicaid Programs.

Penalties should be dealt to Hospitals, Dootors, Technioians and/or

to recipients of service, as warranted.

Why not reduce some of the Deficit spending and allot some of this money to Medicare.

For example, We would not impair our preparedness, by eliminating one of the nuo lear

Airoraft barriers, planned for construction.

Reconsider the sensibility of the ?X

Missle System

perhaps strike the B-1 Bomber from the plans, (The B-52 18 8 worthy

present-day and near future weapon). As a U. S. Marine Corps, Purple Heart Veteran,

I certainly want this Great Country to be ever ready to defend itself.

Senior Citizens of Manuille, Inc.

BOROUGH HALL

101 South Main Street Manville, New Jersey 08835

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Perhaps, a nominal increase in Payroll taxes, paid by employers. They have already

beon granted generous tax credits and allowanoes.

Repeal this year's 10% tax credit -- which roully will not greatly benefit the

average family. There was really little beneficial economic uplift with the last 58

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In oonolusion, we plead with your committee to do all in your power to curb the

runaway Health Care Inflation rate,

It certainly is a burden and ourse on the elderly.

We certainly trust that your most important Committee will again serve the interost

and welfare of our elderly, as you have done in the past.

Respectrally submitted,

Frank Sterbinsky, President
Senior Citizens of Manville, Inc.
1008 June Place
Manville, N.J. 08835

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My name is Peter Shields, Director of the Union County Division on Aging for the past ten years, one time County Welfare Personnel Officer and prior to that retired as a Field Representative from the U. S. Social Security Administration with over 30 years federal service,

I'm presently Chairman of the Long Term Care committee of the New Jersey Association of Area Agencies on Aging, a member of the State Nursing Home Task Force, Immediate Past President of the New Jersey Association of Area Agencies on Aging and former Legislative Chairman of the National Association of Area Agencies on Aging.

I'm also Chairman of an Advocacy Conmittee representing the state's Area Agencies, Visiting Nurses, Home Health Aides, and Medical Social Workers.

I am honored to be invited to express my thoughts on the future financing of
Medicare.

The possibility of increasing the payroll tax for allocation to the Medicare Trust Fund would be unpopular with the working population, but a moderate increase is probably unavoidable,

The recommendation to increase beneficiary co-payments for hospital stays with "so-called catastrophic" protection after 60 days seems totally unacceptable to senior citizens and a misinterpretation of what "catastrophic" coverage means to most of them. I believe they consider it in-patient hospital days beyond "life-time reserve" and extended nursing home stays. The proposed recommendation to pay co-insurance through the 60th day is financially unacceptable to senior citizens. Since the average stay is 11.5 days the burden for payment would be on the seven million elderly annually admitted to hospitals for the benefit of about 170,000 patients (a small percentage of the seven million) who stay longer than 60 days. Implementation of this proposal would cause chaos in the MedicareGap insurance with seniors scrambling to protect their interests at presently unestimated but surely prohibitive costs.

Most senior citizens do not have the financial ability now to carry supplemental
Medicare insurance and if the proposed co-payments become effective most of
those who now have supplemental coverage would have to drop this coverage due
to inability to pay for

Most of the seniors I talk to are more satisfied with Part A than Part B of
Medicare, because even some who can barely afford it have protected themselves
for their co-insurance through Medigap Insurance. However, the change in hospital
billing to the DRG (Diagnosis Related Group) system must be evaluated carefully.
Since this system is in use in New Jersey, it should be possible to obtain detailed
information from the New Jersey Department of Health to compare the costs prior
to DRG and now for hospitals in a variety of locations, Most people are of the
opinion that DRG places the burden of payment for "bad debts which includes
patients who can't or won't pay their hospital bills" in one year on patients
admitted the next year when the new DRG rate is set. This places an unfair
responsibility on those who need to enter a hospital and have provided for this
possibility. It would seem the cost of care for non-paying patients should be
the responsibility of all people, not just those who become ill.

Concerning Part B the seniors are disillusioned with the "reasonable charges" allowed as they are unrealistic and a very small number of doctors accept assignment. Seniors are frequently told to ask their doctor this question before being treated. This is impossible in some instances particularly when the patient needs anesthesia and has to use the group in a particular hospital. Placing a one year freeze on "reasonable charges" would only add to their problems. The only solution for the patient would be if doctors accepted assignment and reasonable charges were realistic. If this could be accomplished, most beneficiaries would not oppose having a 75% 25% ratio used for Part B reimbursement.

Social Security and Medicare have helped many people stay out of poverty. To
preserve this protection I would agree to the use of general revenues if at
some point the trust funds are threatened. In that case, on a temporary basis
use of general funds might be acceptable. I am fearful that use of general revenues
could nullify the original goals of Medicare and lead to possible future applica-
tion of a means test. It could also work adversely against cost-containment in
the event a future Congress was tempted to use an increase in Medicare benefits
to gain support in an election.

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It might be appropriate to transfer Medicare costs to general funds for kidney dialysis patients under 65 and for disability beneficiaries under 65.

I believe more extensive use of home health services of high quality would be a substantial saving. If a patient felt assured of this type of care they would feel more confident in returning home. A less stringent definition of skilled mirsing care is needed for Medicare patients. Being cared for safely and properly at home would also help the patients avoid or postpone institutionalization,

I do appreciate this opportunity to enter these remarks.

Respectfully submitted,

Peter M. Shields
Director
Union County Division on Aging

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