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EFFORTS TO REDUCE MEDICARE BENEFITS RESISTED: The interest of the
At the December meeting, Chairperson Dr, Otis Bowen listed four issues the Advisory
Several groups cited their opposition to limiting Medicare to only the financially needy. Hacking opposed any means test as a flagrant breach of contract. Henry Nicholas of the National Union of Hospital and Health Care Employees also strenously opposed any change in the social contract between the government and its citizens. Father Harvey of Catholic Charities pointed out that means-tested programs have been far more severely cut than social insurance programs. Speaker after speaker cited the inadequacy of present benefits and their concentration on expensive institutional care rather than on care for the predominant problems associated with chronicity and aging. Numerous witnesses called for coverage of drugs, eyeglasses, dental care and long term care.
Jacob Clayman, testifying for the Leadership Council of Aging Organizations, called for health-system-wide cost controls (public and private) as did Seidman of AFL-CIO
and Glasser of HSAC. Medicare-specific cost containment, said Hacking of AARP, will : not contain costs over the long run. Several groups called for system-wide prospective reimbursement, with assurances of accessibility and quality. At the January hearings, testimony by groups of insurors, providers, and others demonstrated the conflict and uncertainty about what needed to be done. The Health Insurance Association of America (HIAA) affirmed support of the extension of a hospital prospective payment plan to all payors, public and private (although not necessarily the DRG plan). The "Blues" stated their opposition to such extensions too regulatory. The Group Health Association of America (HMOs) reported the problems and increased costs they have experienced with the New Jersey DRG system. Trustees of voluntary hospitals recommended increasing co-payments for people with gross incomes over $40,000. There was general discussion of means-testing, and the HHS staff was asked to look at alternative ways of means-testing for Medicare. NEXT PUBLIC HEARINGS: San Francisco 2/24/83, Chicago 3/9/83. For information, contact the Council at 200 Independence Ave., S.W., Washington, D.C, 20201 (202-7558670).
MEDICARE VOUCHERS AGAIN: Rejected by the Congress in December 1982, the Administration's plan to allow Medicare beneficiaries to opt out of Medicare and receive credits to buy a prepaid insurance plan, H.M.O., of preferred provider program has surfaced again. This is of grave concern because of its potentially adverse effect on beneficiaries and on the long term soundness of the basic Medicare structure...
A brochure, written for laymen, discussing Medicare vouchers, is available from the Health Security Action Council. 1-5 copies, no charge; 6-100 copies, 154 each; 100 or more, $14 per 100; 1000 or more, $130 per 1000. HEALTH INSURANCE FOR THE UNEMPLOYED: Health Security Action Council Chairman Douglas Fraser called on Congress to provide health insurance for unemployed workers and their families. Testifying January 24th before the Energy and Commerce Committee of the House, Fraser, speaking also for the UAW and the AFL-CIO, estimated 25–30 million people lost health protection in 1982. With predictions of slow economic recovery and up to 5 more years of high unemployment rates, Fraser said: "This tragic, by-product of unemployment may .... cost the nation as much in 'damaged and lost lives as the unemployment itself".
Describing the impact of joblessness on the health of the unemployed and their families, Fraser said: "This intolerable situation would not have existed if Congress had enacted a universal, comprehensive national health insurance program we have however, a massive serious problem that calls for immediate attention". Fraser suggested possible approaches to needed protection: 1) Require private insurance to provide longer continuation after lay-off, and shorter delays before coverage at new job entry; 2) Liberalize Medicaid eligibility to provide for the unemployed; 3) Publicly finance continuation of the worker's company health plan for at least a year after lay-off; 4) provide an essential minimum package beginning when unemployment benefits start, and continuing for a year, or until new employer-provided benefits take effect. Fraser's testimony was given added import by the release of a Food Research and Action Center study which reported that a century long decline in 'infant mortality rates had been reversed from 1980 to 1981 in eight states and several major urban centers. At least one state Health Director attributes increases in infant deaths in part to unemployment and decreased access to health services. NEW JERSEY HEALTH SECURITY ACTION COUNCIL Chairman Milton Wilkotz spearheaded a letter-writing campaign to the New Jersey Congressional delegation to bring to their attention the urgency with which their constituents view the need for health insurance for the unemployed. They have also worked on the news media, with letters, news articles, and radio coverage. The New Jersey Council found it useful to have the staff of members of Congress in their congressional district join them in visits to the nearest unemployment offices, where the jobless have been able to help them understand what it really means for them and their families to be without health insurance. Said Wilkotz: "With the Administration's lack of concern the time has come when pur elected officials must prove they deserve our votes by their votes in Congress": PRICES, COSTS AND PREMIUMS: As the controversy about how to contain runaway health care costs escalates, the figures and the terms continue to confuse the issue. In late January the N.Y. Times reported "Health Care Costs up 11%, nearly triple overall rises". (Consumer Price Index for 1982 rose 3.9%). But it wasn't costs, it was prices that rose 11%. Costs are numbers of services times .prices. The 1982 figures for costs are probably higher than an 11% increase, and are not out yet. Of particular interest is, the Bureau of Labor Statistics report that private health insurance premiums rose 15.9% in 1982 more rapidly than the increases in hospital room rates or physicians' fees. Health Insurance Association spokesmen attributed the premium increases to larger numbers of medical services used, and cost shifting from Federal payors.
As Pederal payments are increasingly limited, providers are inclined to make up the difference by increasing charges to private insurance payors. TAX CAP ON HEALTH INSURANCE: Rejected in 1982, the so-called "tax cap" "on health insurance premiums is again being proposed by the President. - Above ä certain ceiling, probably $2100 per year for a family plan, and $840 for a single plan, the amount an employer pays for worker health insurance would be added to the worker's taxable income. Group plans with good coverage cost more than this. Cost-shifting from public to private sector insurance is contributing further to runaway increases in private insurance premiums. Family coverage under the UAW-General Motors Michigan plan, for example, costs $3624 a year. The proposed tax cap would cost the average worker with such coverage several hundred dollars a year in added taxes.
A broad based coalition is working to defeat the tax cap. Senator Bob Packwood
Health Security Action Council
New Health Care Cost Containment Plan Proposed
A broad based coalition has proposed a comprehensive plan to contain fast-rising health care costs as an alternative to further destructive Cuttacks is such programi a.; Medicinci mini Medicare.
Called H.A.L.T., or Health Action to Limit Takeaways, the plan was drawn up over the past several months by health care experts working with the Health Security Action Council. The coalition includes more than a hundred labor, consumer, religious, senior citizen, business, civii rights and farm groups.
Legislation embracing the cost containment proposals will be introduced earl. in the next session of Congress, according to MOLTSN WILHOTZ Chairman of the Health Security Action Council. Naj Winkoricaised in "The only constructive alternative that has been offered thus far to further cuts in programs.
If adopted, the plan would iminediately save $5 billion annually in federal expenditures and would result in comparable savings in the private health sector.
Over several years, the H.A.L.T. plan is aimed at bringing down yearly increases in health custs to the level of increases in the Consumer Price Index. Over the past year or so, the health care component of the C?! has continued rising at a double-digit pace despite the overall lessening of inflation: ,;
The plan would be implemented in two phases. Under the first phase, hospital and nursing homes charges, doctors' fees and other health care costs would be limited to the necessary cost increases of previous year.
These limits n charges would include the Medicare and Medicaid prograns as well ilds private insurance.
After two years of this initial phase, the plan would be fully in place. The states would have the flexibility to work out specific budgets to contain lealth care costs within the general cost increase limits, as well as federal guidelines. These budgets would be determined in annual negotiations anong a state health commission, Medicare intermediaries, providers, insurance companies and consumer representatives.
She is. A.I.T. plan is "comprehensive rather than drastic;" according to Melvin A. Glasser, Director of the lealth Seality Action Council. "It's a systematic rather than a piccome il f':'I och