Seniors Shape Policy
February 23, 2001
Health-related legislation could benefit older Americans
By Leah Shafer
legislation is getting more political attention than ever,
with the new administration promising a better future for
aging Americans. Since there are currently almost 35 million
Americans over age 65, and since more baby boomers will be
joining their ranks soon, paying attention to the needs of
aging American voters makes economic (and re-election) sense.
By 2015, the number of seniors in this country will swell
to 47 million -- which is 15 percent of the population.
The Bush administration and our congressional representatives
promise some interesting programs for seniors, including Medicare
reform, a patients' bill of rights, help with long-term-care
insurance, better programs through the Older Americans Act,
and prescription-drug funding. All of these improvements,
if carried out, might make the golden years better for millions
Medicare HMOs are dropping patients' coverage -- time
Health maintenance organizations (HMO) that accept Medicare
patients are becoming scarce. On January 1, 2001, almost 1
million senior beneficiaries were dropped from HMO coverage
lists as these organizations bowed out of the federal health
insurance program altogether. Three million more seniors will
see their prescription drug benefits lowered in 2001.
HMOs say that government reimbursements aren't keeping up
with the increasing price of drugs and that they can't afford
to cover Medicare recipients anymore. This limits seniors'
health care choices, as providers become scarce and seniors
lose prescription drug coverage as well as other benefits
-- like free checkups and low-cost preventive care.
Many seniors are forced to purchase supplemental insurance
policies with drug coverage; these policies can cost up to
$150 a month.
Both Democrats and Republicans will weigh in on this issue
as more of their constituents are dropped from HMOs. No plans
are in the works yet to alleviate the problem, but expect
this issue to weigh heavily in the national debates about
senior prescription drug coverage and Medicare overhauls in
the next year.
Medicare reform is sure to be the subject of much
political wrangling this season. The issue was heavily
debated in both congressional and presidential campaigns,
and prescription drug benefits are likely to be
the subject of one of the primary health care initiatives
Prescription drug coverage as part of Medicare reform
Because the new Congress is split nearly evenly between the
two parties, Medicare reform is sure to be the subject of
much wrangling this season. The issue was heavily debated
in both congressional and presidential campaigns, and prescription
drug benefits are likely to be the subject of one of the primary
health care initiatives of 2001. Expect gridlock as legislators
debate the best way to provide the 39 million Medicare recipients
with realistic options for affordable prescription drugs.
Will this become part of a major overhaul of the whole Medicare
system -- a monumental task for Congress and the President
-- or will legislators create a separate package to satisfy
this vocal senior constituency?
President Bush has proposed a plan called Immediate Helping
Hand, which would direct $48 million to the states to cover
prescriptions for low-income seniors. But the plan is unpopular
with both Democrats and Republicans in Congress; the Democrats
want more-inclusive benefits for more seniors, and the Republicans
think changes should be made as part of comprehensive Medicare
Another proposal in the works is Breaux-Frist 2000, which
builds on the private sector and encourages competition among
The Senate Republican Conference has created a task force
on Medicare and prescription drugs. The task force's recommendations
will be thrown into the debate mix in the next few months
to compete with ideas from Republicans and Democrats in the
House of Representatives. Look for a compromise to be sent
to the Senate floor before the end of the year.
Patients' bill of rights
This long-anticipated legislation is likely to be the second
major health care initiative of 2001, and we are likely to
see legislation enacted this congressional session. Legislators
have been wrestling with different versions of this bill for
five years, with few results. Last year, for instance, the
House of Representatives passed a sweeping bill, only to see
it defeated in the Senate.
The so-called patients' bill of rights is popular with many
sectors of the population, so legislation is likely to move
quickly in both the House and Senate. There are a number of
bills in Congress, including the bipartisan patient protection
act of 2001, the patients' bill of rights, the patients' bill
of rights act, and the common sense patients' bill of rights
act. Specifics under debate are a patient's right to see specialists,
the right to have access to all the treatment options for
a given condition, the right to appeal insurance denials to
an impartial committee, and the right to sue HMOs in state
courts for compensatory and punitive damages in the case of
death or serious injury.
President Bush has voiced support for a national patients'
bill of rights, and when campaigning he said he would make
it possible for people to sue their HMOs. Currently, federal
law bars patients from suing HMOs for more than the cost of
Long-term-care expenditures for nursing home or home health
care are expected to grow dramatically in the next four decades
-- from $123 billion in 2000 to $207 billion in 2020, and
to $346 billion in 2040. For the 43 percent of seniors who
will need temporary or permanent long-term care, insurance
can offer protection against the monumental costs associated
with extended illnesses.
Long-term-care insurance is pricey -- up to several thousand
dollars a year -- but it's a bargain compared with the annual
cost of a nursing home, which runs about $50,000. With the
growing popularity of this type of insurance, in September
2000, President Clinton signed into law the Federal Long-Term
Care Security Act. With this act, federal employees, members
of the uniformed services, and civilian and military retirees
will have access to long-term-care insurance.
Two notable bills involving long-term-care insurance are
currently in congressional committee for discussion -- the
omnibus long-term care act of 2000, and the live long and
prosper act of 2000. The omnibus act aims to increase Americans'
access to long-term care by authorizing a $3,000 tax credit
for insurance premiums and other expenses associated with
it. The "live long" act calls on the President to convene
a national bipartisan summit on long-term care and insurance
at the White House, to discuss public education about long-term
care, to develop recommendations for additional research,
and to promote public policy reforms and actions in the field
of long-term-care insurance.
Older Americans Act
After a lapse of five years, Congress re-authorized the Older
Americans Act (OAA) of 1965, which provides programs like
Meals on Wheels, legal services for seniors, senior centers,
protection against abuse, and employment services. But the
current version of the act adds several important provisions,
the most notable being the National Family Caregiver Support
As part of the OAA, the National Family Caregiver Support
Program authorizes $125 million to "help hundreds of thousands
of family members -- spouses, adult children, and others who
are struggling to care for their frail older loved ones who
are ill or disabled," said President Clinton when he signed
the bill into law, in November 2000.
"The support provided through this new program includes critical
information, training, and counseling, as well as much-needed
quality respite care for those caregivers who are juggling
jobs and other family responsibilities while meeting the special
needs of loved ones in their care," Clinton said.
The baby boomer influence
More than ever, baby boomers are demonstrating their ability
to greatly influence domestic policy agenda. As Medicare reform
begins in earnest and a patients' bill of rights is debated
this year, the baby boomer generation will undoubtedly shape
the political process.
Check the Senior Health section
of Rx.com magazine frequently for updates on senior issues
in the health care system.
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