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February 23, 2001
Seniors Shape Policy
Health-related legislation could benefit older Americans

By Leah Shafer
Jason Stout

senior-related 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 of people.

Medicare reform

Medicare HMOs are dropping patients' coverage -- time for reform?

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 of 2001.


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 reform.

Another proposal in the works is Breaux-Frist 2000, which builds on the private sector and encourages competition among Medicare carriers.

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 a service.

Long-term-care insurance

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 Program.

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 magazine frequently for updates on senior issues in the health care system.

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