Perspective               

By Focusing on Medicare Spending, Congress Will Never Ensure Adequate Health Coverage for Older and Disabled Americans, Advocates Warn

Leaders of national consumer organizations say Congress places far too much emphasis on what Medicare costs and not enough attention on whether health care coverage is affordable, or adequately meets the health care needs of older and disabled Americans. Millions of older and disabled Americans with Medicare aren't getting the health care they need because they can't afford it. When Congress talks about Medicare, the focus is on saving the government money. Congress must also talk about guaranteeing good, stable and affordable health care for people with Medicare, the consumer groups argue.

Today, older Americans typically spend 19 percent of their annual income on health care and that amount is expected to rise to 29 percent by the year 2025. People with Medicare generally must pay out-of-pocket for prescription drugs, premiums, deductibles, co-insurance and supplemental insurance. The average annual income of older Americans is only $15,500.

Consumer advocates maintain that the private marketplace is clearly not the solution that Congress was banking on. Managed care has not saved taxpayers any money and has shifted the focus away from the need for stable and affordable health care. Moreover, Original Medicare already offers people choice -- it's just not affordable to many.

Congress enacted the Balanced Budget Act of 1997 to reduce the Medicare budget and expand health care options -- especially managed care -- for people with Medicare. However, Medicare HMOs are not available to about one in four many people on Medicare. Clearly, Medicare HMOs are not the magic solution for Medicare. And out-of pocket expenses are rising for people who are enrolled in Medicare HMOs. In the year 2000, people in Medicare HMOs will have the following expenses:

· For the first time, every Medicare HMO that offers a prescription drug benefit will charge a co-pay.

· Drug coverage in 2000 is limited to $500 or less by a third of the plans, compared to just 21 percent of the plans in 1999.

· The average price of HMO premiums will nearly triple to about $190 per year, from about only $64 a year in 1999.

· The percentage of HMOs charging no premium is 77 percent in 2000, down from 85 percent in 1999.

· The number of people with access to only one Medicare HMO whose premium is $960 a year or greater will more than quadruple to 207,000, compared to 50,000 in 1999.

Congress needs to find a careful and fair solution to the problem of high health care costs for people with Medicare. Advocates say they support innovative approaches to cutting Medicare costs as long as they do not cost people more money to get good health care. Advocates recommend contracting with medical Centers of Excellence, which lower the cost for specialty care, yet improve the quality of care. The advocates also favor competitive bidding to purchase durable medical equipment

For the first time since Medicare's inception in 1965, Medicare spending declined in 1999. In fiscal year 1999, it declined by 1 percent. However, health care costs for people with Medicare have increased. Advocates say that when it comes to health care for older and disabled people, Congress can't just look at the bottom line. Every cut in Medicare spending should be examined first to see whether it makes it harder for people with Medicare to get the care they need.

If you are having trouble paying for your health care, there are some government programs that can help you, QMB, SLMB, QI-1, and QI-2. To find out more about these programs, call your State Health Insurance Assistance Program, or SHIP. The number is in the back of your Medicare Handbook or call 1-800-MEDICARE. You can also call your Senator or Congressperson for assistance.

 

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