Former President George Bush has graciously agreed to serve as an Honorary Co-Chairman of the Coalition. He joins two other distinguished leaders who currently serve as Honorary Co-Chairmen of the Coalition, former Presidents Jimmy Carter and Gerald R. Ford

Patients’ Rights Discussed At Coalition Meeting

“Patients’ Rights” is a complex term that has various meanings and implications for public policy, as was evidenced in the remarks of two speakers at the Coalition’s July 8 meeting. Charles N. (Chip) Kahn, III, Chief Operating Officer and President Designate of the Health Insurance Association of America (HIAA), focused his remarks on the continuing debate in Congress over the regulation of managed care and the formulation of a patients’ bill of rights. Daniel Callahan, Director of International Programs at the Hastings Center, addressed the broader, more basic issues facing our nation’s health care system.

Kahn noted that the way in which “Patients’ Rights” legislation has been handled in Congress has been “abysmal.” He characterized the proposals before Congress dealing with the regulation of managed care as a “mishmash” of pieces with no central philosophical core. Managed care has become the “whipping boy” in the public’s mind for everything that is wrong with the health care system. And Congress has used that public perception to formulate ill-thought-out “solutions,” as Kahn sees it.

Kahn agreed that the nation must achieve universal coverage, but maintained that the way this goal is attained will be the sticking point. Kahn, whose Association represents the major health insurers, indicated that the insurance industry alone cannot solve the problems of coverage and cost. All parties – providers, consumers, government, health plans and insurers – have to be part of the solution, just as they are all part of the problem. Nor can employer mandates be the entire answer; some kind of direct subsidies will be needed to cover many of the uninsured he said. Kahn believes there are areas of common interest in which HIAA could work with the Coalition on seeking solutions to some of these problems.

Dr. Callahan noted that he has looked at the health care systems in 14 countries and concludes that all of them have serious problems. In the United States, we have no goals for our system, according to Dr. Callahan, other than “the more we have the more we want!” To assure patients’ rights in the broadest sense of the term, Dr. Callahan believes we need to establish a new paradigm for health care, a “Sustainable Medicine” model. Such a model would consist of a system that was affordable (which entails a leveling off of the rate of cost increases), equitable (universal access), and satisfying (within certain limits) to the American people. The model would incorporate the results of a close examination of the open-ended use of medical technology and therapies and would set limits on certain services. In protecting patients’ rights, we will have to come to grips with balancing the health of the population as a whole versus the health of the individual. That is not an easy task, Dr. Callahan points out, especially in a country such as the United States in which people have very high – and often unrealistic – expectations of the health care system.

NCHC at the National Conference of State Legislatures

The Coalition had an exhibit at the 1997 National Conference of State Legislatures Convention in Las Vegas, July 20-24th. Support for our efforts was expressed by many conference participants. In addition, many people representing several states included in our field effort indicated an interest in working with us.

Although the Coalition is not involved in advocating state legislative initiatives on health care, state legislature lists are an excellent source for opinion leader and decision-maker contacts.

The Coalition also will have an exhibit at the upcoming American Legislative Exchange Council in Chicago in mid-August.

NCHC In the News

• An article prepared by the Coalition on the public’s attitudes on health care issues, which was syndicated by North American Precis, appeared in over 750 newspapers across the country over the past year. Average coverage for such an article is 100 to 400 papers, with the latter being an exceptionally high average. Coverage for the Coalition’s article rated a special award from North American Precis .
• Peggy Rhoades, Executive Director of the Coalition, appeared on Fox News Channel “Fox on Health” on July 20th. U.S. News & World Report released “America’s Best Hospitals,” and the issue of quality in America’s health care system was the subject of discussion. She also was interviewed on WJBO Radio in Baton Rouge, Louisiana on quality care.
• Henry E. Simmons, M.D., Coalition President, was interviewed by WSMN in Nashua, New Hampshire on health care reform.
• Dr. Simmons taped a 30 minute segment for “Radio Health Journal,” a program that is syndicated to 250 radio stations around the country. He also met with the Editorial Boards of the Chicago Tribune and the Chicago Sun Times to discuss the problems in the health care system.

In The Field

The National Coalition has hired nine experienced grassroots organizers to build state coalitions and lead our education efforts in 12 states. These State Directors have a variety of organizing experience ranging from social justice and transportation to religious and political issues. In January, additional staff will be added in other states.

In July, the State Directors completed four intensive days of issue and tactical training at Airlie, a retreat center in Warrenton, Virginia. It was an opportunity for them to come together as a team, learn the nuances of health care issues and begin creating a strategy for building their state coalitions. For the next six months, they will be working to build coalitions and traveling around their state educating the public on the importance of health care issues and how they can get involved.

National Candidate Outreach

The Coalition sent over 900 questionnaires to major party candidates running for the U.S. Congress, and the response rate is good. This effort is designed to reinforce the importance of health care issues and to begin the process of educating candidates on the five key principles of the Coalition.

The results of the survey will be used to assess the importance of the health care issues to the candidates. State Directors will offer to assist all campaigns by providing pertinent information. They will also look for opportunities to partner with state Coalition members on candidate education efforts.

If you would like to get involved in your state coalition, please contact your local state director. They are looking forward to hearing from you.

New State Directors and Coalition staff attend the training session.
Photo by Rebecca Twitchell

Raising the Medicare Eligibility Age Could Leave Many Seniors Without Health Insurance

The National Coalition on Health Care commissioned a study by The Lewin Group on the ramifications of raising the Medicare eligibility age to 67 by the year 2020, which is being considered among other options by the Medicare Bipartisan Commission. The study found that many 65 and 66 year olds would be left without health insurance each year under such a change unless Congress allowed those individuals to buy into Medicare and provided federal subsidies to help low-income seniors pay for the coverage.

While most 65 and 66 year olds would probably continue to work to maintain their health coverage, many would be left without any or without adequate coverage – absent a buy-in and federal subsidies – because: (1) affordable, comprehensive health insurance is simply not available in the private, individual insurance marketplace to the vast majority of people in this age bracket; (2) seniors leaving jobs at 65 or 66 may be able to get less costly and more comprehensive “COBRA” coverage through their employer for 18 months, but they would still have to pay the full premium, which may be $2,000 to $4,000 a year; and (3) employer-sponsored retiree coverage is already eroding and an increase in the Medicare eligibility age could increase this unfavorable trend by inducing more employers to discontinue or cut back on health benefits for retirees.

The impetus to raise the Medicare eligibility age is to reduce spending in the program (now projected to rise at 7.4% a year over the next decade) and preserve it for future generations. But the Lewin analysis, led by John Sheils, says the magnitude of the savings is uncertain. Medical costs for 65 and 66 year olds are a relatively small portion of total Medicare spending because people this age are healthier than older beneficiaries. In addition, many 65 and 66 year olds may put off costly care until they qualify, resulting in a spurt of costs among 67 year olds.

Still, an increase in the eligibility age would reduce projected Medicare costs by up to 6% a year, and billions of dollars over many years, by (1) reducing the number of beneficiaries, and (2) inducing later retirement resulting in an increase in payroll tax revenue, Sheils says.

The report, Rethinking the Medicare Eligibility Age, also examines the pros and cons of President Clinton’s recent proposal to allow some 55 to 61 year olds and all 62 to 64 year olds to buy into the Medicare program. It concludes that, as structured, the buy-in would have little impact on reducing the number of uninsured in this “near-elderly” population, now around 3 million. The main reasons: (1) the plan limits 55 to 61 year olds who could buy-in only to those displaced from jobs because of corporate downsizing or forced early retirement; (2) it requires such ex-workers to pay a premium of around $400 a month; and (3) it requires 62 to 64 year olds to pay a premium of $300 a month. Few seniors could afford the premiums, the study concludes.

The President’s plan could also lead some large employers to drop their health benefit plans for early retirees, according to the study. Employers would do so on the assumption that the early retirees would have access to the Medicare buy-in. Some companies, however, could choose to give their retirees an increased pension payment to pay a portion of the costs for the Medicare buy-in.

Rethinking the Medicare Eligibility Age is the first of five studies the Coalition is funding this year to analyze problems in and challenges facing the Medicare program. All are being conducted by The Lewin Group, a private health care research firm based in Fairfax, Virginia. Copies of the Study are available from the Coalition.

MSAs, NOT A PANACEA

Medical Savings Accounts (MSAs) are unlikely to have broad public appeal or solve the deepening problems in the health care system such as the growing number of uninsured persons and the rising cost of medical care, according to Jack Meyer, President of the Economic and Social Research Institute. Meyer, who co-authored a study for the Coalition, The Role of Medical Savings Accounts in Health System Reform, and spoke at the July 8th Coalition

meeting, reaffirmed that MSAs are not a panacea for the major health care problems that our country faces.

The MSA concept, as described by Meyer, is an alternative form of health coverage that involves a combination of catastrophic (high-deductible) health insurance with a savings account that is used to pay for non-catastrophic medical expenses. Meyer said that although MSAs may be attractive to a limited number of individuals who are able to incur a large deductible and are healthy, the concept will not benefit uninsured individuals whose family incomes and health status are not conducive to this kind of approach. Meyer was also concerned that, if lower-income individuals purchased MSA coverage, they might forgo or delay needed care to preserve their MSA savings.

Meyer noted that MSAs are likely to encourage risk segmentation, appealing to relatively healthy people, while leaving sicker people in more comprehensive plans, resulting in higher premiums in those plans.