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Health Care Reform

By Fred Misilo

Health care reform is back in the top tier of policy initiatives being analyzed by the President and Congress. There is no question that America’ health care system needs reform. It is estimated that 46 million Americans are uninsured and, with the current increase in unemployment due to the recession, more are joining the uninsured ranks every day. The U.S. Department of Health and Human Services reported in March, 2009 that from 1996 to 2006 health care spending in the U.S. doubled to $2.2 trillion in 2006. Any serious health care reform proposal must lower costs, but real reform must also increase affordable coverage and health care quality.There are several competing interests at work here ~ the insurance industry, health care providers, and consumer groups ~ each seeking to influence legislation on the scope and nature of health care reform, such as whether a public plan should be included and how to pay for overall reform.

In the context of my experience in representing elders and individuals with disabilities who have Medicare and Medicaid as their primary health care coverage, I view the current debate with hope. I hope that Congress will recognize that Medicare has been a successful program for most Americans over age 65 and for many individuals with disabilities. I also hope that our health care system moves its focus from sickness to wellness, care coordination, chronic disease management, and shifting payment rates to focus on performance rather than services provided. I hope that the savings that are derived from this shift in focus are invested back into the Medicare system to improve care for America’s seniors by removing the doughnut hole in prescription drug coverage under Medicare Part D, by lowering drug prices through government negotiation and by reducing co-payments and deductibles in the Medicare program. I also hope that a sensible option that will enable Americans under the age of 65 to buy into Medicare as an option to consider when choosing health care coverage can be developed.

An interesting legislative proposal is to include long term services and supports in health care reform. Under the CLASS Act, introduced by Senator Kennedy, a national long term services insurance program would assist eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into impoverishment in order to receive Medicaid benefits. This program would be financed through modest voluntary payroll deductions (with an opt-out enrollment like Medicare Part B). This legislation would provide a cash benefit to pay for housing modifications, assistive technologies, personal assistance services, transportation, and other services and supports to help eligible individuals stay at home rather than have to move to a more restrictive setting such as a long-term health care facility.

Under this proposal, any individual who is at least 18 years of age and actively working would be enrolled unless he or she opted out. Each program participant would pay premiums though payroll deductions or a similar mechanism. To qualify for benefits, the individual would have to be “vested” after paying into the system for a minimum of five years and be determined disabled through a disability determination process. The proposal further refines the level of benefit into two separate tiers based on the degree of impairment. From my experience, most elders and individuals with disabilities would willingly utilize this type of benefit which would enable them to remain in their home rather than seek a more expensive Medicaid paid placement in a long term institutional setting.

During a March White House Health Reform Summit, President Obama stated that health care reform is essential to achieving economic recovery.It is now up to Congress to reach consensus on how to craft an overall health care reform plan that makes sense for all Americans. Let’s hope they’re successful.

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