19058 EXTENSIONS OF REMARKS July 8, 1987 EXTENSIONS OF REMARKS GAO REPORT COMPARES CATA­ dates as well. For me, the "acid test" for my tration CV A>. which provides care through STROPHIC HEALTH INSURANCE supporting any. Presidential candidate next its hospitals, outpatient clinics, and VA-op­ PROPOSALS year is whether or not that candidate is firmly erated and community nursing homes. In committed to protecting the 37 million Ameri­ 1984, Medicaid paid about 13 percent of the elderly's health care bills; VA paid about 3 HON. EDWARD R. ROYBAL cans who are uninsured and the 200 million percent. OF CALIFORNIA who are underinsured for long-term care. Even with government programs, the el­ IN THE HOUSE OF REPRESENTATIVES GAO's report "pours fuel on the fire" which derly face high out-of-pocket health care is building under the Congress and the admin­ costs. According to a December 1986 report Wednesday, July 8, 1987 istration to enact a full catastrophic health ini­ sponsored by the American Association of Mr. ROYBAL. Mr. Speaker, I want to take tiative with full protection for Americans who Retired Persons, 1 married couples over age this opportunity to make you aware of a new are poor and who need long term care. How­ 65 averaged about $3,000 in out-of-pocket General Accounting Office [GAO] report which ever, much work remains to be done before health care costs in 1986. I released this past Monday. This GAO report we will enact such a full scale initiative. In November 1986, the Secretary of deserves your careful consideration because Based on this careful assessment by the Health and Human Services <Otis R. Bowen, M.D.> reported 2 to the President on cata­ it, for the first time, critically compares the cat­ nonpartisan GAO, few of the current congres­ strophic illness expenses. Subsequently, the astrophic health insurance proposals before sional proposals, with the notable exception of administration submitted a proposal to the the Congress. my U.S. health legislation (H.R. 200), provide Congress, and others have introduced bills At the same time, I also want to take this the full measure of protection and truly give to relieve the elderly from the burden of opportunity to declare my strong support for peace of mind to Americans of all ages. I be­ catastrophic health care expenses. the compromise catastrophic health insurance lieve the "Bipartisan Commission on Compre­ METHODOLOGY proposal which has been worked out among hensive Care," included in the House propos­ To determine the potential effect of the the Committees on Ways and Means, Energy al, will provide the impetus for next year's various legislative proposals on Medicare and Commerce, and Aging and the Speaker congressional action in this direction. beneficiaries' out-of-pocket health care ex­ and which will be coming before the House Again I encourage you to examine the GAO penses, we <1> reviewed GAO and other re­ shortly. report closely over the next few months with ports to identify the types and amounts of The insightful and timely report by the non­ an eye to the broader catastrophic problems out-of-pocket expenses incurred by elderly, <2> reviewed Medicare law and regulations partisan General Accounting Office points out of the under and uninsured. In addition, I to determine beneficiaries' out-of-pocket li­ the real catastrophic problems facing over 30 strongly encourage you to support the com­ ability for covered services, (3) reviewed million older and disabled Americans-the promise catastrophic health insurance bill minimum coverage requirements for Medi­ high costs of noncovered services including which will be coming before the House short­ gap policies to determine how they affect long-term care and prescription drugs. The ly. out-of-pocket costs, <4> analyzed 14 cata­ key finding is that virtually all of the current Mr. Speaker, I would like to enter into the strophic coverage bills introduced during House and Senate catastrophic health insur­ RECORD the transmittal letter from the GAO the lOOth Congress to determine how they ance bills have shortcomings when it comes briefing report, "Comparison of Catastrophic would address the major types of cata­ Health Insurance Proposals": strophic health care costs the elderly incur, to providing full catastrophic protection. and <5> compared the financing mechanisms However, nothing in GAO's report forces U.S. GENERAL ACCOUNTING OFFICE, HUMAN RESOURCES DIVISION, of those bills. me to pull back from the current House com­ RESULTS IN BRIEF promise which I strongly support and which I Washington, DC, June 19, 1987. B-226390. The catastrophic health insurance bills we will work hard to get approved by the House Hon. EDWARD R. ROYBAL, reviewed either place an upper limit on ben­ and Senate. By adding prescription drug and Chainnan, Select Committee on Aging, eficiary liability for Medicare deductibles respite coverage to Medicare, making other House of Representatives. and coinsurance or attempt to provide pro­ needed Medicare reforms and providing in­ DEAR MR. CHAIRMAN: This briefing report tection against some of the costs of services creased protection to elderly Medicaid benefi­ responds to your January 22, 1987, request not currently covered by Medicare, such as ciaries, the House is prepared to take a criti­ concerning catastrophic health expenses long-term care and prescription drugs. The cal first step and has ensured the support of and their effect on American families. As major effect of the first approach, which is myself and the major aging organizations. My agreed with your office, this report focuses adopted in both the House Committee on on legislative proposals to provide cata­ Ways and Means and Senate Committee on immediate fear is that the Senate might fur­ strophic coverage to Medicare beneficiaries. Finance approved bills, would be to make ther water down the House catastrophic pro­ A future report will discuss the catastrophic unnecessary a number of the coverage items posal which is already a compromise position. health expenses of those under age 65. in existing Medigap policies purchased by As stated in the GAO report, most of the BACKGROUND the elderly from private insurers. Benefici­ catastrophic health insurance proposals Public programs financed two-thirds of aries, including lower income individuals "would leave the elderly at risk of high out-of­ the elderly's estimated $120 billion in per­ who may not be able to afford Medigap pre­ pocket costs because they- sonal health care expenditures in 1984. miums, would pay increased part B premi­ Provide only limited protection for nursing Medicare, which provides health insurance ums. Medicare beneficiaries' income taxes home and home health care for chronic condi­ benefits for most individuals age 65 and would also be increased to finance the new older, pays about half of the elderly's total coverage. According to the Congressional tions, the major source of out-of-pocket ex­ health care bill. Implemented in 1966 under Budget Office, both bills would be budget penses; title XVIII of the Social Security Act, Medi­ neutral, and benefit costs paid out would Exclude-coverage of-out-of-pocket ex­ care comprises the Hospital Insurance Pro­ range from $21.6 to $26.6 billion over the penditures for physician charges above the gram (part A> and Supplementary Medical next 5 years. The Budget Office has not es­ Medicare-approved payment; and Insurance Program (part B>. Medicare has a timated the additional costs of the other Exclude-coverage of-out-of-pocket ex­ uniform eligibility and benefit structure and bills that would expand services. penditures for services not covered by Medi­ makes protection available without regard to income or assets. care." Other major government sources of funds ' ICF Incorporated, Medicaid's Role in Financing As for the next step in providing full cata­ for the elderly's personal health care are the Health Care of Older Women, December 1986, p. strophic health insurance protection, GAO's 36. Medicaid, a federal/state program of medi­ 2 Department of Health and Human Services, report lays out a clear challenge-not only for cal assistance to certain categories of low­ Catastrophic lllness Expenses, Washington, D.C., the Congress but for the Presidential candi- income persons, and the Veterans Adminis- November 1986. e This "bullet" symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. July 8, 1987 EXTENSIONS OF REMARKS 19059 Most of the proposals would essentially taxpayers, and are intended to be budget than 100 years, the legislative branch has apply catastrophic dollar limits only to phy­ neutral. been invested with full and comprehensive sician services and hospital care, which ac­ As requested by your office, we did not legal authority over the conduct of Govern­ count for about 27 percent of the out-of­ obtain agency comments on this briefing pocket costs incurred by the elderly. report. Unless you publicly announce its ment Printing and, pursuant to that authority, Most of the proposals would leave the el­ contents earlier, we plan no further distri­ since 1919 the law has required that all Fed­ derly at risk of high out-of-pocket costs be­ bution until 30 days from the report's issue eral printing be performed by the Government cause they date. At that time, we will send copies to Printing Office unless the Joint Committee on Provide limited protection for nursing other congressional committees having ju­ Printing or an act of Congress specifically au­ home and home health care for chronic con­ risdiction over the matters discussed in the thorizes otherwise. The benefits of this re­ ditions, the major source of out-of-pocket report, the Secretary of Health and Human quirement as it has been implemented over expenses; Services, and other interested parties.