Recommendations of the Task Force on Medicaid and Related Programs*

Recommendations of the Task Force on Medicaid and Related Programs* In July 1969, the Secretary of Health, Edur ductirity of the economy, but also because human cation, and Welfare appointed a task force to compassion insists that essential individual health look into the deficiencies of Uedicaid-the Fed- needs shall be met. era&Xtate m-edical assistance program under title With rapidly rising costs, many misgivings XIX of the Social Xecurity Act--and to malce were expressed about the growing tendency to be- recommendations for improvements in that pro- come excessively preoccupied with cost at the gram and related programs. expense of community goals. The Task Force, The 27-n&ember Task Force included persona along with what is possibly a majority in the representing consumers: industry, labor, govern- health professions and certainly a majority of the ment. and the social sciences, M well as the medb population, considers the recent Federal enact- cnl profession and health in..titution~ and services. ments as intending that access to basic medical The report of the Taslc Force, submitted on June care shall be a right or entitlement of all citizens. $?g9:contnins 14% recommendations for program It is the position of the Task Force that t,he right improvements and for steps needed to prepare or entitlement is not fulfilled when millions in the Nation’s health system to m,eet increased the population do not know about or cannot get, demands. It a7so outlines the complexities and to the places where some care is available to dimensions of the national henlth insurance issue deprived populations, or when the millions who and provides objectives for assessing policy in do get to such places are given a kind of service the financing of national health care. that is woefully inferior by every standard known Twenty-on,e of the Task Force Recomm,enda- to man and doctor. Neither is the right or entitle- tiowy were included in the proposed amendm,ents ment concept honored just because physicians and to the #o&al Security Act, passed by the Hou‘se hospital administrators can say, “We never turn of Representatives in May and now before the away a patient.” However virtuous the declara- Senate. The Department of Zgealth, Education. tion may make the doctors and hospital people and Welfare has taken adminktratke action on feel, it does nothing to make good the right or several other recommendations, and the remaining entitlement for those who never get within sight proposals are to receive further study. of a docto$s office or hospital. The Bulletin has excerpted the Introduction and Xummary of the Report below, as well as the section on extended-care benefits under Medicare. SUMMARY . The scope of the inquiry was broad ; neither the purposes nor design of government programs INTRODUCTION can be comprehended adequately in today’s en- As the Task Force grappled with its charges, vironment without reference to the health system several themes emerged that merit recognition as a whole. The Task Force sees the current in setting the stage for recommendations. One system, overall, as a vital part of the Smerican that was expressed repeatedly during the dis- culture and economy, involving vast investments cussions was the conviction that health must re- in acute care and related biomedical research. At main high on the scale of social, economic and the same time, the Task Force sees serious flaws political priorities-not only because the health in the system that appear in particularly bold of the Nation is basic to the growth and pro- relief against the background of an economic and political structure able, if willing, to cope with them. In essence, significant numbers of people * Excerpted from Recommendutions of the Task Fowe do not have adequate access to care and the serv- on Medioaid and Related Programs, June 1970, Depart- ment of Health, Education, and Welfare, 1970. ices of many who do are so far below the mark, BULLETIN, SEPTEMBER 1970 23 with reference to the potential productivity of The statecl objective of Medicaid was to assure the system, that the credibility and accountability adequate health care to the Sation’s poor and near of the system it,self is at stake. poor. If this continues to be a primary goal-and The report contains recommendations under the Task Force believes emphatically that it these headings : Eligibility and Protection under should-a considerable inlprovement in financing Existing Financing Programs; Effecting Changes and delivery capabilities will be required. We and Improvements in the Delivery of Health recognize that expenditures on behalf of those C are; Management of Health Activities; Con- now lacking purchasing power and services will sumer Participation ; Comprehensive Health add initially to the problems of inflation within Planning; Long-term Care; and Long-term Fi- the health field. Rut against this, a double stand- nancing Policies. ard for a service so deeply rooted in human con- The recommendations vary widely in nature passion and so essential to a productive commu- and scope. Some of them deal with the logistics nity cannot be tolerated. Moreover, there remains of implementation. A critical few call for major the prosl)ect that if the new money, joined with changes in the orientation and strategems of the other government am1 private means, is spent total health system without which, the Task more wisely than in the past, inflation can be Force is convinced, revision of title XIX and minimized. To redeem the promise of Medicaid related programs would be ineffectual and un- and help give meaning to the declaration that productive. No attempt is made, in this sum- access to medical care is a right to all within the mary, to repeat all recommendations made in the context of current legislation : text. The major ones are cited in the context of themes derived from the debate of 1 year and set We recommend converting Medicaid to a program with forth in the introduction to the report. a uniform minimum level of health benefits financed 100 percent by Federal funds, with a further Federal matching with States for certain types of supple- mentary benefits and for indiriduals not covered under the minimum plan. There should be maintenante-of- Significant Deficiencies in Access to Care effort requirements upon the States to retain at least their present expenditure levels. Even after 4 years’ experience under Medicaid First priority for protection under a basic Federal and Medicare, and with parallel opportunities floor for Medicaid should be all persons eligible for for expansion in the private sector, a significant payments under the proposed Family Assistance Plan. Additional groups should be phased in until all persons number of Americans are not adequately protected with incomes at or below the poverty line are covered. against the cost of needed health services. As The disabled social security beneficiaries should be a direct result, too many do not get services they included as soon as possible under title XVIII. need. Approximately 26 million people in the Legislative changes are needed to establish Federal l’nited States live below the poverty line (about responsibility for the cost of medical rare and services for migrant workers and other eligible people who do $70 a week income for a family of four) and ap- not hare established residence in any State; migrant proximately 15 million more are near poor ($90 workers should be eligible for benefits of title XIX. a week income for a family of four). Only 13 million will be covered by Medicaid in 1971. Less Several recommendations are made to improve than 30 States, despite the availability of Federal the operation of title XIX, e.g., use a digni- matching money, have programs for persons who fied and simplified method of determining eligi- are medically needy but do not qualify for cash bility and payment; give greater protection to assistance. Two out of three children in poor or clients who are dissatisfied with actions or failure near-poor families are not included under Mater- to act ; make information about the program more nal and Child Health or Medicaid programs. widely and forcibly available; eliminate discrim- Among the poor and near poor, only a little over inatory practices by providers guaranteeing the a third below the age of 65 have private prepaid care of persons without permanent residence in medical care or medical insurance of some sort. any given State. In total, depending on different estimates, be- Other recommendations are directed at the tween 30 and 45 million people under age 65 are private sector to improve the coverage, scope and without any health insurance to speak of. efficiency of benefits. For example, means are 14 SOCIAL SECURITY proposed to improve the protection of employees The Task Force is convinced that it no longer during short periods of disability or layoff, small makes sense to keep pouring new wine in old groups and self-employed individuals, part-t.ime casks-some of which are leaking. Additional and temporarily employed persons. Strong en- financing must, be accompanied now with oppor- couragements are given to greater exploitation tunities and encouragement to physicians, hos- of the work environment for health education and pitals and others to provide service in ways that prevention programs. permit a logical response to sound economic and patient-care incentives, and to engage in a com- petition of organization and method. The concept of planned intervention can be Improving Delivery of Health Services organized in three interacting and interdependent In the light of rapidly rising cost and trouble- categories : more responsible purchase of services, some inflation in the health field, the recom- better management of health services, and broader mended addition of new expenditures through concept of health care.

Load more