New Year, New Congress, New Health Care?

The new 110th Congress will have a slew of health care issues to figure out in 2007, one of them being Medicare.

Congress will have to decide how to pay doctors, how to negotiate drug costs, and if long-term care is something that the program can afford.

This matters not only to current Medicare beneficiaries, but to their adult children, many of whom pay the medical costs that Medicare doesn’t cover. This is one of the major issues WomenMatter will track on our Congress Watch.

What is Medicare?

Medicare is a government health insurance program for people age 65 and older and for individuals with disabilities. We all pay into the Medicare program when we’re younger, and then hope to collect when we’re elderly. Medicare was conceived as a health care plan for all older Americans, whether rich or poor.

Doctors’ fees

Many doctors accept Medicare along with private forms of health insurance and get reimbursed by the federal government for care and procedures. The system used to calculate physician payments is called the Sustainable Growth Rate. This structure has been used since 1997 to keep government costs down and consequently demanded a 5.1 percent cut to doctors’ payments in 2007.

Congress bandaged the problem at the last minute so doctors would not lose money, but legislators have not yet healed the deeper wound. Lawmakers will have to figure out a way to balance costs but continue to pay doctors so they, in turn, will continue to take Medicare patients.

The Sustainable Growth Rate formula will need to be reconfigured. The Medicare Payment Advisory Committee has a report due out in March 2007 that will make recommendations about how to overhaul the system, giving Congress a guide.

Negotiating drug costs

For the past few years, Republicans and Democrats have been arguing about who should negotiate drug costs -- the government or private insurance companies.

In 2003, Congress authorized Medicare Part D, a drug benefit program and Medicare’s largest expansion since its inception in 1965. Unlike most Medicare benefits, the drug program is delivered entirely by private insurance companies that were given payments by our government (subsidies) in addition to their profits from selling their insurance policies to elderly individuals. Those insurers bargain with drug manufacturers and often receive discounts on particular drugs. The 2003 law prohibits the government from interfering with these negotiations or negotiating with drug companies directly.

Democrats have wanted to change this portion of Medicare law since 2003, but being in the minority, had little power to do so. Now that they’re in the majority, Democrats are expected to repeal it.

Republicans’ argue that the Department of Health and Humans Services would have to hire hundreds of people to negotiate prices for over 4,000 drugs, with questionable results. Further, they say, health and human Services would be besieged by lobbyists from certain drug companies.

For more on Medicare prescription drug coverage, click here.

Does Medicare provide enough?

Medicare covers doctors’ visits, surgeries, and some hospital stays, but what about the costs of long-term care like home health aides, nursing homes, and day-to-day medical expenses?

More than 15 million adult children are covering these costs for their elderly parents. Many spend down their own savings and retirement to take care of their parents’ costs. The situation has many wondering, "is Medicare enough?"

What’s your health care coverage situation? Your parents’? Should the government provide more comprehensive coverage to the elderly? Tell us what you think on our blog. And don’t forget to contact your representatives.

Your input matters

Your representatives in Congress DO care what you think. Let your congressmen and women know what you think! Give your senators a piece of your mind! To get to your reps, click here.

To explore our archive of past Health Issue updates, click here.

About WomenMatter

WomenMatter is a place to discuss life issues with other women. We don’t want to wedge women apart, but rather bring them together to dialogue. To participate in our blog, click here.

WomenMatter is the place where we can take one issue at a time, match what we do about it every day of our lives to the facts of the bigger system that we all live in and recognize that every idea for making it better has tradeoffs.

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