STATEMENT OF THE NATIONAL RETIRED TEACHERS ASSOCIATION AMERICAN ASSOCIATION OF RETIRED PERSONS ON S. 2410 THE HEALTH PLANNING AMENDMENTS OF 1978 FOR THE SUBCOMMITTEE ON HEALTH AND SCIENTIFIC RESEARCH OF THE SENATE COMMITTEE ON HUMAN RESOURCES February 14, 1978 Background: The National Health Planning and Resources Development Act of 1974, P.L. 93-641, was enacted to augment areawide and State planning for health services, manpower, and facilities. The purposes of this legislation are: to improve the health of residents of health service areas; increase accessibility, acceptability, continuity, and quality of services; restrain increases in cost of providing services; and prevent unnecessary duplication of health resources. The aforementioned considerations are certainly consistent with the steps which must be taken to address the health care needs of our nation's older citizens. The aged are highly visible users of a wide spectrum of health services. of the more than 23 million older persons who were enrolled in the Medicare program in 1977, approximately one in five used inpatient hospital benefits. Indeed, the federal government is beginning to stagger under the weight of the costs of the Medicare and Medicaid programs which are estimated to reach $37 billion in 1978. Although the aged constitute less than 11 percent of the population, they account for 29 percent of personal health 2. care expenses. persons. Since Medicare legislation was enacted on their behalf, it should come as no surprise that they represent the bulk of the expenditures for this program. Many are surprised, however, to learn that Medicaid, which is usually perceived as a program for welfare mothers and their children, devotes 38 percent of its expenditures to older Despite these high contributions by the government to offset the costs of health care, the aged are still left with a substantial portion of the health care bill to pay out-of-pocket. The average health bill for an older person in Fiscal Year 1976 was $1,521. Of this amount, 26 percent was paid directly by individuals. These high costs place many older persons at a severe disadvantage. expenses associated with long-term care in an institution are even more ruinous and often lead to total destitution. A reflection of this is the fact that 47.5 percent of nursing home patients whose costs were paid by Medicaid in 1974 were not initially poor, but depleted their resources and qualified as medically needy. The Because of the high costs of health care, the aged members of our society welcome efforts to control the rate of increase in these costs. Cost control alone is not a sufficient answer by itself, however, because not all services which older persons need are currently available. One of the great challenges facing those who implement the National Health Planning and Resources Development Act is to help bridge the gap between the services that are needed and those which are available. The area of long-term care offers a suitable example of what is presently wrong with the current system of meeting the needs of the aged. Many who need services do not obtain them either because services are not available or no means exist to pay for them. Our country does not have an adequate supply of home health agencies and day hospitals nor do we have a sufficient amount of sheltered housing facilities. The health care needs of the aged usually bear a close relationship to other services which are more social-oriented in nature. While such tasks as helping an older person to eat, bathe, dress, clean the house, and run errands do not traditionally fall under the category of health, they are indispensable elements which may mean the difference between living at home or being institution alized. 3. Although various governmental programs have been designed to address some of these needs, no single program is comprehensive enough to provide what is necessary. The accompanying diagram gives some indication of the complexity of |