"Everything's a lower priority. All the other little issues seem less important to debate."

--Sen. Byron Dorgan (D-North Dakota), on the unlikely prospect that Congress will act on several health issues pending as of September 11, 2001.

"Funny, isn't it, that they could find $15 billion for private airlines, but nothing for senior citizens? Fifteen billion dollars would buy all the drugs the poor elderly will need for the next two years."

--Charles Inlander, consumer advocate and president of Pennsylvania-based People's Medical Society, on the death of the Medicare prescription-drug issue in Congress.

The September 11, 2001, terrorist attacks accomplished at least one thing the terrorists might have wanted: bringing almost all pending domestic legislation--especially much-needed healthcare legislation--to a grinding halt. Several longstanding issues, matters that threaten the well-being of tens of millions of Americans, have been lost in the shuffle since that terrible day.

Legislative Loose Ends

Among a number of the loose ends Congress seems to be in no hurry to tie up are the Patients' Bill of Rights legislation, Medicare's perscription-drug benefit, and Medicaid relief and help for the uninsured.

Patient's Bill of Rights. Congress bad scheduled a vote the week of the attack on the proposed Patient's Bill of Rights, hoping to strike a compromise between the restrictive version passed in the House and the more expansive version passed by the Senate. The vote, of course, never took place. While discussions on a compromise continue, there is little likelihood that Congress will act together on the issue before the end of the year.

Medicare prescription-drug benefit. Even before September 11, the campaign for a Medicare prescription-drug benefit had slowed to a crawl. A leading issue in the last presidential election, President Bush's initial promise to add a 10-year, $158 billion Medicare prescription drug benefit was almost immediately described as insufficient. The need for additional Medicare funding was recognized in the February budget resolution passed by Congress, which set aside $300 billion as the target expenditure for all of Medicare, including prescription drugs for senior citizens.

Yet the budget woes of a declining economy led many legislators to conclude the benefit simply was no longer affordable, and campaign promises for such a benefit were on shaky ground. Based on 2000 election promises by both former Vice President Al Gore and President Bush, senior citizens expected copayments of $10 to $15 per prescription with little or no annual premium. In reality, the best they can hope for will be copayments of 25 to 33 percent of prescription costs with annual premiums of more than $600 per year.

Senior citizens who feel they were promised more than could be delivered may take their displeasure out on candidates during the 2002 and 2004 election cycles.

And senior citizens must face the still soaring costs for prescription drugs, which the Congressional Budget Office (CBO) estimates will reach $1.3 trillion by 2011--more than the nation spent on all health care in 2001.

Rising Medicaid enrollments and the uninsured. Welfare reform was popular when there was a ready supply of jobs and reform seemed to be working. Now it is getting a real test as unemployment is on the rise. The ranks of Medicaid eligibles are growing exponentially with fewer dollars available. State governments, through the National Association of State Legislators, are asking that Federal authorities enact measures to minimize the number of laid-off workers joining Medicaid.

Specifically states want the Federal government to help workers hold on to private health insurance by offering them financial assistance until they find new coverage. The National Conference of State Legislatures sent a letter to President Bush asserting that "states' fiscal health has declined rapidly" since the September 11 attacks. Meanwhile, millions of Americans being laid off do not qualify for unemployment benefits due to state legal restrictions. These restrictions may apply to part-time workers, recently hired employees with low wages, and individuals who voluntarily leave their jobs. As a result, proposals to help the recently laid-off by extending unemployment benefits may be meaningless to these people.

Thus, despite the official good news of a recent decline in the number of uninsured--from 44.2 million in 1997 to about 40 million in 2000--experts now suggest the number of uninsured could be as high as 50 million by early 2002. President Bush's 2000 campaign suggestion for allowing a $2,000 refundable tax credit to help the uninsured buy health insurance was left on the sidelines in favor of other new tax cuts directed mainly at reducing capital-gains taxes and instituting more general income taxes in the higher tax brackets. The burden for caring for the uninsured is being shifted to the states and providers.

Conclusion

President Bush has requested that all U.S. citizens return to our daily lives. He would like us to travel, to frequent restaurants, and to keep spending our money. However, for senior citizens who can't afford their medications and the uninsured who face pressing medical costs, even going out for fast food may be out of the question. As horrible as the September 11, 2001, tragedy was, we cannot let our political leaders use it as an excuse to ignore other vital issues. If we do, the terrorists will have won.

Jeanne Schulte Scott, JD, is director of government relations, NDCHealth, Washington, D.C.

COPYRIGHT 2001 Healthcare Financial Management Association
COPYRIGHT 2002 Gale Group