November 30, 1973
Page 38911
AMENDMENTS NOS. 640, 644, 645, 731, 739, 747,748, AND 749
Mr. LONG. Mr. President, I have indicated previously that I was going to offer, on behalf of various Senators, their amendments, which I would urge the Senate to accept. I ask that the following amendments, which I have submitted at the desk, be laid before the Senate and considered en bloc:
Amendment No. 640, by Mr. MUSKIE.
Amendment No. 644, by Mr. CRANSTON.
Amendment No. 645, by Mr. CRANSTON.
Amendment No. 731, by Mr. BIDEN.
Amendment No. 739, by Mr. TAFT.
Amendment No. 747, by Mr. CRANSTON.
Amendment No. 748, by Mr. CRANSTON.
Amendment No. 749, by Mr. CRANSTON.
I ask unanimous consent that the amendments be printed in the RECORD at this point and considered en bloc.
The PRESIDING OFFICER. Is there objection to the request of the Senator from Louisiana?
Without objection, it is so ordered, and the amendments will be considered en bloc.
Mr. MUSKIE's amendment No. 640 is as follows:
At the appropriate place in the bill, insert the following new section:
LIMIT ON MEDICARE INPATIENT HOSPITAL DEDUCTIBLE
SEC. -. (a) (1) Section 1813(b) (1) of the Social Security Act is amended
(A) by striking out "$40" and inserting in lieu thereof "$72"; and
(B) by striking out "1969" and inserting in lieu thereof "1975".
(2) Section (b) (2) of such Act is amended
(A) by striking out "1968" and inserting in lieu thereof "1974";
(B) by striking out "$40" and inserting in lieu thereof "72"; and
(C) by striking out "1966" and inserting in lieu thereof "1972".
(b) The amendments made by subsection (a) shall be effective with respect to services provided after December 31, 1973.
AMENDMENT NO. 640 – MEDICARE DEDUCTIBLE FREEZE
Mr. MUSKIE. Mr. President, the medicare deductible freeze amendment which I offer today would prevent a scheduled increase in the medicare deductible and coinsurance rates next year, and reduce the amount of future increases. I am pleased to say that 41 Senators have cosponsored this amendment: Senators ABOUREZK, BAYH, BIBLE, BIDEN, BROOKE, BURDICK, CANNON, CASE, CHILES, CHURCH, CLARK, CRANSTON, EAGLETON, EASTLAND, GRAVEL, GURNEY, HART, HARTKE, HATFIELD, HATHAWAY, HUGHES, HUMPHREY, JACKSON, JAVITS, KENNEDY, MAGNUSON, MCGEE, MCGOVERN, MCINTYRE, METCALF, MONDALE, MONTOYA, MOSS, PELL, RANDOLPH, RIBICOFF, STAFFORD, STEVENS, STEVENSON, TUNNEY, and WILLIAMS.
The Department of Health, Education, and Welfare announced last month that the deductible – the amount a hospital patient must pay before medicare takes over – would increase from $72 to $84 in 1974. This increase in the hospital deductible would also have the effect of raising by 17 percent the medicare coinsurance charges – the portion of the costs that patients must pay for hospital stays longer than 80 days and for nursing home extended care after 20 days.
If the increase is allowed to take place, it would affect some 51/2 million aged and disabled medicare beneficiaries who are expected to be hospitalized in 1974. It would add yet another burden to the aged who have limited incomes and still must somehow cope with ever-rising prices. It would also come hard on the premium charge under the medicare supplementary medical insurance program, which has just risen from $5.80 to $6.30 per month.
These additional medicare charges are robbing the aged of the small amount of discretionary income that they have. For many of the aged, food and shelter and medical costs consume almost their entire income. Even relatively small increases in medicare charges can have a major impact on their personal finances.
The deductible for medicare hospital insurance was $40 when medicare went into effect in July 1966. Raising the deductible to $84 would mean that it has more than doubled since the program began. At the same time, the coinsurance payments, which are linked to the deductible, would also more than double. Next year, if a medicare beneficiary required more than 60 days hospitalization, the coinsurance payment per day for the 61st through 90th day would be $21 a day as compared to $18 currently and $10 when medicare was enacted. For a post-hospital stay of more than 20 days in a nursing home the coinsurance would be $10.50 a day compared to $9 currently and $5 when medicare began.
As things now stand, this increase is mandatory because the law requires the deductible to be determined annually according to changes in average per diem hospital costs covered by medicare. Under section 1813(b) of the Social Security Act, each year the medicare inpatient hospital deductible for the following year is set – in multiples of $4 – at $40 multiplied by the ratio of average per diem inpatient hospital costs for the previous year compared to the average per diem cost for 1966. For instance, the deductible for 1974 is set in 1973 based upon inpatient hospital rates in 1972.
My amendment would declare a 1-year moratorium on the ever-increasing hospital deductible and coinsurance charges. The amendment requires that the deductible remain at $72 during 1974, thus also freezing coinsurance at current levels. In addition, the amendment modifies the cost increase formula by providing that increases from the $72 level would be based on the percentage increase in the average per diem rate for hospital services since 1972. Under the amendment, for example, the deductible and coinsurance for 1975 would be set during 1974 based on hospital cost increases in 1973. By in effect changing the base year in the formula, my amendment would reduce the amount of future increases, so that the deductible and coinsurance would be 15 percent less than under current law.
This temporary relief for medicare recipients can easily be borne by the hospital insurance trust fund. The estimated additional cost of the amendment would be $103 million for 1974, but in that year the hospital insurance trust fund is projected to have a surplus of $8.6 billion even under the provisions of H.R. 3153. The fund is expected to have increasingly surpluses in later years under H.R. 3153 – $10.1 billion in 1975, $11.3 billion in 1976, $12 billion in 1977, and $14.9 billion in 1978. The cost of my amendment in each of these years would be slightly over $100 million. It would not significantly reduce the ratio of assets to outgo, which would remain at about the 75-percent level My amendment thus would not jeopardize the short-term or long-term actuarial balance or safety of the trust fund, and would require no further financing.
Finally, there is no policy justification for allowing the medicare deductible and coinsurance to increase. Hearings I have conducted, as chairman of the Subcommittee on Health of the Elderly of the Special Committee on Aging, show that increased "cost-sharing" under medicare would not increase the efficiency of the program, but would merely impose financial hardship on millions of the elderly, and possibly discourage needed preventative health care leading to increased longrun costs.
Mr. President, this amendment Is enthusiastically supported by the National Council of Senior Citizens and the National Retired Teachers Association-American Association of Retired Persons. Together they represent almost 9 million aged and aging Americans who are more than a little concerned about escalating medicare charges.
Now is the time to provide at least temporary relief from yet another stiff medicare increase. I urge the Senate to adopt this medicare deductible freeze amendment.