In the 107th Congress, health care concerns took a back seat to the impending war with Iraq and the establishment of the U.S. Department of Homeland Security. In the limited time that was spent discussing health, Congress and the Administration could not come to agreement on how to address the issues of the uninsured, prescription drug coverage, mental health parity, and HIV/AIDS funding. As such, consumers and health advocates will have to push the 108th Congress (2003-2004) even more forcefully to find solutions for these and other health care concerns.

The economic downturn and rising health insurance costs have hindered working families’ access to health care. In 2001, 41 million Americans were uninsured, of whom 21 percent were children; and of uninsured adults, 75 percent were employed. Without a concerted effort on the part of the government and other stakeholders to find a way to provide affordable, accessible coverage for all, health care costs and the number of uninsured Americans will continue to climb, as was the case this year. In 2002, health insurance premiums increased by an average of 12.7 percent, unemployment rose to 6 percent, and monthly worker contributions for family health coverage increased 13.3 percent. (Footnote: The New York Times, 11.25.02, “The Enduring Problem of the Uninsured.”)

Looking at the issue of health internationally, HIV/AIDS is having a devastating impact on communities throughout the world. An estimated 42 million people were living with HIV/AIDS by the end of 2002, nearly half of whom are women. [Read More]

About 70 percent of people living with HIV/AIDS live in Sub-Saharan Africa, and the epidemic is growing at an alarming rate in South and Southeast Asia, Latin America, the Caribbean, and Eastern Europe/Central Asia. Even so, the U.S. government failed to authorize steep increases in appropriations for inter- national HIV/AIDS programs. The Senate and House both passed bills to increase appropriations, but failed to agree in conference committee because of differences over funding amounts and the scope of the legislation. Because they failed to increase funding in the 107th Congress, this issue should be addressed in 2003.

The Uninsured

As health care costs continue to rise and more and more Americans find themselves without health insurance, Congress will receive increasing pressure to find a solution to the impending health care crisis. Two pieces of legislation are likely to be reintroduced in the 108th Congress to address this issue. The Health Care Access Resolution (H. Con. Res. 99) calls for Congress to enact legislation by October 2004 that provides access to comprehensive health care for all Americans, and the Health Care That Works for All Americans Act (S. 3063), sponsored by Senators Hatch (R-UT) and Wyden (D-OR), would establish a Citizens Health Care Working Group to facilitate public debate about how to improve the health care system for Americans. In addition, one can expect much debate in 2003, among potential Presidential candidates and others, regarding how to fix the health care system. Many Democrats support expanding public health programs to aid the uninsured, while many Republicans favor using tax credits to ease the burden of health care costs.

Prescription Drugs and Medicare

Having failed to pass a Medicare prescription drug benefit in the last Congress, both the Congress and the Administration are eager to approve a benefit early on in 2003. As was the case in 2002, the sticking points in debating such a benefit will be cost, program administration, and eligibility. In the last Congress, Republicans overwhelmingly supported administering the program through private insurers, while Democrats supported administering the program through Medicare. In 2002, Congress offered proposals ranging from one supported by conservative Republicans (S. 2736) to spend $160 billion over 10 years for a benefit to cover low-income seniors with high drug costs, to another, offered by Senate Democrats (S. 2625), to spend nearly $600 billion from 2005-2012, to cover all 40 million Medicare beneficiaries. Bipartisan and tripartisan proposals were offered in 2002 that provided some middle ground on the issue. One can expect a very heated debate surrounding this issue, as well as continued discussion of drug pricing, and the availability of generic drugs.

HIV/AIDS

Faced with recent statistics estimating that 42 million people around the world were living with HIV/AIDS by the end of 2002, and having failed to pass legislation to support a broad expansion of international HIV/AIDS funding, Congress will have to tackle the issue again in 2003, under even tighter budget constraints. Both the Senate and the House passed bills supporting increased funding for overseas HIV/AIDS programs in the 107th Congress, and the Senate version was more expensive than the House version. The House version called for an additional $1.4 billion in funding for multilateral and bilateral HIV/AIDS programs in fiscal year 2002, while the Senate version would have authorized $4.7 billion, including $2.2 billion for a global AIDS fund and $1.7 for bilateral programs, for fiscal year 2003.

Mental Health Parity

Senator Pete Domenici (R-NM) and the late Senator Paul Wellstone (D-MN) sponsored the Mental Health Equitable Treatment Act (S. 543), which would have bolstered the 1996 Mental Health Parity Act by prohibiting group health plans from providing unequal coverage of mental health care compared to medical/surgical health care. The legislation was not passed in the last session. At a memorial service for Sen. Wellstone, Sen. Domenici vowed that the next Congress would enact a parity bill, as a tribute to Wellstone. The legislation has strong support, having had 66 co-sponsors in the Senate and 242 in the House in 2002.

Children’s Health Insurance

The State Children’s Health Insurance Program (SCHIP), which has succeeded in reducing the number of uninsured children, is in serious jeopardy. When the program was established in 1998, the Balanced Budget Act of 1997 created a dip in allocation of funds for the middle years of the program. As such, states now face a 26 percent reduction in federal funds available for FY 2002, 2003, and 2004, and $2.7 billion in federal SCHIP funds will revert to the Treasury in FY 2002 and 2003. Having failed to correct this problem during the last session, Congress will again be charged with fixing the “CHIP dip.” If they fail to do so, the Office of Management and Budget estimates that 900,000 children will lose health coverage between 2003 and 2006.

By Carolynn Race