By Carolynn Race
Associate for Domestic Poverty, Health Care and Environmental Issues

In the first session of the 108th Congress (2003), the most significant health policy development was the passage of a prescription drug benefit for Medicare beneficiaries. The legislation, which funds $400 billion over 10 years for prescription drugs for seniors and people with disabilities, is coupled, as Mary Agnes Carey of Congressional Quarterly noted, with “a fundamental shift in the composition of the program in its provision requiring that private health insurance companies compete for the health care of America’s senior citizens” and people with disabilities. The funding is not nearly enough to provide a universal benefit, since the Congressional Budget Office estimated (prior to the passage of the drug benefit) that $1.8 trillion would be spent on prescription drugs by seniors in the next 10 years.

When Congress returns to Washington in 2004, Members will be faced with a myriad of health care concerns including the increasing number of uninsured, the HIV/AIDS pandemic, and the escalating cost of prescription drugs and health care premiums, along with legislation to promote parity for mental health care, to restructure Medicaid, and to improve the Medicare prescription drug benefit. The President will deliver the State of the Union on January 20, 2004 and will release his budget in early February. According to the Washington Post, one issue said to be on the short list as a priority issue is providing health insurance for every child.

Uninsured

The number of people who are uninsured grew by 2.4 million between 2001 and 2002, to 43.6 million, according to the U.S. Census Bureau. That means that an estimated 15.2% of the population had no health coverage during all of 2002. The Census Bureau noted that the overall increase in uninsured is attributable to the decrease in the percentage covered by employment-based health insurance. Public programs, particularly Medicaid, covered more people through this time period and helped soften the loss of employer-based health insurance.

Those who are insured are experiencing increased costs for health insurance premiums and prescription drugs. According to the National Coalition on Health Care, health insurance premiums rose at a rate eight times faster than general inflation in 2002, experiencing the largest one-year surge in premiums in more than a decade. In the absence of comprehensive reform, the average annual premium for employer-sponsored family health insurance could reach $14,545 by 2006.

No federal legislation was passed in 2003 that called for health care for all. With the upcoming Presidential and Congressional elections, one can expect increased political dialogue in 2004 from candidates about how to tackle the issue of the uninsured. Prospects are less likely that Congress will resolve this issue this year. Legislation on the subject includes the Health Care Access Resolution (H Con Res 99 and S Con Res 41), sponsored respectively by Rep. Conyers (D-MI) and Senator Kennedy (D-MA), which would direct the Congress to enact legislation by October 2005 that provides access to comprehensive health care for all Americans.

HIV/AIDS

According to UNAIDS, “The global HIV/AIDS epidemic killed more than 3 million people in 2003, and an estimated 5 million acquired the human immunodeficiency virus (HIV)—bringing to 40 million the number of people living with the virus around the world.” An estimated 25-28 million of those living with HIV/AIDS live in sub-Saharan Africa, but UNAIDS remarked that more recent epidemics continue to grow - in China, Indonesia, Papua New Guinea, Viet Nam, several Central Asian Republics, the Baltic States, and North Africa. (For more information, go to http://www.unaids.org/en/default.asp and click on “AIDS Epidemic Update 2003.”)

In the United States, an estimated 800,000 to 900,000 people are currently living with HIV, with approximately 40,000 new HIV infections occurring in the U.S. every year, according to the Centers for Disease Control and Prevention. (For more information, go to http://www.cdc.gov/hiv/pubs/facts.htm.)

The omnibus appropriations bill yet to be approved by the U.S. Senate would increase fiscal year 2004 federal spending on President Bush’s global AIDS initiative to $2.4 billion, $400 billion more than the Bush administration requested (though Bush’s five-year, $15 billion initiative authorized $3 billion in the first year). The omnibus bill could be brought to the Senate floor as early as January 20, 2004. Following passage of an omnibus appropriations bill, one can expect continued action through the appropriations’ process to fund this HIV/AIDS initiative.

Mental Health Parity

Senator Pete Domenici (R-NM) sponsored the Senator Paul Wellstone Mental Health Equitable Treatment Act of 2003 (S. 486) as a tribute to the late Senator, with whom Senator Domenici had sponsored similar legislation. S. 486 and the House version, HR 953, would bolster 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. Though the legislation has 67 co-sponsors in the Senate and 242 co-sponsors in the House, it was not brought to a vote in either chamber in 2003. Senator Domenici said that he received assurances from Senators Judd Gregg (R-NH), Chair of the Health, Education, Labor and Pensions Committee, and Senate Majority Leader Bill Frist (R-TN) that the Senate would move on this legislation as soon as Congress returns in 2004, according to CongressDaily.

Medicaid

In his FY 2004 budget proposal, President Bush recommended significantly altering the way Medicaid is funded and administered. The proposal called for providing states the option of additional funding for Medicaid in the short term, but such funding would come with a catch: states would have to repay those funds in later years and would consent to restructure their Medicaid and SCHIP programs into a capped, consolidated block grant. The proposal was not adopted in 2003. However, as states continue to face fiscal crises, as health care costs continue to rise, and with the federal government faced with an enormous deficit, one can expect Congress and the Administration to consider alternative approaches to funding this program, which finances health and long-term care services for 47 million lower-income Americans. Past General Assemblies of the PC(USA) have called for Medicaid to be expanded and strengthened.

Improving the Medicare Drug Benefit

President Bush signed the Medicare Prescription Drug Benefit into law on December 8, 2003, and polls already indicate a mixed reaction to the new law. A December 8th ABC News/Washington Post poll found that 32% of respondents approved of the new legislation, 38% disapproved, and 30% said they had no opinion. Of those surveyed ages 65 and older, 26% approved, compared with 47% who disapproved, and 28% who had no opinion. In a CNN/USA Today/Gallup poll released the same day, 52% approved of the legislation, while 30% disapproved. Among respondents ages 65 and older, 46% said they supported the law, compared with 39% who opposed it. About 80% percent of respondents overall said they were concerned that the prescription drug benefit as written will be inadequate and among respondents ages 65 and older, 56% said they were "very concerned" about an inadequate benefit.

Public reaction to the legislation’s shortfalls is likely to spur legislation to improve the law. The issues of drug reimportation from Canada, the escalating cost of prescription drugs, and concern about direct competition of Medicare with private insurers are likely to be debated again in 2004. In early December, Senate Minority Leader Tom Daschle (D-SD), who opposed the prescription drug bill, introduced legislation, S. 1974, to repeal several provisions and allow the reimportation of drugs from Canada and Western Europe. In addition, Daschle’s legislation would repeal the pilot project that would allow private insurers to compete directly with Medicare in 2010 along with the $12 billion in subsidies to private health plans. His legislation would also repeal the provision in the prescription drug bill that prohibits the federal government from negotiating for lower drug prices from drug companies.