The latest HMO laws being haggled over in Congress.
Many members of Congress want to make it easier for you to appeal a decision
made by your HMO. President Bill Clinton wants the government to help you pay
for prescription drugs if you are in Medicare. The U.S. Department of Health
and Human Services wants to keep your computerized medical records
At every turn, someone in Washington is trying to do something to change --
and maybe even improve -- health care. Current ideas on Capitol Hill range from
schemes to completely overhaul Medicare to prohibitions against assisted
suicide. But only three proposals that will have a noticeable effect on most of
our lives are likely to become laws in the near future.
Finding the bottom line cost for Medicare isn't simple. The amount you'll spend can vary depending on the type of coverage you have, your income and assets, and many other factors. But to give you a rough idea, here's an outline of Medicare's costs -- both the obvious and hidden costs.
Medicare Part A:
For most people Medicare Part A is free. That's because they -- or their spouses -- were paying Medicare taxes while they worked.
You might have to pay for Medicare Part A if you were...
The public has become disenchanted with the managed care industry. According
to Lou Harris and Associates, only 34% of Americans now think the industry is
doing a good job. Physicians are also critical: In a poll taken for the Kaiser
Family Foundation, more than 75% of doctors said managed care lessened a
patient's ability to receive necessary services and drugs.
In response, Congress is considering a number of restrictions on the managed
care policies that have upset many people. The restrictions are grouped
together and called a patient protection act or a patient's bill of rights.
Depending on Congress's final decision, such an act may guarantee:
insurance coverage for treatment at any emergency room,
direct and easy access to specialists when you are seriously ill,
coverage of drugs that are not on your HMO's approved list if the drugs are
prescribed by your physician,
a timely appeal before an outside panel if an HMO declines to pay for
certain medical services, and
the right to sue a managed care plan if its refusal to cover medically
necessary services compromises your health.
The cost of prescription drugs is on the rise. Health insurance premiums
climbed a little more than 5% between 1998 and 1999, and most of the increase
was caused by the price of prescription drugs, according to the Hay Group, a
health care consulting firm. At the same time, many managed care organizations
-- including those serving seniors on Medicare -- are dropping prescription
drug payment from their benefits.
The Clinton administration and many members of Congress agree that senior
citizens, at least, need some form of federal assistance to pay for
prescription drugs. But the specifics are hotly debated. Clinton wants to help
all Medicare beneficiaries, while many members of Congress prefer to limit this
to seniors with low incomes. The administration wants to add a subsidy of as
much as $2,500 a year to pay for drugs. Others would rather create a tax
deduction or fund state assistance programs.