The Congress: Three-in-One Care

The House Ways and Means Committee had haggled for weeks over three rival schemes dealing with medical care for the aged: 1) The Administration’s medicare program aimed at compulsory hospital insurance through social security; 2) a Republican alternative proposing a federally assisted voluntary protection system, covering both hospitals and doctors; and 3) “elder-care,” the American Medical Association’s widely publicized plan, under which federal-state funds would help pay private premiums on the basis of need, in an extension of the 1960 Kerr-Mills Act authorizing aid to the medically indigent elderly.

Then, in a master political stroke, Chairman Wilbur Mills proposed a sugarcoated, horse-pill-sized medical care bill containing aspects of all three plans. And last week, by a 17-8 vote, the committee approved the Mills bill. Its key provisions:

> For everyone 65 or older, 60 days of hospital room and board for each illness, plus drugs, without charge after an initial $40 deductible; also, up to 100 days of post-hospital nursing-home care, and 100 home calls by a visiting nurse per year. All of these benefits would be financed by social security taxes, which would rise in eight steps over the next 21 years, more than doubling the maximum annual employee contribution from $174 at present to $369.60 by 1987.

> A voluntary plan providing an additional 100 home nursing visits per year —plus coverage of 80% of doctors’ fees and 80% of related necessities such as bandages, X rays and lab tests. Participants would have to be 65 or over, pay $3 per month, which would be matched by the Federal Government.

> A broadening of Kerr-Mills to grant federal-state medical help not only to indigent people 65 or older, as at present, but also to certain other needy people regardless of age—those blind and disabled, members of indigent families, and homeless children. They would receive a full range of doctor and hospital services, with other benefits left to the states. The minimum federal share of the program would be raised from 50% to 55% .

Benefits from both compulsory and voluntary plans would start July 1, 1966. Retroactive to Jan. 1, 1965, would be the accompanying sweetener: a basic 7% increase in social security pensions, with everyone getting at least $4 more a month, and a host of other expanded social security benefits.

The total estimated cost of the three-in-one medical care package per year would be close to $6 billion—$2.3 billion for hospital costs, $1.1 billion for doctors, $200 million for the enlarged Kerr-Mills bill, $2.1 billion more for social security benefits. Officials estimated that $5 billion would come from social security taxes and voluntary payments, the remaining amount from Government general revenues.

President Johnson immediately gave the Mills bill his blessing, called it “a tremendous step forward for our senior citizens.” Republicans planned a last-ditch fight to amend the measure by extending its voluntary provisions to hospitalization and establishing an income ceiling on participants. But they had little hope, and Wilbur Mills’ bill seemed virtually certain to be the final blueprint for the medicare law, opening the way to a vast new Government role in health.