Have we not been through this before?
Editor's Note: This is part one of two blogs exploring how today's healthcare debate mirrors historical issues. Part Two will be published Thursday.
Recently, the former head of the Centers for Medicare & Medicaid Services indicated that the agency should scrap a rule requiring three days as a hospital inpatient to qualify for Medicare coverage of skilled nursing care. It is hard to understand opposition to the rule given the fact that it was eliminated for three years, and there were no dire effects and it makes no sense.
The elimination came about as part of sweeping healthcare legislation that occurred in the 1980s — the Catastrophic Health Act. While catastrophic health did not have specific benefits geared to long-term care, it did have significant implications for providers. However, at the time few providers were aware of or capable of taking advantage of its provisions. Many may not be familiar with how this remarkable piece of legislation operated since it predated the post-acute boom of the late 90s. In a number of ways, it provides us with insights into the difficulties and opportunities that healthcare reform presents and will present.
From its inception in 1965, Medicare access and coverage remained the same until the enactment of the Medicare Catastrophic Act. While not as concerned with “quality” as the current act, its thrust was mainly to expand access with some provisions related to cost. The story of the Medicare Catastrophic Coverage Act from its initial unveiling in President Reagan's 1986 State of the Union address to its congressional repeal in November 1989, represents an interesting time in the history of health policy making. It had several provisions, which were not just advantageous to seniors but also to providers such as Medicare coverage for catastrophic care and the elimination of the three-day stay. It also had a prescription drug program, which was later passed by President Bush.
The seeds of its destruction were not in its access provisions or expansion of coverage. It is in the unwillingness of interests such as elderly individuals, who already were protected against the economic consequences of catastrophic illness, to accept a new tax that would have financed such coverage for the entire Medicare population. Further many providers even though advantaged by the act did not support it or work to offset the “wealthy” elders and insurance interests. They formed a formidable opposition to the plan despite the bipartisan nature of the act – President Reagan proposed it and a Democratic Congress passed it.
James Lomastro, Ph.D., has worked in acute, community based and long-term care for 33 years. He has held an administrator license since 1991. Prior to involvement in administration, he held academic and research appointments at Boston University School of Medicine and Northeastern University.