HEARING - U.S. Senate Special Committee on Aging

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January 28, 1987
Pressing Concerns About Medicaret
The Patient Advocate's Perspective
Testimony Presented to
the United States <strong>Senate</strong> <strong>Special</strong> <strong>Committee</strong> on Aging
T. TNTRODUCTION
By Judith Stein HUlin
and
Charles C. Hulin
We are the Co-Directors of the Center for Medicare Advocacy, a
non-profit organization located in Willimantic, Connecticut which
provides legal representation to low-income elderly and disabled
people who have been unfairly denied Medicare benefits. We have
been assisting Medicare beneficiaries since 19771 from 1977 until
April 1986, we were the Co-Directors of Legal Assistance to
Medicare Patients, a project of Connecticut Legal Services, Inc.
During the past nine years, our colleagues and we have taken more
than 1,000 Medicare appeals to administrative hearing, winning
more than 70 percent. We have also litigated 22 class action
lawsuits in an effort to resist attempts by the Health Care
Financing Administration to restrict and deny illegally the
Medicare coverage to which Medicare beneficiaries are entitled,
and the health care services which Medicare beneficiaries
desperately need.
In our practice, we speak with many beneficiaries and their
families every day. We have also developed a large database
containing significant information regarding hundreds of
individual patients. All in all, we believe we have a unique
'window' on the real life situation of beneficiaries struggling
to arrange financing for the health care services they require.
Our experience over the years convinces us that our present
health care financing system is failing to finance the medical
care our citizens have a right to expect. First, certain crucial
gapa- in the Medicare program as written by Congress mean that
beneficiaries are for the most part unprotected against the
catastrophic cost of nursing home and home health care. Second,
the Health Care Financing Administration has taken steps to
restrict, radically and illegally, the degree of Medicare
coverage presently provided by law. The end result is a system
which leaves patients vulnerable to the enormous and destructive
cost of long term care. Forced to depend on their own limited
resources, beneficiaries, in a misguided attempt to economize,
will often deny themselves essential medical care. They become
poor and are forced onto welfare. They are unable to sustain
themselves in the community, and must enter institutions.
The final irony is the fact that a system which fails to protect
against the cost of catastrophic illness is profoundly
uneconomic. The present financing structure fails to assist
patients while they are financially solvent and still have a
chance to regain their health and live independently. Instead,
we encourage patients to become disabled, institutionalized, and
indigent, at which time the Medicaid program absorbs the enormous
cost of long term nursing home care. These huge Medicaid
expenditures would not be necessary had adequate financial help
been available when it was first needed.