The number of people without health insurance is on the rise in the U.S., and economic indicators predict that the number will keep growing through the end of 2002. According to the National Coalition on Health Care's recent report "A Perfect Storm: the Confluence of Forces Affecting Health Care Coverage," an unprecedented number of economic forces-rising premiums, increasing unemployment, and an economic downturn-fueled by the terrorist attacks on September 11th have combined to unleash a 'perfect storm' that could increase the number of uninsured persons in the U.S. by as much as 6 million in 2001 and 2002 combined. This predicted number would add to the nearly 39 million people uninsured in 2000, assuming that few of them attained insurance in the economic downturn in 2001.

Health care advocates are holding out hope that the stalled-out economic stimulus plan will be revived and revised this year. While the economic stimulus bill that the House passed in 2001 contained some provisions for health care coverage for the unemployed, these were not enough to secure approval from the Senate leadership. Advocates also generally agreed that the proposed plan did not do enough for the millions of unemployed workers and their families who are facing prospects of unaffordable private health insurance or COBRA (an extension on coverage offered by their former employers at 102% premiums.)

Medicaid

The already-uncertain health of Medicaid has been placed in further jeopardy as war, the economic downturn and election-year politics have caused the Bush Administration to reprioritize areas in its 2003 budget. As funding is channeled into military spending and anti-terrorism measures, money must be taken from other programs, and domestic programs will be taking a hard hit.

Medicaid makes up a significant portion of States budgets, and state legislators, needing to cut corners, are being encouraged by the Administration to use funding set aside for SCHIP (State Children's Health Insurance Program) to cover Medicaid-eligible persons in their states. While the SCHIP budget may look plentiful, the funds in it have been set aside with the knowledge that SCHIP enrollment would increase as more low-income parents enrolled their children. Moreover, policymakers in 1997 wrote into the law that established SCHIP funding a 26% cut in SCHIP funding scheduled to start in fiscal year 2002 through 2005 in order to balance the budget. 4 Therefore, if SCHIP budgets are drained to cover adults under Medicaid, it will create an earlier and greater reduction in the number of children whose health care needs are met.

Prescription Drug Benefit for Seniors

As reports come out from various polls, lawmakers are finding that a Medicare drug benefit is one of the top health care issues on voters ' minds. [Got some new info for this section-am revising it today]

Early Treatment for HIV

In the fall, National Organization Responding to AIDS (NORA) alerted the Presbyterian Washington Office to the Early Treatment for HIV legislation, which had been introduced in both houses of Congress. If passed, this legislation would provide increased Medicaid coverage to low-income persons living with HIV. Currently, a low-income person is not usually eligible for Medicaid coverage until he or she develops full-blown AIDS ("disabled" status) and is no longer able to work. With early treatment, persons with HIV could stay at work longer and live longer and better-quality lives with reduced numbers of opportunistic infections and a decreased risk of lapses in their treatment regimens.

At present, the passage of this legislation is now uncertain. States, as said in the previous section, are already hard-pressed to find money to cover Medicaid needs, and any legislation that would increase Medicaid coverage is a tough sell. In addition, the Bush Administration has not voiced its support for the Early Treatment for HIV legislation, and attention to other health concerns (bioterrorism, growing number of uninsured) makes any endorsement highly unlikely.

Mental Health

Mental Health Parity legislation looked as though it had a chance of passing in 2001 as an amendment to the Labor-HHS-Education appropriations bill. However, the hopes of mental health advocates were not realized as the amendment was cut from the bill in final House-Senate conference negotiations. While the legislation had wide support among health care, education, and civil rights advocates and religious groups including the Presbyterian Church (U.S.A.), House conferees in the House-Senate conference did not agree to the inclusion of the amendment. The legislation's passage was made even more unlikely by a lack of support from the Bush Administration.

Sen. Domenici, one of the sponsors of S. 543 Mental Health Parity bill, said that he would attempt to pass it in the Senate as a free-standing bill in early in 2002, and then work with advocacy groups to but pressure on the appropriate House committees to report the bill. Further, House Commerce Chairman Billy Tauzin (LA) has promised hearings. 5 Still, much opposition to mental health parity legislation still exists among House leadership, and widespread public support for passage of S.543 is needed if it is to have any chance of House and Administration approval.

Patients' Bill of Rights

Patients' rights bills passed in both chambers last summer, but talk of a patients' bill of rights all but disappeared from most legislators' offices in the months after September 11. The new year, however, has brought renewed energy to talks, and Senate Majority Leader Tom Daschle (S.D.) has said he will call a conference committee soon to work out difference between the two versions. While these will be the first formal joint talks since the bills' passages, Sen. Daschle's office reports that conversations among the bills' sponsors and the Administration have been positive and could increase the likelihood of a successful conference. The Senate patients' rights bill (S. 1052) would give patients a broader right to their HMOs, while the House version is more conservative in the power it gives patients, allowing them to sue in state courts but capping non-economic damage awards at $1.5 million.

Last March, President Bush said he would veto any patients' rights legislation that contained any proposal whose right-to-sue provisions would "drive up" health care costs. With the costs of health care already skyrocketing (rising 7% in 2000) and the added pressure of rising rates of uninsured persons, any patients' bill of rights legislation passed will probably not grant all the rights that patients and health care advocates had hoped.