KEN STREMSKY DISCUSSES HEALTH CARE LONG TERM CARE, MEDICARE, NURSING HOMES, HOSPITALS, AND TAXATION Congress should give Medicare at least 10 billion dollars a year to pay for long term care provided by nursing homes from general tax revenues. Congress should give at least 10 billion dollars a year to Medicare to pay for hospital care provided to Medicare participants and the money should come from general tax revenues. Nursing homes that meet reasonable regulations set by the Federal Government should not have to pay a federal tax rate greater than 10 percent. Hospitals that meet reasonable standards set by the Federal Government should not have to pay a federal tax rate greater than ten percent. A nurse should not have to pay a yearly federal tax rate greater than seven percent on the first $100,000 the nurse makes in a year. The social security tax and medicare tax should not be part of the seven percent. A person should be able to deduct the yearly cost of long term care insurance from the person's yearly federal taxes. A family should be able to deduct the full cost of yearly long term care insurance bought for family members from their yearly federal taxes. If a family deducts long term care insurance from its federal taxes, a family member may not also deduct the cost of long term care insurance from the person's federal taxes that year. A person should be able to deduct the full cost of the person's yearly nursing home care and/or in home care from yearly federal taxes. A family should be allowed to deduct the full yearly cost of nursing home care provided to family members from the family's yearly federal taxes. A family should be allowed to deduct the full yearly cost of at home nursing care provided to family members from their yearly federal taxes. This provision will allow more people to stay in their homes and get taken care of by visiting nurses and/or family members. If a family deducts a family members yearly nursing home care and/or in home care from yearly federal taxes, the person may not deduct the person's nursing home care and/or in home care as well from that year's federal taxes. MEDICAID AND CHILDREN The Federal Government should contribute at least 30 billions dollars a year more than the Federal Government does now from general tax revenues to Medicaid funding for children. Medicaid should pay for services for children and adults at least as much as Medicare pays for services to increase the probability that Doctors and hospitals will want to provide care to Medicaid patients. Our country should care a lot more than our country does now about the health of children. I think healthy children are more likely to do well in school than sick children. I think healthy children are more likely to be healthy employees of companies. I think healthy children are more likely to be healthy adults who may not need to obtain as much care from hospitals as adults and may not need to obtain as much money from Medicare after they turn 65 years of age. The first people that a society should protect are its children because without healthy children the society will probably not have much of a future. Improving the health of our nation's children is one of my main priorities. On August 14, 2002, I received the following information from the American Academy of Pediatrics which has the website http://www.aap.org and National Association of Children's Hospitals and Related Institutions which has the website www.childrenshospitals.net. "The Medicaid program provides health insurance for more than 63,000 low-income children in New Hampshire. Medicaid is essential to poor children's access to basic medical care. WHAT IS MEDICAID? Medicaid provides health insurance for one in every five American children, making it the largest children's health program in the country. It is also the primary source of health care for low-income and elderly and disabled people. One in seven Americans under 65 is insured through Medicaid. Medicaid covers a broad range of health care services with few costs paid by the family. More than half of all Medicaid enrollees are children, and most of them live in a household where at least one parent works. Unless otherwise noted, data reference in this document refers to Medicaid only and children younger than 21. HOW IS MEDICAID DIFFERENT FROM MEDICARE? Medicaid is a joint program with costs shared by both federal and state governments, while Medicare is paid entirely by the federal government. Medicaid mainly serves low-income families, while Medicare covers elderly and disabled people who receive Social Security, regardless of their income. Medicaid also covers many services for low-income elderly and disabled people that Medicare does not pay for. Both programs are individual entitlements, which means that you qualify if you meet certain criteria. In 1999, Medicaid had 40 million people enrolled, including more than 22 million children. Medicare enrollment for 1999 was 39 million. Under broad federal guidelines, each state establishes its own standards for Medicaid eligibility, benefits package, and provider payment rates, although they must meet certain minimum standards and benefits. In 2002, federal government contributions ranged from 50 % to 76% of expenditures, depending on the state. WHY IS MEDICAID IMPORTANT TO CHILDREN? By far the nation's largest provider of children's health insurance, Medicaid is a critical health care safety net for millions of low-income children. It covers all services that a doctor or other health care professional indentifies as "medically necessary," including physician and hospital visits, well-child care, health screenings, vision care and dental services. Without Medicaid, most-if not-all -of these children would have no health insurance. HOW DOES MEDICAID HELP CHILDREN IN NEW HAMPSHIRE? One in six children in New Hampshire is enrolled in Medicaid. Although they make up more than half of New Hampshire's Medicaid population, the state only spends 24% of Medicaid funds on children. In general, New Hampshire children who are in families of 4 with incomes below $33,485 are eligible for Medicaid. This income eligibility data includes Medicaid expansions and covers children younger than age 19. Each Medicaid eligible child costs New Hampshire $1,963 per year, on average, compared to the average cost per adult Medicaid enrollee of $9,529. WHY ARE PEDIATRICIANS IMPORTANT TO CHILDREN ON MEDICAID? Pediatricians provide the care children need, including routine check-ups, immunizations, and treatment for problems found during health screenings. Between 1994 and 199, pediatricians and pediatric subspecialists provided 51% of all office visits to children on Medicaid. More than two-thirds of pediatricians accept all Medicaid patients who seek care. Plus, more than a third of pediatricians help enroll additional eligible children. Unfortunately, low Medicaid reimbursement rates place an unfair burden not only on pediatricians, but also on children and their families. On average, Medicaid pays just 65% of what Medicare pays for the same service. By law, children covered by Medicaid must have access to the same care and services as children with private insurance. Without consistent payments and decreased paperwork, fewer physicians may be able to participate in Medicaid, threatening children's access to quality health care. WHY ARE CHILDREN'S HOSPITALS IMPORTANT TO CHILDREN ON MEDICAID? Committed to serving all children regardless of ability to pay, children's hospitals are essential to the health of all children, especially low-income children. They provide 40% of all inpatients hospital care for children on Medicaid, devoting almost half their inpatient care (47% of inpatient days) to children assisted by Medicaid. Virtually all children's hospitals are termed "disproportionate share hospitals" (DSH) by their state Medicaid programs - a designtaion reserved for hospitaks that serve a disproportionate share of Medicaid patients, which provide these hospitals additional Medicaid funds. But state Medicaid payments to children's hospitals are already low, covering only 69% to 80% of what it actually costs to provide care. It's getting worse: many states, facing budget shortfalls, have further reduced Medicaid payment rates. If Congress does not act this year, federal Medicaid DSH funds will be dramatically reduced, increasing the burden on children's hospitals and other hospitals serving Medicaid patients. WHY DO CHILDREN ON MEDICAID NEED YOUR HELP? Medicaid faces serious financial threats that endanger the health of New Hampshire's children. An estimated 22,000 New Hampshire children - more than one in fourteen - are uninsured. If Medicaid funding is cut, that number will grow dramatically. And since the federal government pays 50% of the total cost of New Hampshire's Medicaid program, the state will lose $10 in federal funding for every $10 it cuts from its Medicaid budget." I wrote the following section the way that I did because before you can make many people think a lot about the issues you often need to make them angry.