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Elderly question health plan Key to support is hefty benefits for long-term care


WASHINGTON -- The country's largest senior citizens group, alarmed by the growing possibility that the president's health reform plan won't substantially cover the elderly for long-term care, warned yesterday that it might withhold support for the plan.

John Rother, legislative affairs director for the 33-million-member American Association of Retired Persons, said in an interview that it is "certainly possible" the administration could lose the organization's support if the plan doesn't include more than a modest benefit for long-term care.

Long-term care ranges from home-based services, usually the least expensive, to nursing homes, where the average annual cost is more than $30,000.

Although the elderly need long-term care more than any other group, administration officials want to include people of all ages, among them the physically disabled, the mentally retarded and people with acquired immune deficiency syndrome.

"I think we've always taken the view there is no single litmus test," Mr. Rother said after an afternoon visit to the White House. "But I think members would be so disappointed."

Documents of the president's health reform task force, first reported on yesterday by the New York Times, show that the task force is considering a program for long-term care that would cost $8 billion to $15 billion a year.

Mr. Rother said $15 billion is a "bare minimum in terms of an adequate program," which could cost as much as $50 billion if it included expensive services such as nursing home care and was available to everyone who needed long-term care.

In an effort to put pressure on President Clinton, a coalition of senior citizens groups released a poll yesterday showing popular support for long-term-care insurance. And the AARP, a member of the coalition, disclosed plans for a $50,000 advertising blitz this week aimed at gaining public backing for its position.

Mr. Rother said he still hopes Mr.Clinton will recommend a bigger budget for long-term care. The president, who is deciding what his plan will include, had wanted to make an announcement this month but appears increasingly likely to delay it until June to avoid embroiling health reform in the current debate over his deficit-reduction plan.

Long-term care is one of the trickiest health reform issues for Mr. Clinton. Although he needs the support of the powerful seniors citizens groups to pass the reform plan, he doesn't want to make health reform so expensive that it will require huge, controversial tax increases on top of those included in his deficit plan.

Most people do not have good insurance benefits for long-term care, and government programs provide little home and community care. Although very poor people get nursing home coverage through Medicaid, the Medicare program for senior citizens doesn't pay for such care.

Administration officials have said generally that they will emphasize home and community services in the initial phase of a HTC health reform plan.But they have not spelled out such critical details as the amount and source of financing, or the timetable for adding more costly services such as nursing home care.

The poll put out by the Leadership Council of Aging Organizations found that nine of 10 Americans consider it important that health reform plans include coverage for long-term care. A majority of the 2,000 adults polled in late April by the independent IRC Research Group said they were worried that they or a relative would need long-term care.

The survey asked whether people would rather pay $30 a month in additional taxes for a health reform plan that guaranteed only hospital and doctor care or $50 a month for a plan that also included long-term care. About half said they would prefer to pay $50, and 37 percent favored the less expensive option.

After the poll was released at a news conference, Mr. Rother went to the White House with a letter to Hillary Rodham Clinton, who heads the task force. The senior citizens coalition expressed its flexibility, saying it recognizes the financial need to phase in benefits for long-term care over 10 years.

But the letter made it clear that the coalition -- which includes the National Council of Senior Citizens, the National Council on Aging and the Older Women's League -- ultimately seeks a substantial program.

"If a comprehensive long-term care program . . . is included in the proposal, it will greatly enhance our organizations' willingness to do our part in supporting the president's plan."

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