WASHINGTON -- The American Association of Retired Persons has expressed concern that President Clinton's health plan would let states lock elderly people into a two-tier system, providing them less generous benefits than would be available to people under 65 years old.
The AARP wields considerable political power and has 33 million members, most of them keenly interested in health care. It ardently supports efforts to control health costs and expand coverage, and it has praised Mr. Clinton's proposal as a "bold and constructive plan."
But in the past few days, the association has sent Mr. Clinton a detailed list of questions expressing concern about his proposal, with many recommendations for "fine-tuning" it.
Whether to incorporate Medicare in the new health care system was a topic of continual debate as the Clinton administration drafted its plan.
To avoid frightening elderly people, the administration, after consulting with groups such as the AARP, decided not to force the elderly into the new system immediately.
But by allowing them to remain in the Medicare program, the administration authorized differential treatment and a different set of benefits.
Under the Clinton plan, most Americans would get a standard package of health benefits that would be paid through large groups known as regional health alliances.
The standard package proposed by Mr. Clinton is more generous than that provided under Medicare. For one thing, it would cover far more preventive care. In addition, Medicare beneficiaries have higher out-of-pocket costs than would younger people enrolled in the alliances.
The Clinton plan would allow states to request permission to integrate Medicare beneficiaries into the health alliances -- a provision that makes association officials uneasy.
They note that the Clinton plan says that states integrating Medicare beneficiaries into the new health care system must provide them only "access to the same or higher level of benefits as standard Medicare."
John Rother, the AARP's legislative director, said, "That's not a sufficient standard as far as we are concerned," because it would allow less generous benefits for elderly and disabled people than for younger people in the same alliance.
In an interview, Mr. Rother said: "Our goal is a health care system that provides the same level of benefits and quality for every person, regardless of age. Under the president's proposal, young people would have a standard benefit package that is much, much better than the benefits available through the current Medicare program."
The White House plans to submit detailed legislation to Congress in the coming week, fleshing out the vision Mr. Clinton presented to the nation on Sept. 22.
Since his speech, many groups that support his goals and even his overall approach have spoken out against particular parts of the plan, hoping to win changes as the bill moves through Congress.
Defending the president's proposal, Christine Heenan, a health policy analyst at the White House, said, "Medicare beneficiaries would not lose any coverage they now have, and they would gain new protection against the cost of prescription drugs."
In addition, she said, states would be free to provide additional benefits to the elderly, and she predicted that many would do so.
Marla Romash, a White House spokeswoman, said the elderly would also benefit from Mr. Clinton's proposal for a new government program to help finance long-term care for people of all ages with severe disabilities.
But, Mr. Rother said, the proposed benefits for people under 65 "would still be superior to the Medicare package," even considering the new coverage for prescription drugs and long-term care.
Mr. Clinton's proposal would set limits on consumers' "out-of-pocket costs" for doctors, hospitals and other health care services: $1,500 a year for an individual and $3,000 a year for a family.
The Medicare program has no such overall limits. Mr. Clinton's proposal, as now drafted, would not establish such limits for Medicare.
Under Mr. Clinton's plan, consumers could choose, at the age of 65, to remain in an alliance or to enroll in the traditional Medicare program, which currently finances health care for 32 million elderly and 4 million disabled people at a cost to the federal government of $143 billion this year.
Judith Brown, the AARP's chairwoman, told Congress on Thursday, "We are concerned that individuals who decide to join the Medicare program would be subject to higher cost-sharing, no cap on out-of-pocket costs and less generous low-income protections -- in short, worse coverage -- than that available through regional alliances."
In addition, Ms. Brown said, "We are deeply disappointed that the president's plan would not provide the same coverage for Medicare beneficiaries as it would for younger populations."
Noting that the association has primarily supported Mr. Clinton's effort, Ms. Brown said her group would "not support or oppose the president's plan blindly."
She added: "The day after the president's speech, we began a series of field hearings across the country to ask our members what they think. We will carefully analyze the plan in terms of its effects on our members, their families and the nation."
Ms. Brown also said she was concerned about the amount of responsibility the Clinton health plan would give states.