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\ lirruarnr: lifl-rnut"„r rsrr'rn'r:<< ~?%%d ltadcruiin ro cr11Y RIII7i7Ii'r"R17u1: STATEMENT of the AMERICAN ASSOCIATION OF RETIRED PERSONS on PREVENTIVE HEALTH CARE Presented by MARY EDITH ROGERS HEALTH ADVOCACY SERVICES AREA COORDINATOR before the Special Committee on Aging United States Senate WASHINGTON, D.C. May 6, 1993 For further information contact: Kirsten Sloan Federal Affairs Department (202) 434-3770 n:.::, A•u~,j nim „t l:riirc,l 1'rr.,n, nill I\'t1 11. •li: _: ,n. I 1 c ?uU-?•/ 'l1? -;;-+ ~_

Good Morning. I am Mary Edith Rogers from Gastonia, North Carolina. I am the Health Advocacy Services Area Coordinator for the American Association of Retired Persons. I appreciate the opportunity to appear before you today to discuss the importance of including coverage of preventive care services in a reformed health care system. As a former public health nurse, I have long been aware of the significant impact preventive health care can have on the well being of Americans of all ages. My own personal experience with breast cancer strengthened my belief that preventive care not only saves the expense of costlier treatments that are required if a serious illness goes undetected -- it can also save lives. Unfortunately, early detection and prevention is often not an option for millions of Americans who have no coverage for even the most basic preventive care services. In 1989, only one in four full-time participants in health plans offered by medium and large businesses had coverage for routine physicals or immunizations. Due, in part, to this lack of coverage, 40 to 60 percent of children under the age of 2 have not received the recommended immunizations. Not only is this penny wise and pound foolish, but it too frequently results in tragedy and life long impairment. 1

The lack of access to preventive health care coverage is indicative of the much broader problems in our current health care system. Millions of people are now finding that their health care coverage is alarmingly inadequate. Millions more -- many of whom are working men and women and their families -- have no access to health care coverage at all. Even though most older people have coverage through Medicare, the increasing out-of-pocket costs and the serious gaps in coverage for necessary services, such as prescription drugs and long-term care, are undercutting the financial protection it provides. This increasing vulnerability of Americans of all ages and income underscores the need for broader health care reform. AARP strongly supports a comprehensive reform of our health care system that contains costs and provides affordable, quality health and long-term care. We also believe that any standard benefits package developed as part of health care reform should provide for a continuum of services -- from preventive care to long-term care -- and should be available to all age groups. Increasing Support for Preventive Care The increasingly important role that preventive care is playing in our health care system was illustrated by a recent health care reform survey conducted for AARP by DYG, Inc. This survey, of 2

1,500 people age 18 and older, found that there is a strong public preference -- expressed by Americans of all ages -- for a health care system that includes preventive health care. In fact, when asked to rank the relative importance of key components of a health care program, survey participants ranked preventive care, whether as part of a basic plan or more generous plan, second only to their concerns about cost and willingness to pay. Preventive Care Services and Health Care America Because preventive health care services are an important ingredient in health care reform, AARP included preventive care in its own health care reform proposal -- Health Care America. The benefits included in this proposal are not limited to the elderly but encompass a wide range of services ages, including: periodic check-ups, prenatal mammography screening, pap smears, colorectal prostate cancer screening, ajid dental, vision for people of all and well-baby care, cancer tests, and hearing screening. In addition, there would be no copayment for prevention or screening services. To enhance health promotion and disease prevention efforts, Health Care America would direct additional resources toward activities aimed at communities. In particular, we recommend national, state and local educational campaigns to inform and 3

motivate the general public on public health issues such as: smoking cessation, drug and alcohol abuse, prevention of injuries and accidents, nutrition, fitness, family planning, mental health, driver safety, food and drug safety, and environmental health. AARP's Preventive Care Activities In addition to the preventive care provisions in Health Care America, AARP conducts programs to provide older adults with the knowledge and skills necessary to lead healthier lives and make informed decisions about their health care. The Association produces an extensive library of consumer-oriented publications and audio-visual programs on health promotion issues. AARP volunteers provide information and conduct programs on a range of health promotion and disability prevention issues in their communities including: mammography screening, nutrition, exercise, heart disease, smoking cessation, fall prevention, immunizations, stroke, incontinence, medication misuse, hearing, vision, and health care unique to men and women. Volunteers work with other community groups to cosponsor health fairs, wellness programs, cancer screening, and exercise programs. Following are some examples of specific programs. 4

Mammography Screening AARP is currently participating in a mammography education campaign cosponsored by the Department of Health and Human Services entitled: "You Owe It To Yourself: Mammography Awareness Campaign For Older Women." The purpose of this campaign is to: (1) educate older women that the risk of breast cancer increases with age; (2) that Medicare now helps pay for the cost of screening mammograms; and (3) to increase access to mammograms for all older women. In addition, the campaign informs health providers of the need to refer older women for mammograms. Our involvement in this campaign is due, in part, to a 1991 national survey of women 65 and older conducted by the Association which found that 70 percent of these women were unaware that Medicare covered screening mammograms. AARP volunteers from every state in the country have now been trained to implement mammography education programs in their local communities. Strategies the volunteers are implementing include: cosponsoring free screening with the public health departments, compiling directories of Medicare certified/accredited screening facilities, organizing educational programs, and conducting media advocacy. Some specific examples include: 5

o AARP volunteers in Connecticut have established a cooperative program c:ith Yale/New Haven Medical Center. They will develop a directory of facilities, provide information to consumers, and cosponsor a free mobile screening for low-income African American women in Bridgeport. o New Jersey volunteers are working with the State Office on Aging to expand outreach to Hispanic elders. o Kentucky volunteers are working with the Kentucky Cancer Care Program and a coalition of local organizations to encourage women to get mammograms. Nutrition Screening AARP and the American Heart Association have developed a nutrition education program directed to older African Americans who are more at risk from death due to heart disease, stroke, cancer, diabetes, high blood pressure, and cirrhosis of the liver than other populations. To encourage better nutrition, AARP and the American Heart Association have jointly produced "Eating for Healthy Tomorrows", a nutrition education program that can help older African Americans make dietary changes that can promote better health. CD ~ N m 6

The pilot program was established in 1990 and the response was overwhelmingly pcsitive. A one-time, two-hour session promotes awareness and understanding of nutrition and its role in reducing risks for major chronic disease. A demonstration of healthy ethnic cuisine is included to teach participants how to improve their diet while keeping cultural traditions. Evaluation of the pilot indicated that the program was effective in presenting information on nutrition and its role in reducing risks for cardiovascular diseases among African-American adults age 50 and over. In addition, the pilot program indicated overwhelmingly that participants increased their knowledge of nutrition and learned ways to improve their health. AARP volunteers have begun to implement this program on a national level directed to African American elders as well as to modify the program to serve other ethnic communities. Staying Healthy After 50 In 1984, AARP, the American Red Cross, and the Institute for Better Health at the Dartmouth Medical School joined forces to establish a nationwide health promotion program called "Staying Health After Fifty." The goal of the course was to help older adults acquire the confidence necessary to assume more direct responsibility for maintaining and improving their own health. 7

This ten-session course addressed such issues as: medication management, high blood pressure, nutrition and emotional well-being and better communication with physicians. Preventive Care in Health Care Reform Despite the achievements of these state and local programs, AARP believes that in order for all Americans to reap the advantages of preventive health care, it should be included as part of a comprehensive standard benefit package along with other priorities like long-term care. If a standard benefit package is less than comprehensive and omits important coverage like long-term care or prevention, then health care reform would merely perpetuate the many gaps in people's coverage evident today. As a result, millions of Americans who cannot afford supplemental coverage for benefits not included in a standard package would be relegated to a second tier of care and system-wide cost containment would be less effective. We understand that a guaranteed comprehensive benefits package that includes benefits like preventive health care and long-term care will require additional resources from the federal government, businesses, and some individuals. Some businesses and individuals with less coverage now will pay higher premiums 8

for a higher level of benefits. Additional federal funding will be needed to expar.3 benefits to Medicare and Medicaid populations and to subsidize care for others who do not have adequate employer coverage. Some of this funding could come from health care providers or insurers who will benefit from reduced cost shifting from uninsured and underinsured individuals. But additional sources of funding will be needed. AARP firmly believes that this need for additional federal funding, however difficult to discuss, must be an integral part of the debate over a standard benefits package. While the Association believes funding sources should be broadly- based and equitable, there is one particular financing method we believe is especially appropriate -- increased taxes on alcohol and tobacco which reflect the health costs to society associated with the use of these substances. We recognize that these taxes would raise limited revenues, particularly because of their narrow base, however, they may also serve to discourage consumption of these commodities and lessen the health care risks associated with their use. 9