Call to health: a special Washington report.

Health care has become the hottest issue in town.

Congress finally seems to have heard the outcry of the American people expressing their dissatisfaction with the current system (85% in a recent New England Journal of Medicine story) and is beginning to grapple with reform:

Senate Majority Leader Mitchell (with Senators Kennedy, Riegle and Rockefeller) has introduced S.1227, a reform package known as Health America. This is one of several proposals building on the current model of employer-based insurance but requiring employers to "play or pay" (provide health insurance or pay into a public system). House Ways & Means member Russo has introduced H.R. 1300, a national health system similar to the Canadian system. Variations of these two basic approaches to universal coverage are included in the more than 30 reform bills already introduced by other members of Congress. However, no one in Washington thinks the solution will be found quickly and even more bills are expected to be introduced in the weeks ahead. (At present the Administration has not been heard from on this issue.)

We, in the National MS Society, have been deeply involved and active for many years in the critical issues of health care. Ultimately, the focus of national efforts must be to assure access to affordable, equitable health care for all Americans. The Society's principal work, however, will be to insure the inclusion of the specific needs of persons with MS in any reform that might become law.

Research indicates that tens of thousands of people with MS (and possibly family members as a consequence) are uninsured. Virtually all are under-insured with coverage insufficient to their current needs or offering little protection against possible future needs. Those who have private insurance coverage constantly risk its loss, the imposition of restrictions, or excessive premium increases due to changes in health status or employment of self or spouse.

Medicare requires first meeting Social Security work history requirements, undergoing difficult bureaucratic roadblocks, successfully gaining a disability determination, and then waiting two years for coverage. Medicaid is available only to those who meet very stringent needs tests of below poverty-level income and assets.

Over the years people with MS have been making us aware of their pressing health care needs. The insets in this article, culled from the hundreds of calls received by our Information Resource Center, are ample evidence of the problems that exist. The changes that address some of these needs and problems are incorporated in the list below.

* There must be no "medical underwriting," no exclusion from coverage because of health status, no restrictions from full coverage, no waiting periods for coverage of needed health services.

* Coverage must not end with change in employment status; it needs to be portable and to exist for periods of unemployment.

* Coverage must include chronic care, i.e. services needed to maintain one's health status or to slow deterioration, and should also include preventive care and allow for special consultation as needed outside the designated medical group.

* Coverage should include durable medical equipment and consultation to insure appropriate fit and use.

* Coverage should be available for physical rehabilitation therapies; occupational, physical and speech therapy, nursing, relevant consultations. It should also cover personal assistance services needed by people to perform activities of daily living (ADLs).

* Premiums must be community-rated, based on the broadest possible group with no rating up of premiums on the basis of health status or group size.

Help us. This is only the beginning. The list above is not difinitive. Your thoughts, suggestions and experiences are needed as together we continue our critical advocacy work in the development of health care reform. We invite your comments. Address them to Health Care, INSIDE MS, NMSS, 205 E. 42nd Street, New York, NY 10017-5706.