Lawmakers Brace For Next Round on Health-Care Issue

ONE of America's most vexing social issues - how to provide financial help to elderly people with expensive illnesses - has temporarily been dealt with. President Bush late last week signed Congress's repeal of catastrophic health insurance. But like a favorite horse on a carousel the issue soon will circle back into view.

Next year Congress will again take up the catastrophic illness issue. This time it will focus on what it excluded last time: so-called long-term care, the most frequent and costly illness expense the elderly face. Sometimes referred to as custodial care, this assistance is largely in such activities as eating, bathing or dressing; it can be given in nursing homes or at home.

One of the prime objections the elderly and members of Congress had to the now-rejected catastrophic illness legislation of 1987 was that it would not pay the expenses of long-term care.

``The foremost issue for the elderly in Congress this year will be long-term care,'' a congressional staffer says.

There are plenty of other issues as well: providing federal funds to meet costs of medical care at home, hospices, and prescription drugs; liberalization of social security earnings; and raising supplementary social security payments for elderly whose income is below poverty remain primary points.

Together they are ``a fairly substantial agenda of intiatives'' ready to be debated in 1990, says John Rother, legislative director for the American Association of Retired Persons (AARP). But foremost among these is long-term care.

Senate majority leader George Mitchell (D) of Maine articulated the rationale for dealing with long-term care even as Congress was repealing the catastrophic illness law: ``By repealing the legislation we have not repealed the problem.''

The first step in next year's debate will be in March by the commission named in honor of the late Congressman Claude Pepper. It will report on two health problems: long-term care and the 35 million Americans without health insurance. ``The Pepper Commission will have the first shot'' at the long-term care issue, Mr. Rother says. Senator Mitchell, who introduced a long-term care measure in 1988, has promised a new proposal after viewing commission recommendations.

Even backers of long-term care say it faces an uphill battle next year, even though it is an election year - and more Americans over 55 vote than any other age group. That is because Congress has an exceedingly difficult task: finding billions of dollars to slice from the budget to meet Gramm-Rudman deficit-reduction targets.

This makes it a difficult time at best to persuade Congress to add an expensive new program, however meritorious - even if the program contains its own self-financing mechanism, as Mitchell's plan is expected to contain.

In addition, the heat that members of Congress took last year from a relatively small group of older Americans over the catastrophic illness issue has made many in Congress initially reluctant to support any major new program for the elderly, lest they somehow find themselves being raked over the coals again.

In an effort to forestall such criticism, Sens. David Pryor (D) of Arkansas and John Heinz (R) of Pennsylvania are seeking to find out exactly what programs elderly Americans really want and are willing to pay for. The two senior members of the Senate Committee on Aging have asked permission to poll elder organizations.

``We're going to be cooperating,'' says Rother of AARP, the largest organization of Americans over 55. ``Every poll we've ever done, the message has always been'' that AARP's members strongly support long-term care. Rother says he expects this sampling to yield the same results.