The health care reform bill moving through Congress will not solve the country's health care woes, said John Rother, executive vice president of policy and strategy for AARP, which has endorsed the bill. But it is a necessary first step.

"If we don't take the step, we'll be much worse off," Rother told Monitor editors and a reporter yesterday. "Our current health care spending is not by any standards giving us good value for our money."

Rother praised the bill as taking steps toward three goals - covering all Americans, slowing the rate of growth of health care costs and changing the way health care is delivered by making the system less fragmented.

Critics of the plan say it would hurt seniors because of changes it would make to Medicare and Medicaid. According to a Kaiser Family Foundation summary, the savings from Medicare and Medicaid are an estimated $426 billion over 10 years. The savings would come mainly from improving productivity in parts of Medicare, reducing payments to Medicare Advantage plans, changing Medicaid drug rebate provisions and cutting payments to hospitals for charity care.

Rother said that seniors would still see the same services and benefits, and that the cuts to Medicare are necessary.

"Medicare is growing at an unsustainable rate," he said. "We need to demand efficiencies."

The only area where seniors could see a difference, Rother said, would be in Medicare Advantage, which has about 11,000 enrollees in New Hampshire. The law would lower the government's payments to insurance companies that administer the Medicare Advantage plans, and the differences seen by consumers would depend on how the insurance companies respond to the change in law. Rother said the bill would be a good opportunity for Medicare Advantage, along with other insurance plans, to promote more coordinated care and pay based on performance, not on a fee-for-service model. Any money taken from Medicare would remain in the Medicare Trust Fund to extend the fund's viability for an extra five years.

Rother stressed that there would be many advantages for seniors, including closing the "doughnut hole," a gap that exists in Medicare prescription drug benefits at a price range where standard benefits run out and catastrophic coverage does not kick in. It would also give more money to primary care doctors and would let seniors get certain preventive screenings for free.

Rother acknowledged there would be an additional burden on states to implement the program - a concern that Democratic Gov. John Lynch has voiced as well. Rother said reform would require states to change the state insurance commission, enact new legislation, oversee changes to enrollment, and do education and outreach. Because of an expansion to Medicaid, the state would need to set up new infrastructure for the program, even though the federal government would pay for the new enrollees for the first five years. After that time, states would have to pay 9 percent of costs for new enrollees. Rother said he hoped there would be federal money available for implementation, but that is still unknown.

AARP has not taken an active role in the debate over whether to include a government-run insurance plan to compete with the private market. Rother said AARP believes affordable health care can be achieved with or without a so-called public option, and he does not want to risk derailing the bill. AARP offers its own health insurance plans, but Rother said that is not the reason for the organization's position. AARP has not taken a position on federal funding for abortion for similar reasons.

Some major issues AARP will look for in a final bill include limiting "age-rating," the process of charging higher rates for older people, strengthening Medicare in ways that include closing the doughnut hole, and focusing on long-term home- and community-based care for people with chronic conditions.

Rother said although the votes of New Hampshire's senators' on the bill are unlikely to change - Democrat Jeanne Shaheen supports it, and Republican Judd Gregg opposes it - AARP is still lobbying them on various amendments. Gregg, for example, worked on an amendment relating to a self-funded, voluntary public insurance program for the disabled to ensure the program's costs would not fall to taxpayers.

"Sen. Gregg has paid attention to the content of the legislation, though some of his colleagues have not, and I give him credit," Rother said.