Hospitals can expect rise in medicare aid. But amount of increase is uncertain

When Congress reconvenes Monday, one of the items on its agenda will be a decision that will affect the millions of elder Americans who obtain medical care in hospitals. The issue: How much more money should the government give to hospitals this coming fiscal year for treating medicare patients? The Reagan administration decided last week to give hospitals 0.5 percent more for the coming fiscal year, which begins Oct. 1, than they now receive. Proposals now on the floor of the House of Representatives and Senate would raise that to 1.3 percent or 1.5 percent, respectively. If Congress passes one of these measures, and President Reagan does not veto it, the higher rate would become law. But if Congress does not act, the administration plan would take effect.

Advocates for the elderly are pushing for congressional acceptance of the higher level. ``I'm very concerned that half of 1 percent is not enough to make sure that [the elderly] continue to get quality health care,'' says Sen.Max Baucus (D) of Montana. The concern of such advocates isthat hospitals would, for financial reasons, respond by trimming services to the elderly, or discharging them before it was physically wise to do so. Frequent accusations have been made in recent months before congressional committee that these two problems already have occurred; medicare officials maintain that, in general, the level of care is good.

``We are concerned'' about the lower Reagan administration reimbursement, says Stephanie Kennan, legislative specialist on health issues for the American Association of Retired Persons. advocates hold that many hospitals then would be under financial pressure to discharge older patients too soon, before their medicare reimbursements to the hospitals ran out, and they became a financial liability. ``The problem,'' says Ms. Kennan, ``is geting care once they leave the hospitals.''

The most serious difficulties could face elderly Americans who live in rural areas. ``The place where the problems tend to show up first,'' says Senator Baucus, ``is rural America, where many hospitals are struggling to survive.'' Beyond the question of next year's medicare rates lie more fundamental issues. What Congress decides will depend, in part, on how it views these issues:

How much of a boost in medicare rates is required for older Americans to continue to obtain the high quality of medical care that American society implicitly promised when Medicare was established in 1965.

Are residents of rural America, where many hospitals are having financial difficulty, at risk of a substantial curtailment in medical services? If only a small increase is provided to hospitals, would they become more efficient without reducing services -- or would older Americans wind up getting less medical assistance than they should?

Finally, given the financial pressures on the US budget, should medicare expenses be held down anyway, even if some reduction in services results? The Gramm-Rudman measure will force Congress to trim costs this month from expensive programs. Medicare has such a strong constituency among elderly Americans that members of Congress can be expected to approve the higher medicare reimbursement figures unless virtually all other efforts to trim the budget fail.

``Everyone who has looked at this issue this year,'' says Baucus, ``thinks that the administration's proposed rate of increase for hospitals is too low. The Senate Finance Committee approved a higher amount, and so did the House Ways and Means Committee, because we want to make sure that America's senior citizens continue to get the quality health care they deserve.''

These are the proposals that await action by the Senate and House when they return Monday from summer recess. Advocates for the elderly will be waiting, too, to see what Congress ultimately does. So, they point out, will the nation's elder voters, many of whom will be voting in congressional elections in a mere two months.