Elderly Line Up to Fight Changes in Medicare Costs : Health: The plan calls for raising deductibles, premiums. Beneficiaries are among the most influential voters.

The budget deal may have bipartisan support in Congress, but it seems certain to generate intense anger and a political backlash among one of the most influential and vociferous groups of voters--the elderly.

Congress could face a replay of the 1989 battle over catastrophic care. Last year, elderly voters forced repeal of the biggest increase in Medicare benefits since the program started in 1965 after they learned that the more affluent among them would have to pay for the benefits. The catastrophic-care program would have provided unlimited days of hospital care and prescription drug coverage with financing coming from the 40% of persons over 65 who pay federal income taxes.

On Sunday, the President and congressional leaders decided again that the elderly should pay more but this time without even compensating them with increased benefits.

If Congress adopts the package proposed on Sunday, the 34 million Medicare beneficiaries would be forced to pay significantly more for the Part B coverage that helps pay doctor bills. The annual deductible, now $75, would climb to $100 next year, and level off at $150 in 1993 and beyond.

The Medicare insurance premiums, now $28.60 a month, would rise to about $33.50 next year and reach $54.30 by 1995, according to estimates by the American Assn. of Retired Persons.

Beneficiaries now pay 25% of the total cost of Medicare’s Part B, which helps cover doctor bills. General tax revenues pay for the rest. Under the budget agreement, the beneficiaries’ share would rise to 30% of the program’s cost. This could mean a significant increase in monthly premiums each year, because inflation in doctor bills has been racing at double-digit levels.

Advocacy groups for the elderly offered quick opposition.

“We are concerned about the level of cuts in Medicare,” said Horace Deets, executive director of the AARP. “We urge Congress to seek ways to ameliorate the effects . . . on those for whom any increase in health care costs is unaffordable. We further urge Congress to ensure that any cuts in Medicare do not impede the access of older and disabled persons to quality health care.”

“We’re going to work strongly against this package to see that more fairness is put in it,” said Bill Ritz, a spokesman for the National Committee to Preserve Social Security and Medicare. “Let’s share some of the pain with the wealthy--those who had the greatest gain during the 1980s.”

And congressional opposition began stirring Sunday night.

One of the congressional leaders on health care issues, Rep. Henry A. Waxman (D-Los Angeles), said he would vote against the budget agreement when it reaches the House floor. “What troubles me about the budget is that it asks the elderly in this country to take a very hard hit,” Waxman said. “It doesn’t distinguish between those who can afford it and those who can’t. Many of the elderly will have to make a choice between paying for health care and rent.”

Rep. Edward R. Roybal (D-Los Angeles), chairman of the House Aging Committee and one of the more influential senior Democrats, said he will vote against the budget because of the impact on the elderly.

Rep. John Bryant (D-Tex.) called the increase in payments by Medicare beneficiaries “a major negative” in the budget package.

Medicare covers persons over 65 and disabled people of all ages. Part A covers hospital bills, and Part B deals with payments to physicians.

The budget agreement aims for savings of $60 billion in Medicare outlays over five years.

Half would come from reduced payments to doctors and hospitals, both of whom are already complaining that reimbursement levels are too low. About $30 billion in budget savings would come directly from the pockets of the beneficiaries.

Some of the reduced spending by the government would result in higher costs to patients under 65 who are not covered by Medicare, because doctors and hospitals are likely to increase their charges to make up for the Medicare reductions.

The increase in the annual deductible would cost beneficiaries $6 billion. For the first time, they would pay 20% of the cost of clinical laboratory fees, spending $3.6 billion.

The biggest item, by far, is the boost in premiums to cover 30% of the fast-growing program. This would cost beneficiaries $20 billion.

Americans over 65 already spend about 18% of their income on health and long-term care, according to a study by the House Aging Committee. The proposed increases would “aggravate an already unacceptable burden on elderly Americans,” according to Roybal.

The Part B Medicare premiums are automatically deducted from monthly Social Security checks. The average Social Security check this year is $594 a month, with a Medicare premium of $28.60.

By 1995, the average Social Security check will climb to $713 monthly, but Medicare, rising much faster, will be $54.30 a month.