Despite economic prosperity and the passage of several laws intended to expand healthcare coverage, the number of Americans without insurance has risen steadily. Small businesses that created most new jobs are less likely than large corporations to provide health insurance, and when coverage is available, employees often cannot afford the premiums. Meanwhile, medical costs are projected to accelerate, making health care more expensive and less accessible for everyone. In light of the compelling needs of the uninsured and underinsured, and the organized Jewish community's longstanding position supporting universal health care, the JCPA calls upon federal and state governments to develop system-wide approaches to assuring adequate, affordable healthcare coverage for all individuals and families, regardless of income.

Although efforts to enact legislation regulating managed care failed in the closing days of the 105th Congress, both political parties have vowed to bring the issue back in the new Congress. As bills are drafted, the Jewish community will press for measures that guarantee elderly people access to religiously appropriate long-term care facilities in their home communities, and to ensure that residents of facilities offering a continuum of care are, upon discharge from a hospital, allowed to return to those facilities.

Meanwhile, a restructuring proposal developed by the National Bipartisan Commission on the Future of Medicare, established by Congress to consider options for preserving the fiscal integrity of the program, did not receive the majority support needed to become an official Commission recommendation.

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Nevertheless, it is likely to become a major element in Congressional debate on Medicare reform. Opponents of the proposal, which would raise the age of Medicare eligibility and offer beneficiaries a fixed amount of money for purchase of public or private health insurance, have charged the plan would not ensure Medicare's long-term solvency and would place at risk the health security of older people and people with disabilities. The JCPA believes any restructuring of Medicare must ensure the program's fiscal integrity and the well-being of beneficiaries. Any reforms must take into account the special needs of the Medicare population, including the need for coordinated, high quality care for people with chronic illness, available in all delivery settings-both managed care and fee-for-service. Further, the Jewish community believes seniors with the capacity and desire to remain in their homes should be able to do so and receive home health care under Medicare.

Finally, tests to identify genetic mutations, which render individuals susceptible to certain diseases, have increased the potential for employment and insurance discrimination. The Jewish community's interest in this issue is based broadly on civil liberties concerns and specifically on reports that mutations in certain genes which may increase the likelihood of developing certain cancers are potentially more prevalent among Ashkenazi Jews. The JCPA continues vigorously to support passage of the Genetic Information Nondiscrimination in Health Insurance Act.