Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform

[eridani]

Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform
http://www.kff.org/medicare/8169.cfm

Several major deficit-reduction and entitlement reform proposals include raising Medicare's age of eligibility from 65 to 67 as a way of improving Medicare's solvency. This Kaiser Family Foundation report estimates the expected effects on such a change on the federal budget, as well as on affected seniors' out-of-pocket costs, employers, Medicaid and others in light of the major changes in coverage enacted under the 2010 health reform law.

The study estimates that raising Medicare’s eligibility to 67 in 2014 would generate an estimated $5.7 billion in net savings to the federal government, but also result in an estimated net increase of $3.7 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree health-care costs. In addition, the study projects that the change would raise premiums by about 3 percent both for those who remain on Medicare and for those who obtain coverage through health reform's new insurance exchanges. The study assumes both full implementation of the health reform law and the higher eligibility age in 2014 in order to estimate the full effect of both the law and the policy proposal.

In the absence of the health reform law, raising Medicare's age of eligibility would result in an increase in the uninsured, according to other studies, as many older Americans would have difficulty finding affordable coverage in the individual market in the absence of Medicare. With health reform, virtually all 65- and 66-year-olds would be expected to obtain alternative sources of coverage.

The study is authored by researchers from the Kaiser Family Foundation and the Actuarial Research Corporation and is available online. It is the first in a new series of Kaiser Family Foundation studies examining the effects of proposed Medicare changes on the program’s beneficiaries, the federal budget and other stakeholders.

NOTE: Originally released in March 2011, this report and news release were updated in July 2011 to reflect additional provisions of the 2010 health reform law. These adjustments result in lower estimates of net federal savings and aggregate out of pocket spending attributable to raising the age of eligibility.

Despite the savings to the government, overall health care costs will INCREASE due to shifting them to employers and to sick people, by $2.5 billion dollars.

[Igel]

1. I've looked at some half dozen such studies.

I probably won't look at this one.

Every one, right or left, has the same problems when reported on.

The newspaper (blog, website, magazine, radio report) said what the conclusions were. They said nothing about the assumptions that had to be made to reach any conclusion.

Some assumed that the ACA/HRCA assumptions were golden. Others assumed that the Massachusetts experience would be scaled up. Others assumed that nobody would lose or have their health care changed. Some assumed there'd be a wholesale increase in healthcare services. Anybody who actually believed the set of assumptions for any one report would probably be properly classified as clinically insane.

Without discussion of the assumptions, the conclusions are meaningless except to confirm what we already knew--that we're great and wiser than everybody else.

[eridani]

2. Scaling up MA would be a disaster for for the 50-64 age demographic

Having Health Insurance Does Not Mean Having Health Care
Statement of Rachel Nardin, MD., President, Massachusetts Chapter of Physicians for a National Health Program, neurologist at Beth Israel Deaconess Medical Center in Boston, and assistant professor of neurology at Harvard

In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform we know a lot about what has worked and what hasn't. Examining this data critically is vitally important as the Obama administration considers elements of the Massachusetts' plan as a model for national health care reform.

On Feb. 19 we released a new study on the Massachusetts reform. This study details many problems with the reform effort. We are also releasing a letter from nearly 500 Massachusetts physicians to Senator Kennedy asking him not to push for a Massachusetts-style reform nationally. My colleagues and I see the effects of the Massachusetts reform on patients every day and know that this is not a healthy model for the nation.

The Massachusetts reform is an example of an “incremental” reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid, and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private insurance or pay a substantial fine ($1068 in 2009).

The reform has reduced the numbers of uninsured, although our report shows that the state's claim is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones—two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in Massachusetts may well be even higher than 5 percent.

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7000 before expenses before the insurance pays a single medical bill. It is not surprising that many of the state's uninsured have declined such coverage.

The study we released on Feb. 19 also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state's old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent Boston Globe/Blue Cross Foundation survey, 13% of people with insurance in our state were unable to pay for some health services that they had received and 13% could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost.

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. She told us “Under Free Care I saw doctors at Mass. General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization. Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well.” Now that she's “insured,” Kathryn's medical expenses consume almost one-quarter of her take home pay, and she wonders whether she'll be able to continue taking her life saving medications.

[CTyankee]

3. This reveals the fallacy of thinking that you can simply raise the eligibility rate by snapping

your fingers and saying "Let it be so!"

The aging process does not magically become frozen for the two or three years that you make people wait to go onto Medicare. Sh*t happens to people in that time: hips and knees have to be replaced, medications often increase to take care of aging arteries, typically there are onsets of other age related health issues.

Why does anyone assume that, like King Canute commanding the tide to roll back, we can simply close our eyes to this being a reality?

[limpyhobbler]

4. k/r

Well in a sane world I guess this would put an end to talk of raising the age.

[eridani]

5. Since it isn't a sane world, please make a commitment to email, phone or fax daily

Even the Repugs.