Jan 17, 2010

The 24 Month Medicare Gap

From the Associated Press:

Disabled by chronic back pain and unable to afford medical insurance, Lea Walker hoped President Barack Obama's health care overhaul would close a coverage gap that has trapped her and millions of other workers.

It won't.

Although disabled workers can expect improvements, the legislation moving toward final passage in Congress doesn't deliver the clean fix that advocates for people with serious medical conditions hoped for. Some of the neediest could find themselves still in limbo. ...

She started receiving monthly disability checks from Social Security, but found she would face a 24-month wait for Medicare. Insurance available through her husband's job was out of reach at $800 a month.

At any given time, an estimated 1.8 million disabled workers languish in the Medicare coverage gap, a cost saver instituted nearly 40 years ago. Many, like Walker, are uninsured. Lawmakers had hoped to eliminate the gap as part of health care overhaul, but concluded it would be too expensive. ...

"I think everyone needs to realize this is going to be a first, very major step toward health care reform and then there will be a need to come back in the next several years and make midcourse adjustments," said Sen. Jeff Bingaman, D-N.M., who pushed unsuccessfully to phase out the waiting period.

While I wish that Congress would deal fully with the problem now, this article makes the problem out to be worse than it is. Many, perhaps most, of the people in the 24 month waiting period will be eligible for Medicaid under the health care reform bills pending in Congress. Because Medicare lacks an adequate prescription drug benefit, Medicaid may be better for low income families anyway. These bills would also give Medicaid coverage to many of those who are stuck in the lengthy process of appealing Social Security disability denials.

By the way, I will make a prediction now. If some combination of the plans pending in Congress come into effect, a higher percentage of Social Security disability claims will be approved because of better documentation of illness. I think we can also hope that eventually the rate of disability in this country will decrease because of better access to medical care.

5 comments:

Anonymous said...

Anyone seen an objective estimate of what it would cost to eliminate the waiting period?

Anonymous said...
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Anonymous said...

I don't know why so many think that expanding Medicaid is such a great idea. The county where I live cannot afford to hire the additional caseworkers needed to manage the increased eligibles. And Medicaid is not that great, anyway. There are limited numbers of participating providers due to low reimbursement rates and gnarly regulations. I have had family members who have been on Medicaid. You can be terminated with no notice and not find out until you go to get a prescription on a weekend, and find out you are stuck until you call the caseworker the following week. Oh, and they don't have voicemail so unless they are sitting at their desk when you call you get nowhere.
Eliminating the Medicare waiting period targets the folks who are most in need with the least effort. Try that first before going on to anything else. Instead, with Obamacare, we are going to get all or nothing. What is wrong with incrementalism?

Anonymous said...
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Anonymous said...

What you have to remove the posts because Brown won and Obamacare is dead.