Health Care Reform And Medicare

The Coalition to End the Two-Year Wait for Medicare has sent a letter to the Speaker of the House of Representatives and the Senate Majority Leader giving their views on the pending health care reform legislation. The two year wait that the Coalition's name refers to is the waiting period for Medicare after a person becomes eligible for disability benefits under Title II of the Social Security Act. The waiting period is actually two and a half years since it is on top of a five month waiting period before cash benefits begin that is usually six months because it is five full calendar months.

The letter is a good summary of the possible effects of the bills going into conference between the House and the Senate. Eliminating the two year waiting period is out of the question at the moment. The main issue is how many of these people will qualify for Medicaid. Here is an excerpt from the letter:

While both bills have a Medicaid expansion as an essential element in providing coverage to the uninsured, the House bill extends eligibility to people not eligible for Medicare with incomes up to 150 percent of the federal poverty level. The Senate bill’s ceiling on eligibility is set at 133 percent of the federal poverty level. Expanding eligibility for Medicaid will provide people with disabilities living near the poverty level access to comprehensive health coverage with limited cost sharing. Compared to providing coverage through an exchange, expanding Medicaid is both cost-effective and provides a level of benefits that helps eliminate cost as a barrier to care. We urge you to adopt the House bill’s directive to set eligibility for Medicaid at 150 percent of the federal poverty level.

The House and Senate bills also differ considerably in the help they provide with premiums and cost-sharing for individuals with limited incomes but above the Medicaid eligibility threshold. For example, under the Senate bill, individuals at 200 percent of the federal poverty level pay a higher share of income in premiums for plans that pay a smaller percentage of health care costs (lower actuarial value) than under the House bill. As a result, people with disabilities and limited incomes could face a combination of high premiums and large deductibles that make cost, even under the new coverage options available through the exchange, a continuing barrier to care. The Senate bill does provide valuable protections worth maintaining in the final bill, including overall caps on out-of-pocket spending and more generous premium subsidies for individuals between 250 percent and 400 percent of the federal poverty level. However, it is essential that the final bill provide affordable coverage to people with disabilities on limited incomes. We urge you to adopt the actuarial values for exchange plans and the premium subsidies for people with limited incomes from the House bill.