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Raising Medicare Eligibility Age: Who Gets Hurt?

Here's another report finding that raising Medicare's eligibility age won't money or cut health care costs. It will just shift the cost to seniors, states and employers. The full report is here.

Raising Medicare’s eligibility age from 65 to 67, which the new Joint Select Committee will likely consider this fall as a deficit-reduction measure, would not only fail to constrain health care costs across the economy; it would increase them.

While this proposal would save the federal government money, it would do so by shifting costs to most of the 65- and 66-year-olds who would lose Medicare coverage, to employers that provide health coverage for their retirees, to Medicare beneficiaries, to younger people who buy insurance through the new health insurance exchanges, and to states.

The report is based on the Kaiser Report I've cited previously: [More....]

The Kaiser Family Foundation, estimates that its increased state and private-sector costs would be twice as large as the net federal savings. If the proposal were fully in effect in 2014, Kaiser estimates, it would generate $5.7 billion in net federal savings but $11.4 billion in higher health care costs to individuals, employers, and states.

Here's what happens if you raise the eligibility age:

* 65- and 66-year-olds would face higher out-of-pocket health care costs, on average. Two-thirds of this group — 3.3 million people — would face an average of $2,200 more each year in
premiums and cost-sharing charges.

  • State Medicaid costs would rise as some of those who lost Medicare coverage (those with the lowest incomes) would obtain coverage through Medicaid instead.
  • Employer costs would rise as more 65- and 66-year-olds whose employers offered coverage to their retirees received primary coverage through their employer rather than Medicare.
  • All Medicare beneficiaries would pay higher premiums because the removal of 65- and 66-yearolds, who are typically healthier than the overall Medicare beneficiary population, would leave the Medicare beneficiary population costlier, on average, to cover.
  • People under age 65 who buy coverage through the new health insurance exchanges would face higher premiums to help cover the cost of insuring the many 65- and 66-year-olds who would enter the exchanges; the 65- and 66-year-olds would be less healthy, and more costly to cover, on average, than other people who bought coverage through the exchanges

As to the effect of Obama's health care law:

Under the health reform law (the Affordable Care Act, or ACA), seniors no longer eligible for Medicare could obtain coverage through Medicaid or the exchanges. But raising the age of eligibility for Medicare would substantially boost out-of-pocket costs for 65- and 66-year-olds, which many of them with modest incomes could have difficulty affording, prompting some to become uninsured and others to forgo needed care. It also would raise health care costs overall.

Policymakers could take some steps, outlined below, to limit — but not eliminate — these harmful impacts. Moreover, if Congress repealed health reform, as the House has voted to do, large numbers of 65- and 66-yearolds who lost Medicare coverage would likely wind up uninsured.

The option that the Congressional Budget Office has considered:

The Congressional Budget Office (CBO) has examined an option that would raise Medicare’s eligibility age by two months every year starting with people born in 1949 (who will turn 65 in 2014) until it reaches 67 for people born in 1960 (who will turn 67 in 2027), remaining at 67 thereafter.1

Under this option, CBO assumes that Congress would make 65- and 66-year-olds with incomes below 138 percent of the poverty level eligible for Medicaid, to match the new Medicaid income limit for other adults that the Affordable Care Act establishes starting in 2014.

The Kaiser report is based on full implementation in 2114 rather than the CBO's gradual two month implementation.

Kaiser says:

Seven million people age 65 or 66 at some point in 2014 would be affected by the policy change for one or more months. This number is equivalent to five million people affected for a full 12 months.

Obama is preparing to toss 7 million people under the bus. Dumb, just dumb.

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  • Display: Sort:
    Another great Republican idea (5.00 / 1) (#2)
    by MO Blue on Fri Sep 09, 2011 at 01:25:45 PM EST
    McCAIN: What we have to do with Medicare is have the smartest people in America come together, come up with recommendations, and then, like the base-closing commission idea we had, then we should have Congress vote up or down. 2008 second presidential debate against John McCain Oct 7, 2008

    that Obama can check off his list.

    I hope your anger remains intact when you learn (5.00 / 3) (#6)
    by BobTinKY on Fri Sep 09, 2011 at 02:00:14 PM EST
    that those who are today over 60 face at most a few months of delayed eligibility and that those of us under 50 are the ones who will suffer the full two year delay. In fact, the Kaiser report quote says that "[s]even million people age 65 or 66 at some point in 2014 would be affected by the policy change for ONE OR MORE MONTHS."  These folks will not have to wait until they're 67.

    My fear is the raising eligibility to 67 yo specter is going uncorrected so that once the gradual phase in is announced people over 60 will say, "Oh, that's not as bad as I feared."

    Well, over 60s, it is as bad as you feared just not for you.  And so I hope your outrage is not diminished when the actual, cynical phase-in is proposed.

    Wait a second (none / 0) (#14)
    by ding7777 on Fri Sep 09, 2011 at 04:03:44 PM EST
    If you are 50 today then in 15 (or 17) years from now a very large portion (if not a majority) of the boomers will be dead and gone allowing the Medicare ship to right itself (with a surplus no doubt)

    Parent
    Not Dumb (5.00 / 1) (#8)
    by koshembos on Fri Sep 09, 2011 at 02:04:14 PM EST
    It is evil!

    Something people rarely discuss (5.00 / 2) (#17)
    by caseyOR on Fri Sep 09, 2011 at 04:30:30 PM EST
    when talk turns making more people eligible for Medicaid is that eligibility does not guarantee actual coverage. Just because you qualify for Medicaid does not mean you will get on the rolls.

    The program is jointly funded by the federal government and by the states. And the $$ amount each state gets from the feds is, in part, determined by the $$amount each state contributes. Before the Great Recession there were states that ran very minimal Medicaid programs. Now, with state budgets imploding, even states that support Medicaid are slashing their programs. I doubt there is a single state in the union that covers all people who are eligible for Medicaid.

    Here in Oregon the demand for a Medicaid spot is so great that the state allocates coverage  via a lottery. Everybody who wants Medicaid and is eligible signs up and the lucky recipients are randomly chosen. Lots, and I mean lot, of people lose out completely.

    The eligibility facts about Medicaid have always rendered ll arguments in favor of Obamacare that are based on Medicaid expansion, well, disingenuous at best and fraudulent at worst.

    Making 65-67 year olds eligible for Medicaid is an empty promise. All it makes them eligible for is the possibility of earlier death due to a lack of health care.

    Yeah, for our(Democrats)  team!!!  (yes, snark.)

    underwriting (5.00 / 1) (#20)
    by dandelion on Fri Sep 09, 2011 at 05:58:40 PM EST
    Any medical insurance underwriter with any basic experience at all knows that the way you solve a medical plan in trouble is by EXPANDING the risk pool, not shrinking it.

    If Obama really wants to save Medicare he should lower the eligibility age to 55 or 60.

    And don't believe that he doesn't know that.  It's Insurance 101.  

    Saving Medicare isn't the goal at sll; the goal is something else altogether.

    Maybe your goal is (5.00 / 1) (#21)
    by Green26 on Fri Sep 09, 2011 at 06:40:47 PM EST
    something different, but mine isn't.

    If the entitlement programs and budget, and a few other things, can get fixed or improved significantly, then over time that should help with the economy, stock/bond markets, and unemployment (at least when economy improves)--and all of us, including seniors, should be better off. Is my view.

    Parent

    Not if (5.00 / 2) (#22)
    by Ga6thDem on Fri Sep 09, 2011 at 06:50:27 PM EST
    you have an economy based on consumer spending like we do. Consumer spending drives demand and when consumer spending is restricted as in raising the Medicare age, it won't do much to help the economy.

    Parent
    The economy is not based (none / 0) (#29)
    by Green26 on Sat Sep 10, 2011 at 12:46:41 AM EST
    on consumer spending. While important, other factors are more important. Also, raising the medicare age will not have much impact on consumer spending.

    Parent
    2/3 (none / 0) (#30)
    by Ga6thDem on Sat Sep 10, 2011 at 07:46:42 AM EST
    of the economy is based on consumer spending.

    Parent
    Yes it (none / 0) (#31)
    by Ga6thDem on Sat Sep 10, 2011 at 07:49:14 AM EST
    will because people will be forced into Obama's HCR and the premiums for people that age run about 1K a month or they will have to pay the tax.

    Parent
    Jeralyn, I agree that raising the Medicare (none / 0) (#1)
    by Buckeye on Fri Sep 09, 2011 at 01:21:41 PM EST
    eligibility age is a dumb idea.  But not because it is unfair to retirees.  

    We cannot say what you have been saying about Medicare, that

    even though I held up my end of the bargain and paid my required share in medicare and social security taxes for 45 years.

    According to Eugene Steuerle and Stephanie Rennane of the Urban Institute

    upon retiring in 2011, [a couple earning $89,000 a year] would have paid $114,000 in Medicare payroll taxes during their careers. But they can expect to receive medical services -- including prescriptions and hospital care -- worth $355,000, or about three times what they put in," the Washington Post reported.

    This is not the case with SS.  But we must reform medicare in some manner.  People are collecting way more than they paid in.

    Greatly (5.00 / 1) (#3)
    by TeresaInSnow2 on Fri Sep 09, 2011 at 01:46:03 PM EST
    because we have no control over inflating health care costs caused by all of the profitability and profit motive built into the system....

    Screwing retirees is not the answer.

    Parent

    Well (5.00 / 1) (#4)
    by Ga6thDem on Fri Sep 09, 2011 at 01:48:36 PM EST
    if you turn it into a Welfare program then you will be pretty much eliminating it for everybody. Using the example above is the same way the GOP uses the poor as a reason to discontinue a program.

    Parent
    The Washpo can kiss my a$$ (5.00 / 2) (#5)
    by BobTinKY on Fri Sep 09, 2011 at 01:51:54 PM EST
    why not get $3 for one put in?  How many dollars are spent on "defense,"  national security state, homeland security, pointless wars, and, wait for it . . . Wall Street Welfare!

    Parent
    Not to mention Bush/Obama tax cuts! (5.00 / 1) (#7)
    by BobTinKY on Fri Sep 09, 2011 at 02:01:33 PM EST
    I agree we have wasted money on (none / 0) (#11)
    by Buckeye on Fri Sep 09, 2011 at 02:26:50 PM EST
    these things.  But even if we reverse them (or hypothetically assume we never did them), we still have to reform medicare (or health care in general).  Even Krugman believes this.

    Parent
    Or if I had invested my $114,000 (5.00 / 2) (#15)
    by Towanda on Fri Sep 09, 2011 at 04:26:21 PM EST
    in my own retirement account and annuities, or if I had bought income properties before the bubble, or etc., I might have half a million or even more now for my health care needs a few years from now.

    See, you're not factoring in that my life insurance company doesn't get to do this.  I pay in based on a promise, it has to keep the promise.

    We were required to pay, based on a promise that Obama talks about breaking.  That's it, that's all, and that's the reason why we get to cast our votes in 2012 based upon whether that social contract is broken.  (Note:  This is talking about the government breaking the contract, not about Obama breaking promises -- because I heard him loud and clear in 2008 so already cast my vote then in part on his plan that some are only waking up to now.)

    Parent

    People are not "collecting" Medicare - (none / 0) (#12)
    by Anne on Fri Sep 09, 2011 at 03:05:19 PM EST
    it isn't money that goes into their pockets once they become eligible; in fact, they pay premiums for Medicare coverage, which, if they are receiving Social Security benefits, are deducted from those benefits.

    It is far from a free ride, especially considering those who cannot find providers who participate in the program - oh, you can find providers who will happily send off the paperwork, but they also want to be paid whatever their charges are, so all Medicare does for these seniors is offset to some extent the total cost of care.

    Many have Medi-gap insurance to pick up the cost of what Medicare doesn't cover - and there's a lot that Medicare doesn't cover, believe it or not - but they pay a premium for that coverage, too.

    Reducing the cost to the government appears to be all about making individuals share more of the burden for the cost; how people who have retired on fixed incomes that are significantly less, usually, than what they were earning while employed, can be expected to pay more for the cost of care, hasn't really been explained.  I suspect the line will be that people will have to make better choices about when to seek care - the underlying message being that old people use too much.  Is it any wonder, really, that Americans are not nearly as healthy as people in countries where health care is considered a right?

    We can keep the defense machine well-oiled, we can bail out banksters and hold almost none of them accountable for their actions, but - old people?  Hell, they're not actually useful, so why should the government spend one more penny than it has to?

    Parent

    Sr'ss will work longer IF they can hold on to jobs (none / 0) (#9)
    by jawbone on Fri Sep 09, 2011 at 02:12:30 PM EST
    IF they hold on to jobs with decent health care insurance, they will be quite possibly keeping younger workers out of that job or off that job track.

    If they can NOT hold on to a job with health insurance, these seniors will either go uninsured or pay probaly $24,000 a year or more given inflation to insure themselves. They will need to spend down their savings sharply, if they have them, to keep themselves insured.

    When the uninsured enter Medicare, they will be sicker and more expensive to insure. They may not make it to Medicare age, which will be viewed as a "cost saving."  One 65 or 66 year-old life is worth...what? Quite the sacrifice Ol' Barry is asking of some people, bless his cold, cold heart.

    If the unemployed seniors manage to keep themselves insured, they will be deeply impoverished and will be less able to contribute to the consumer society.

    Brilliant, you turncoat, Obama. Damn, with his love of Ronald Reagan, why didn't he join the Republican Party.... (Yeah, yeah; I know: He would be able to win only by running as a Dem. Stealth candidate.)

    He's a democrat (5.00 / 2) (#10)
    by the capstan on Fri Sep 09, 2011 at 02:20:58 PM EST
    only because he entered politics with the help of the Chicago machine.  I bet if he'd picked a different home town, he might well have run as a republican.

    Parent
    Bingo. (5.00 / 2) (#16)
    by Towanda on Fri Sep 09, 2011 at 04:28:33 PM EST
    And add to that the reason why Obama is so bad at bargaining with Republicans:  He didn't have to do so in my Chicago -- or Springfield, where it was done for him, or for that matter Washington, where he wasn't in the Senate long enough to have to do so.

    To this day, I cannot imagine why so many Dems thought that he had a track record of PPUS.

    Parent

    It is, I believe, unnecessary (none / 0) (#13)
    by KeysDan on Fri Sep 09, 2011 at 03:57:41 PM EST
    to make any structural or other major changes in Medicare at this time.  The interactions of Medicare and the Affordable Care Act provisions are, of course, not fully known but they are anticipated, and, indeed, are part of the sizable improvements incorporated into the financial outlook for the program by the Social Security Administration.

    ACA provisions also call for reduced costs and encourage pilot programs so as to evaluate and, if applicable, encourage new systems. Moreover, if the reduction in physician payment rates and productivity adjustments currently in effect are not overruled by Congress continued economies are expected.  As with close review of the status of social security, it can also be seen that the Medicare urgency is not all that it is made out to be--a program whose longer term finances need to be addressed but need to be done so neither hastily nor recklessly.  

    In addition, there are components to Medicare that need to be evaluated separately for each has its own characteristics: Hospital Insurance (HI) or Part A and Supplementary Medical Insurance (SMI) which includes Part B (e.g doctor visits), Part C (private plans that contract with Medicare to provide Parts A and B) and Part D (drugs).  Much attention has been already given to economies and efficiencies in Part A and many changes are in progress; Part B is an area that needs additional attention given the rapid increases in costs; Part C, such as the Advantage Plans are expensive and should be given additional scrutiny; and Part D is a great way to achieve big gains through drug purchases in the same way as the VA.  And, of course, persistent efforts to root out fraud.  

    The assumptions, such as are actually detailed, need to be, at a minimum, questioned. The change in eligibility age is an example of a cure in search of a disease. Neither hasty changes nor meat axe cuts are warranted. Unless, of course, one is looking for a reason to mine and/or undermine Medicare.

    and your point would be? (none / 0) (#18)
    by cpinva on Fri Sep 09, 2011 at 04:49:06 PM EST
    this is hardly new news. the same would occur if the eligibility age for social security were raised. it isn't as though the costs are suddenly going to stop for a couple of years, to resume only upon a person reaching the "magic" age. those costs will continue, but payment of them will simply be shifted elsewhere.

    lowering costs to the actual consumer isn't the point of this at all, it's simply an accounting gimmick designed solely to decrease the federal deficit. we all kind of knew that already.

    Medicare is one of the things (none / 0) (#19)
    by Green26 on Fri Sep 09, 2011 at 05:45:54 PM EST
    that needs to be fixed, so that it will be solvent in the coming years. If raising the age of eligibility is part of the fix, I'm fine with that. I'm 61, and this will impact me. However, fixing problems in entitlement programs and other spending is important for our country. I'm glad more politicians are appearing to be willing to look at fixes, even tough ones. It isn't a surprise to me that reducing federal spending programs can have the impact of shifting costs to others.