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Kaiser Daily Health Policy Report

Medicare | Lawmakers, Advocacy Groups Call for Elimination of Two-Year Waiting Period Before Disabled U.S. Residents Can Qualify for Medicare

[Nov 13, 2008] http://www.kaisernetwork.org/daily_r...fm?DR_ID=55536

Lawmakers and more than 75 disability advocacy groups have begun lobbying Congress and the future administration of President-elect Barack Obama to eliminate the wait time the disabled face in qualifying for Medicare, the AP/San Francisco Chronicle reports (Alonso-Zaldivar, AP/San Francisco Chronicle, 11/12). Current rules require a two-year waiting period for people the Social Security Administration has deemed too ill or disabled to work before they are eligible for Medicare benefits (CongressDaily, 11/12).

According to the AP/Chronicle, at any given time, about 1.5 million people who are disabled are waiting to qualify for Medicare coverage. About 40% are uninsured at some point during the waiting period and 25% are uninsured during the entire two-year period, the AP/Chronicle reports. While some people rely on Medicaid in the interim, others "end up depleting their savings on private insurance and medical bills," according to the AP/Chronicle (AP/San Francisco Chronicle, 11/12). In some cases, "the gap in coverage leads patients to forgo treatment, resulting in more expensive care after insurance kicks in," according to Lee Grossman, president of the Autism Society of America (CongressDaily, 11/12).

Among the groups supporting the elimination of the wait period are the American Cancer Society, the Alzheimer's Association, the National Association of People with AIDS, the National Multiple Sclerosis Society and the Medicare Rights Center. In addition, Senate Finance Committee Chair Max Baucus (D-Mont.) has said he supports ending the waiting period (AP/San Francisco Chronicle, 11/12).

Legislation
Rep. Gene Green (D-Texas) and Sen. Jeff Bingaman (D-N.M.) are sponsoring companion bills (HR 154, S 2102) that over 10 years would gradually eliminate the waiting period and would establish a system to immediately grant coverage to people with life-threatening illnesses, the AP/Chronicle reports. Green said, "Every year, we'd reduce it by a few months, so we get down to a level that's manageable for folks."

Bingaman and Green are hoping to get their bills included in a larger health care overhaul package that Obama likely will pursue once in office. If attaching the bill to a larger package is unsuccessful, Green and Bingaman plan to introduce the bills independently, according to the AP/Chronicle (AP/San Francisco Chronicle, 11/12).

Green said that funding is the largest impediment, adding, "We haven't crossed that bridge yet to see where we'll get the offsets. That will be something we'll have to deal with" (CongressDaily, 11/12). According to the AP/Chronicle, researchers estimate that eliminating the wait period in one step would cost about $9 billion annually, which is why Green and Bingaman have proposed a gradual elimination. The AP/Chronicle reports that the cost would be offset in part by a $4 billion savings from Medicaid (AP/San Francisco Chronicle, 11/12).

[Stitcher]

Campaign to end 2-year insurance gap for disabled

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer

Wednesday, November 12, 2008

(11-12) 14:15 PST WASHINGTON, (AP) -- http://www.sfgate.com/cgi-bin/articl...type=printable

Congress and the Obama administration should end the two-year wait that people deemed too sick to work by the government face before qualifying for Medicare, lawmakers and leading advocacy groups said Wednesday.

Medicare covers people 65 and older and the disabled, and at any time, 1.5 million disabled people find themselves waiting to qualify. About 40 percent are uninsured during part of that wait, while 25 percent are without insurance during the entire 24 months. Of the rest, some get coverage through Medicaid, but many end up depleting their savings on private insurance and medical bills.

Legislation sponsored by Rep. Gene Green, D-Texas, and Sen. Jeff Bingaman, D-N.M., would eliminate the waiting period gradually over 10 years. The proposal also would set up a process so people with life-threatening illnesses could get coverage right away.

"Every year, we'd reduce it by a few months, so we get down to a level that's manageable for folks," Green said at a Capitol Hill event. He and Bingaman are trying to get their plan incorporated in a health reform package expected from President-elect Obama, who co-sponsored a version of their bill last year.

But if a health overhaul stalls as it did during the last Democratic administration, Green and Bingaman say they think they might be able to pass their bill anyway. Separately, Sen. Max Baucus, D-Mont., who heads the committee that oversees Medicare, also announced he supports doing away with the waiting period.

The legislation would solve the kind of predicament that 45-year-old Yvonne Brown of Waldorf, Md., had to face. She had a steady job as an audio engineer for a radio network. But in 2000 she was diagnosed with multiple sclerosis, an incurable disease in which the immune system attacks the nerves. She was granted Social Security disability payments in 2003, only to find out that she would have to wait two more years for Medicare.

Brown said she sold her house to pay for medical bills, but eventually wound up homeless. She was reduced to sleeping in her car because shelters were concerned that by accepting her, they would become liable for the costs of her treatment. One type of MS medication was costing $2,200 a month.

"It is an irresponsible and demeaning system that declares people disabled, and then forces them to wait two years for health insurance," Brown.

Although she now has Medicare — and a home thanks to subsidized housing — Brown said she still owes medical bills. "I am still angry and frustrated for the two years that my life was falling apart," she said.

The waiting period for Medicare benefits was instituted in the 1970s, when coverage was extended to the disabled. Cost is the main reason it has endured. Researchers estimate that eliminating the wait would cost about $9 billion a year, if done in one move. Although about $4 billion would be offset by savings from Medicaid, costs to Medicare would rise. That is why Green and Bingaman are proposing to reduce the wait gradually.

Some academic experts say the government should consider other strategies. For example, it might be cheaper to subsidize employer-sponsored coverage for those disabled people who are eligible for it.

More than 75 patient organizations are joining in a campaign to end the waiting period. They include the American Cancer Society, the Alzheimer's Association, the National Association of People with AIDS, the National Multiple Sclerosis Society, and the Medicare Rights Center.

Maryland psychologist Neal Morris, representing the American Psychological Association, said keeping the waiting period may cost more because disabled people without regular coverage get sicker and have bigger problems by the time they qualify for Medicare. "The argument that we cannot afford this is completely bogus, in my opinion," Morris said.