As Medicare recently celebrated its 50th anniversary, few would disagree with the assessment that this centerpiece of President Lyndon Johnson’s “Great Society” has played an important role in ensuring the health of older Americans.
But as we move on from the anniversary, if the program wants to celebrate its 100th anniversary, several proposed changes could undermine the success of the program, so lawmakers better proceed carefully.
As successful as Medicare has been in general, and as important as it is especially for Hispanic people, potential cost-saving changes that have been proposed could seriously affect elderly Hispanic and other low-income elders.
One change that has been proposed is an increase in the age of Medicare eligibility from 65 to 67. For a population that is underinsured, such a change could increase the number of older individuals without coverage at a time when the occurrence of serious illness is increasing. Unless these individuals were allowed to join the new health care exchanges in a highly subsidized manner, the loss in coverage would be disastrous.
When it comes to Medicare, what is often forgotten is that the program has made a major contribution in the reduction of poverty among elderly people.
When Medicare was enacted in 1965, nearly 30 percent of the older population had incomes below the poverty line. By 2014, only 10 percent of older persons were that poor. Medicare’s contribution to reducing medical expenses is one clear explanation.
When Medicare was introduced, 56 percent of Americans ages 65 and older were burdened with out-of-pocket medical expenses. Today, only 13 percent pay for medical care out-of-pocket annually. Greater access to health care has resulted in measureable benefits in health. Estimates from the National Health Statistics show that Medicare has contributed to a five-year increase in life expectancy at age 65.
Almost one-third of Medicare beneficiaries suffer from two or three chronic conditions. Given their life-long earnings disadvantage and the fact that many minority Americans are able to save little for old age, they are particularly dependent on Medicare.
Because of their lack of resources and their often compromised health, Medicare is particularly important for the Hispanic population. Despite high rates of chronic conditions, Hispanics on average live as long as non-Hispanic white Americans.
This fact, in combination with their economic disadvantages, means that many older Hispanics will be particularly dependent on Medicare for protracted periods. Relatively low levels of wealth combined with longer periods of functional incapacity pose challenges to lawmakers and in states with large Hispanic populations.
But gaps in coverage remain. Medicare, for example, pays only 80 percent of hospital costs, and it does not cover long-term care. Part B includes a premium, which along with hospital costs can represent a major burden for low-income elders. For the middle class, Medigap coverage, provided by an ex-employer or purchased privately, covers what Medicare will not pay. For elderly Hispanics who cannot afford a supplemental Medigap policy, Medicaid, the program for poor children and older adults, pays those extra costs.
As we move forward, we must protect the guarantee to medical care that is Medicare’s legacy while at the same time introduce new ways of controlling costs. During the next few decades the elderly population will grow dramatically, and if medical inflation can be kept within limits, the cost of new technologies and medicines will inevitably increase.
In this new and aging world, we must advocate for new experiments in managed care and community and family support that allows older individuals to avoid institutionalization. We must put more of an emphasis on end of life counseling and the rationing of expensive treatments that may not improve the quality of life.
In the end, Medicare is part of a rapidly changing health care reality that will need to adapt to new challenges. The potential response will require informed and realistic public debate.
LBJ achieved his goal of eliminating many health inequities for older Americans at the same time that he reduced poverty among elderly people. President Barack Obama has added to this legacy by extending coverage to more working-age Americans. The challenge for the future will be to preserve, or even expand, health care coverage to Americans while dealing with the fiscal realities facing the nation.
Jacqueline Angel is a professor of public affairs and sociology and a faculty affiliate at the Population Research Center and LBJ School Center for Health and Social Policy at The University of Texas at Austin. Ronald Angel is professor of sociology at The University of Texas at Austin. Their newest book, “Latinos in an Aging World,” explores the welfare of the Latino population in the U.S.
A version of this op-ed appeared in the Fort Worth Star Telegram and San Antonio Express News.
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