Modernizing and Strengthening Medicare:
A Woman's Issue
by Betty Soldz
"No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligation."
President Lyndon Johnson, July 30, 1965
You may or may not remember Lyndon Johnson's words nor followed what has happened to the fulfillment of that promise. If you don't, Medicare is the National Health Insurance Program signed into law in 1965. It covers women (and men) 65 and older, some people with disabilities under the age of 65 and those with end-stage renal disease. More than 5 million Americans with disabilities are enrolled in the program.
Medicare is a program that has worked well for women until recently. It has been, as President Johnson predicted, a source of financial as well as healthcare security for those it covers. Its benefits package, however, is outdated. Today, there are gaps in the program which need to be addressed.
The program no longer covers all of one's health care needs and average out-of-pocket costs for services not covered by Medicare are rising at an alarming rate. In 1998, Medicare covered only 53 percent of health care costs.
The program needs to be strengthened and modernized. One of the serious gaps in the Medicare program is the lack of prescription drug coverage. Secondly, the media and some members of congress lead us to believe that due to the aging of the baby boomer generation, Medicare will become bankrupt by 2015. Because the number of Americans over age 65 will nearly double by 2030, those entitled to Medicare will also nearly double, putting a large drain on the Medicare Trust Fund. Another gap in the system is that the payments for mental healthcare are not on a parity with coverage for physical healthcare. Lastly, without changes to the current Medicare program beneficiaries out-of-pocket costs will climb markedly over the next 25 years.
Let's examine why Medicare is a woman's issue.
- Women's longer lives, lower incomes in retirement, and chronic illnesses make protecting Medicare a woman's issue.
- Nearly three out of five older Americans are women. This proportion rises with age and, according to the U.S. Census (1996), women comprise 71% of those over age 85.
- Six out of ten people receiving Medicare are women.
- Women live an average of six years longer than men. However, the gift of longevity is frequently accompanied by chronic disease and disability.
- Because women are more likely to suffer from chronic health conditions they require more costly medical care. According to a new OWL publication, "The State of Older Women in America," the average women spends 20% more on prescription drugs then men.
- The chance that a woman will live at or below the poverty line increases with age. Data shows that women are almost twice as likely to live in poverty as their male counterparts. Even with Medicare benefits, health care costs are a growing burden for older women. In 1998, older consumers averaged $2,936 in out-of-pocket health care expenditures, a 33% increase since 1990. To add to the problem, the annual Part B Medicare Premium paid by beneficiaries is projected to increase by more than 80 % by the year 2025.
Prescription drugs costs are not covered by Medicare. Medicare beneficiaries must pay out-of- pocket, pay for an expensive Medicare Supplemental Policy, or join an HMO and hope it will cover some of their prescriptions. Prescription drug prices are rising by as much as 14 to 18 percent a year making them even harder to afford.
One in every three Americans over age 65 is without prescription drug coverage. Many women without such coverage spend as much as 30% of their after-tax income for health care. Even those with coverage can face large out-of-pocket costs. Health care costs place a disproportionate burden on women who have retirement incomes about half that of men's. Many women avoid filling their prescriptions because they can't afford to pay for them. Many have to choose between eating well, paying their rent or purchasing their medications.
Although some Medicare supplemental insurance policies pay for medications, these policies are usually too expensive for many women to purchase. Many of these policies have large deductibles and co-payments as well as unrealistically low caps on coverage. Secondly, most insurers refuse to sell policies that cover prescription drugs to elders who have prior illnesses which might require the need for medication. For the 31% of women without prescription drug coverage the problem will become even larger as the cost of prescription drugs continues to increase. Women who obtain their health care through managed care companies (HMO's) may have some pharmaceutical coverage but every year these companies decrease their coverage or increase cost sharing. Some no longer cover prescription drugs.
Strengthening and preserving Medicare for women now and in the future is imperative. Benefits must be modernized to better reflect today's medical practice. Prescription drugs have become an important part of our health care. New drugs can sometimes replace surgery (e.g. heart bypass surgery) or help prevent brain damage in people who have strokes. Other drugs help lower cholesterol levels. Prescription drugs are especially important in managing chronic illnesses such as arthritis, osteoporosis and hypertension, to name just a few. In some cases they may postpone institutionalization.
Another key to good health is health screening. Although Medicare does cover various screenings, women with low incomes sometimes avoid taking them because they can't afford the co-payments and deductibles, keeping them from taking advantage of many preventive health services.
As mentioned above, Medicare does not pay for mental health care on a parity with physical health care. Why, we might ask, should mental illness be treated differently than physical illness? The Surgeon General's report ( December 1999) noted that nearly 20 percent of Americans age 55 and older experience mental disorders that are not part of "normal" aging. According to Dr. Robert Butler, Professor of Geriatrics at Mount Sinai Medical Center, "Depression is the most common of all mental illness disorders" "and women are almost twice as likely to develop depression." Because of limited Medicare coverage these women are unlikely to get the care they need.
The last U.S. Congress (106th) debated changes to Medicare but ended its session without acting on any bills which address these issues. The 107th Congress is expected to take up Medicare changes again. As those most affected by changes to this program, women must understand their Medicare needs and make sure they are met.
Medicare was established to provide affordable health care for all retirees. For some women it is turning that commitment into an empty promise. Whether you agree with these particular changes or not, I urge you to contact President George W. Bush and your Congressional senators and representative about protecting and upgrading this program. Since women have the most at stake they must be included in the Medicare debate.
I would like to suggest that Medicare revisions should:
- Guarantee the use of some of the federal surplus to extend the solvency of the Medicare Trust Fund.
- Control the cost of pharmaceuticals and other healthcare costs.
- Address the income shortfall of the Medicare Trust Fund.
- Establish a voluntary, affordable prescription drug plan covering all Medicare Beneficiaries and subsidizing coverage for low-income recipients.
- Eliminate the existing deductibles and co-payments for preventive testing, such as cancer screenings and bone density testing.
- Equalize coverage for mental and physical illness. Importantly, any changes to the Medicare program should have a stop gap measure to limit out- of-pocket expenses. Long term care assistance also needs to be addressed but may have to be looked at as a separate issue.
Only with these changes will women (and men) be protected as President Johnson promised when he signed Medicare bill into law. There is an old saying "If it ain't broke, don't fix it." Medicare" ain't broke" but does need a little fixing. I urge you to be actively involved in fixing it. If you do, we will continue to have a program that will allow us access to affordable, high quality health care. If you have any questions, please contact me at Milbet@aol.com.