Medicare Buy-In for Older Adults: Commonwealth Fund Resources

December 10, 2009

 Health Care Opinion Leaders Views on Medicare Reform, K. Stremikis, S. Guterman, and K. Davis, The Commonwealth Fund, November 2009.
According to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, more than eight of 10 leaders in health care and health care policy believe Medicare has been successful at accomplishing two major goals—providing beneficiaries with access to basic medical care and providing stable, predictable coverage over time. Several of the Medicare proposals being discussed in Congress as part of comprehensive reform legislation, including expanding the power of the Secretary of Health and Human Services to put payment pilots on a "fast track" and to work with other parties to implement multipayer payment initiatives, are supported by most opinion leaders. Respondents also voiced strong support for using Medicare’s leverage to negotiate pharmaceutical drug prices and creating an independent Medicare advisory council with authority to make payment and benefit design decisions within parameters established by Congress and the president.

 "Medicare Spending for Previously Uninsured Adults," J. M. McWilliams, E. Meara, A. M. Zaslavsky et al., Annals of Internal Medicine, published online October 6, 2009.
The Medicare program spends significantly more for adults who were uninsured before becoming eligible for the program at age 65 than it does for those who had coverage prior to entering the program. Previously uninsured adults also spent more time in the hospital after age 65 for complications related to cardiovascular disease and diabetes and for joint replacements.

"Public Programs: Critical Building Blocks in Health Reform,"  K. Davis, Invited Testimony, Senate Finance Committee, June 16, 2008
In testimony before the Senate Finance Committee, Karen Davis said that public programs such as Medicare and Medicaid "should be considered building blocks in a system of seamless coverage for America's 47 million uninsured people." "Extension of the option to buy improved Medicare Extra benefits to current Medicare beneficiaries; elimination of the two-year waiting period for Medicare coverage for people with disabilities; the ability of adults age 60 or older to buy in to Medicare; and the same financial protection on premiums as a percentage of income for Medicare beneficiaries as for nonelderly households."

Health of Previously Uninsured Adults After Acquiring Medicare Coverage, J. M. McWilliams, E. Meara, A. M. Zaslavsky, J. Z. Ayanian, M.D., M.P.P., Journal of the American Medical Association December 26, 2007 298(24):2886–94
Health care coverage leads to dramatic improvement in health trends for previously uninsured older individuals, particularly those with cardiovascular disease or diabetes, according to a Commonwealth Fund-supported study published in the Journal of the American Medical Association.

Representative Pete Stark’s “Medicare Early Access Act of 2005," Excerpted from: S. R. Collins, K. Davis, and J. L. Kriss, An Analysis of Leading Congressional Health Care Bills, 2005–2007: Part I, Insurance Coverage (New York: The Commonwealth Fund, March 2007).

The Commonwealth Fund commissioned the Lewin Group, a health care policy research and management consulting firm, to estimate the effect of this bill on stakeholder and health system costs and the projected number of people the bill would insure.

 Use of Health Services by Previously Uninsured Medicare Beneficiaries, J. M. McWilliams, E. Meara, A. M. Zaslavsky, and J. Z. Ayanian, New England Journal of Medicine, July 12, 2007 357(2):143–53
In this Fund-supported study, researchers at Harvard Medical School compared the health care use and expenditures of beneficiaries who did and did not have insurance prior to entering Medicare. They found that, among beneficiaries with chronic conditions, the previously uninsured had significantly greater use of physician visits and hospitalization than did previously insured adults.

An Analysis of Leading Congressional Health Care Bills, 2005-2007: Part I, Insurance Coverage, S. R. Collins, K. Davis, and J. L. Kriss, The Commonwealth Fund, March 2007
The first of a two-part series, this report analyzes and compares leading congressional bills and Administration proposals to expand health insurance coverage introduced over 2005–2007. The Commonwealth Fund commissioned The Lewin Group to estimate the effect of the bills on stakeholder and health system costs and the projected number of people who would become newly insured through them. The proposals fall into three categories: those that propose fundamental reform of the health insurance system; those that would expand existing public insurance programs; and those that seek to strengthen employer-based health insurance. The report considers whether the proposals would improve access to care, increase health system efficiency, make the system more equitable, and improve quality of care.

 Will You Still Need Me? The Health and Financial Security of Older Americans, Sara R. Collins, Ph.D., Karen Davis, Ph.D., Cathy Schoen, M.S., Michelle M. Doty, Ph.D., Sabrina K. H. How, and Alyssa L. Holmgren, The Commonwealth Fund, June 2005

Making Health Care Affordable for All Americans, Testimony before Senate Committee on Health, Education, Labor, and Pensions, Karen Davis, Ph.D., The Commonwealth Fund, January 28, 2004
We can no longer afford or tolerate wasteful spending on care that does not benefit patients, the duplication of expensive procedures, medical errors, or the high administrative costs incurred by the nation's insurers and providers. Real solutions should directly target these sources of unacceptably high costs, not simply shift costs from employers to workers or from government to the beneficiaries of public programs. Promising long-run solutions include: rewarding health care providers that achieve demonstrably better quality and efficiency, improving high-cost patient care management, reducing medical errors, improving care coordination, and simplifying unnecessarily complex or duplicative insurance practices.

"Creating Consensus on Coverage Choices," Karen Davis, Ph.D., and Cathy Schoen, M.S., Health Affairs Web Exclusive (April 23, 2003)
To catalyze movement toward consensus and action, a new Health Affairs article by Karen Davis and Cathy Schoen of The Commonwealth Fund outlines a framework for coverage expansions that could bridge differences between private and public program approaches. The framework also illustrates ways incremental steps could build toward universal coverage. To provide options for high-risk individuals and promote continuity of coverage, a new Part E would be added to Medicare for dependents of current Medicare beneficiaries, adults age 60 and older without access to group coverage, and the disabled in the two-year waiting period for Medicare. The out-of-pocket costs of the CHP plans would likely be unaffordable for those with very low or fluctuating incomes. To provide a more stable and affordable choice for low-income adults and families, eligibility for the state Children's Health Insurance Program would be expanded into a new Family Health Insurance Program, open to all individuals and families with incomes below 150 percent of poverty. Enhanced federal matching rates would offset the new costs to states.

Health Insurance on the Way to Medicare: Is Special Government Assistance Warranted?, Pamela Farley Short, Dennis G. Shea, and M. Paige Powell, The Pennsylvania State University, The Commonwealth Fund, June 2001
The survey analyses described in this report are intended to help policymakers understand better the health insurance problems that confront Americans who are approaching age 65 and Medicare eligibility. A clear understanding of these problems is crucial to deciding whether or not to proceed with incremental coverage reforms for older, "pre-Medicare" adults.

Medicare Buy-In Options: Estimating Coverage and Costs, John Sheils and Ying-Jun Chen, The Lewin Group, Inc., The Commonwealth Fund, February 2001
This paper examines the need for insurance expansions for Americans approaching retirement age and analyzes the likely impact of Medicare buy-in options on program costs and their effectiveness in reducing the numbers of uninsured.

A Workable Solution for the Pre-Medicare Population, Pamela Farley Short, Dennis G. Shea, and M. Paige Powell, Pennsylvania State University, The Commonwealth Fund, December 2000
Improving access to Medicare for those from 62 to 65 would help many uninsured older Americans. One way to achieve this would be to provide vouchers for people with low lifetime earnings, and to establish tax-favored IRAs for people with higher incomes, so that everyone could buy into Medicare at age 62. People in both the savings and voucher programs would not be required to sign up for Medicare, but would be offered a range of health insurance choices. They could buy into a Medicare+Choice plan, or purchase employer-sponsored group, retiree, or COBRA benefits if they wished. They might even purchase non-group insurance, although few would be expected to do so, because such plans tend to have the highest premiums and the narrowest benefits. In order to be eligible for funding from the savings or voucher programs, all plans would have to provide coverage that was at least equivalent to traditional Medicare.

Citation

Commonwealth Fund Resources on Medicare Buy-In for Older Adults