Improving Health Insurance Coverage and Access to Care
Program on Medicare's Future
Task Force on the Future of Health Insurance
Health Care in New York City Program

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Since 1995, the Program on Medicare's Future has been dedicated to preserving the role of Medicare — one of the most popular and effective federal programs — in guaranteeing access to health services for the nation's elderly and disabled. Over the past year, as Congress considered proposals to reshape the structure and benefits of Medicare, the Fund provided critical information and analysis on the impact such changes would have on beneficiaries.
Much of the program's work has focused on the negative financial and health consequences of lack of prescription drug coverage. Fund-supported studies have demonstrated that even seniors who have drug benefits may not have coverage adequate to their needs, or that their coverage may not extend through the entire year. Plus, existing levels of coverage seem to be slipping downward. A recent report(1) by Bruce Stuart and colleagues at the University of Maryland documented a significant drop in the share of Medicare beneficiaries ages 65-69 with supplemental employer-sponsored health insurance, from 46 percent to just over 39 percent, between 1996 and 2000. Since employer coverage is the most reliable source of supplemental drug benefits, new retirees may increasingly face the prospect of having no viable source of drug coverage as employers continue to cut back.
The prescription drug needs of an especially vulnerable and often "forgotten" segment of the Medicare population — people under age 65 with disabilities — were examined by Becky Briesacher and colleagues at the University of Maryland School of Pharmacy and Pennsylvania State University. Their report(2) showed that disabled beneficiaries face a daunting combination of burdens — low income, high medication bills, and heavy use of medications that are typically different from those used by the elderly — yet have been largely neglected in the debate over a Medicare prescription drug benefit, with most discussion focusing on the elderly.
Disabled beneficiaries were also the focus of a recent report(3) by Dale and Verdier on the impact of Medicare's two-year waiting period. Over 1.2 million seriously disabled Americans under age 65 are waiting for their Medicare coverage to begin, of whom as many as a third have no current health insurance. The authors found that eliminating the waiting period would give people suffering from a broad range of debilitating diseases access to appropriate medical care to manage their conditions.
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Barbara S. Cooper
Senior Program Director