A Laurel to the AP

For exposing one of Medicare’s biggest holes

The press has pretty much ignored Medicare over the past year, largely because the politicians have ignored it too. Media advisers told their candidates to stay clear of Medicare, even though more than 40 million Americans rely on it for their medical care and the program faces long-term financial problems that are solvable but likely to be demagogued to death in the coming months. So it was good to see AP writer Ricardo Alonso-Zaldivar turn out a piece about Medicare’s step-children—those who receive Social Security disability benefits but must wait two years before getting Medicare coverage. They rarely get press attention, and neither does the legal provision that requires them to wait—often to the detriment of their health. Zaldivar tells us that about 1.8 million disabled workers are in Medicare limbo, and about one in eight dies during the wait.

The waiting requirement may seem perfectly Scrooge-like today, but when the Nixon administration agreed to expand Medicare in the 1970s, it worried that allowing several thousand disabled folks to get Medicare when they needed it would cost too much; what was worse, it would encourage them to game the system. Horrors! Few people actually do that. But almost all are trapped in one of the health system’s most infamous Catch-22s. If their disabilities are severe enough to get checks from the government, they can’t work, and most likely have lost any health coverage that came with their jobs. Although they may be poor, their incomes are too high—yes, too high—to qualify for Medicaid.

That was the case with Annette Murph, a disabled woman we profiled last summer in our Health Care on the Mississippi series. Zaldivar wrote about two people, a fifty-six-year-old man with cancer and a thirty-three-year-old woman with multiple sclerosis. The man cannot pay for a new scan to see if his cancer has spread; the woman needs injections to control her symptoms.

While Zaldivar didn’t mention a grassroots movement composed of Medicare and disease advocacy groups that are trying to change what Medicare advocates say is a “senseless delay” in health coverage, he did offer a clue to Congressional thinking on the matter—and it’s not clear things will change. He got this from Sen. Charles Grassley, the ranking Republican on the powerful Senate Finance Committee:

When it comes to people dying of cancer, you can’t help but be sympathetic. But at the time when we have a big downturn in the economy, it may be questionable what can be done in a lot of these areas.

Zaldivar reported that Grassley hadn’t made up his mind about repealing the waiting period. What about Finance Chairman Max Baucus? Where does he stand? It would have helped if Zaldivar had pressed Baucus. In his health care manifesto released in the fall, the senator from Montana said he favored a phase-out of the two-year waiting period. Does he still believe that? Why a phase-out? Which of the disabled are more deserving of help right now?

All this signals some interesting politics ahead, and a debate on who deserves the government’s help in the broadest sense. Zaldivar and others need to be asking these questions and tailoring their stories to local audiences. If health reform is to be incremental, then this is an increment that needs some ink. The story’s importance resonates beyond those who are disabled now: “It’s easy to think it’s not going to happen to me,” said Penn State economist Pamela Farley Short. “Just over 15 percent of those who are 55 are going to be on Medicare before they turn 65. That doesn’t seem so trivial.”

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.