The Disabled and the Doctors

People with disabilities will still have to wait for Medicare

As members of Congress ticked off for the home crowds the general achievements of their narrowly passed bill Saturday, and advocates for the elderly praised the goodies for Medicare beneficiaries, nobody mentioned that one important fix which would have helped some two million people was still missing. That was ending the two-year Medicare waiting period for people with disabilities—a proposal that some pols, including Sen. Max Baucus, seemed to advocate a year ago, when everything seemed possible.

Currently, those who qualify for Social Security disability payments (SSDI) must wait two years before becoming eligible for Medicare benefits, and that’s after an onerous process to qualify for SSDI and a five-month wait before receiving those benefits. During all these waits, people tend to skimp on medical care and stop taking their prescriptions. About four percent die while waiting for their Medicare benefits to start. Annette Murph, a disabled woman in Helena, Ark., told CJR: “I thought when you were disabled, you automatically get covered.”

No media spotlight has shone on the 1.8 million people who would have been helped by a change in the rules. Apparently a solution for these very sick people didn’t rise to the same level of newsworthiness as the now overreported public plan option—which, in the end, will affect relatively few Americans if it makes it through the final hurdles.

What’s the reason for the waits? Money, of course. In 1972, Congress agreed to the waiting period as a way to stem the growing costs of Medicare. The program could save gobs of money if it didn’t have to pay disabled persons’ health care costs for a couple of years. Also, the government wanted to make sure that if disabled people still had insurance from an employer, the employer—not the government—would have to pay for their care. The Nixon administration blessed the deal, and millions of poor people have been caught in the waiting period ever since.

In the last few years, advocates for the elderly and the disabled cobbled together the Coalition to End the Two-Year Wait for Medicare, a loose coalition of advocacy groups such as the Alzheimer’s Association and the Arthritis Foundation, to fight for ending the waiting period. They didn’t have the lobbying clout of the AMA or other big stakeholders. The press followed the big players, and not the little folks who need to press to raise their issues.

The drive to end the waiting period fizzled early on. Under reform, it’s possible that some of these people, two-thirds of whom have incomes below $22,000, could qualify more easily for Medicaid. About one-third would be eligible for expanded Medicaid. But what about the rest? Perhaps some might qualify for subsidized coverage. But then they face another catch. More than half of them are over fifty, and right now Congress is planning to let insurance companies charge older people more than younger people—twice as much under the House bill and four times as much under the Senate Finance Committee bill. Many of the disabled will be back at square one, forgoing medical care until they reach the magic twenty-four months.

It was the cost thing again. “We could get no traction in Congress because of the cost,” said Joe Baker, who heads the Medicare Rights Center. To cover all the people in the waiting period would cost $113 billion over ten years—too much when the Congress had other needs for the money, like making sure doctors’ fees wouldn’t be cut. The extra money the docs want will cost the government $210 billion over ten years. Geez—that’s a little less than twice what it would cost to help out a couple million disabled people.

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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.