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AMERICA’S SENIORS AND MEDICARE: CHALLENGES FOR TODAY AND TOMORROW

(The following information is excerpted from a National Economic Council report entitled America’s Seniors and Medicare. http://www.whitehouse.gov/WH/New/html/Medicare2000/.   The entire report is in Adobe Acrobat format and requires a downloadable reader. The full report includes a State-by-State analyses of current Medicare coverage.)

Medicare has successfully improved the health and quality of life for millions of seniors and people with disabilities. Yet, enrollment will double over the next 30 years (from 39 to 80 million beneficiaries); Medicare has not been given the tools it needs to be as competitive and efficient as it needs to be in the 21st century; and despite modern medicine’s reliance on pharmaceuticals, the program does not cover prescription drugs.

MILLIONS OF AMERICANS RELY ON MEDICARE
Medicare beneficiaries comprise an important and growing part of all states’ residents. While over half (54 percent) of beneficiaries live in the 10 most populated states, states with the highest concentration of elderly are often smaller (Arkansas, Florida, Iowa, North and South Dakota, Pennsylvania, Rhode Island, and West Virginia). Nationwide, nearly 5 million Medicare beneficiaries are non-elderly people with disabilities. States with the highest proportion of disabled beneficiaries tend to be in the south (e.g., Mississippi, Kentucky, West Virginia, Alabama, and South Carolina).
Women beneficiaries outnumber men in all states. Nationwide, 57 percent of Medicare beneficiaries (22 million) are women. This distribution of women to men is remarkably consistent across all states, ranging from 51 to 59 percent.
40 states have more than 1 in 10 beneficiaries age 85 or older. These 4 million beneficiaries have spent almost one-quarter of their lives on Medicare. States in the upper midwest (e.g., North and South Dakota, Minnesota, Nebraska, Kansas, and Iowa) have the highest proportion of "old elderly."
In 15 states, more than half of Medicare beneficiaries live in rural areas. In fact, in Mississippi, Montana, North and South Dakota, Vermont and Wyoming, over two-thirds of beneficiaries live in rural areas. The 9 million beneficiaries nationwide (about one-fourth of all beneficiaries) living in rural America typically have few to no options for managed care or prescription drug coverage.
Poverty among the elderly has been reduced by nearly two-thirds since Medicare was created. Medicare has contributed to this dramatic improvement by helping seniors pay for the potentially devastating cost of health care when they can least afford it. Nationwide, the elderly poverty rate declined from 29 to 11 percent from 1968 and 1998. In 10 states, the elderly poverty rate fell by 75 percent or more.

MEDICARE ENROLLMENT WILL SURGE
30 states will have one-fifth or more of their population who are elderly in 2025 – compared to no states today. About 62 million Americans will be age 65 or older in 2025 compared to 35 million today. In Florida, where 18 percent of state residents are elderly today, about 5.5 million people – over 25 percent of residents – will be elderly in 2025 as the baby boom generation retires. Nationwide, this demographic increase is over 75 percent from 2000 to 2025, and is over 100 percent in 15 states.
8 states have more than a third of their 55 to 65 year olds who have no or undependable health insurance. People ages 55 to 65 are the fastest growing group of uninsured – and are at great risk of becoming sick. About 6 million people age 55 to 65 are uninsured or have individual insurance, which is typically age-rated, underwritten based on health status, and can be denied. The baby boom generation is about to turn age 55 – which will create an even bigger access problem.

MEDICARE BENEFICIARIES NEED PRESCRIPTION DRUG COVERAGE
16 states have 20 percent or fewer firms offering health insurance to retirees. Nationally, 22 percent of firms offer health insurance to retirees older than age 65. No state has more than 30 percent of firms offering this coverage. Trends suggest that this coverage will continue to decline, so that very few seniors will get their prescription drug coverage through their former employers in the future.
Individual Medigap insurance with prescription drug coverage costs twice as much in high-cost states. The average premium for a 65-year old for Medigap Plan H that includes drug coverage among other benefits is about $135 per month, but exceeds $150 in 9 states. The part of the premium that is attributable to drugs alone can be $90 per month or $1,080 per year for coverage that is limited to $1,250 per year with a $250 deductible. Moreover, in most states, insurers "age rate" or increase premiums as people get older, making insurance more expensive when seniors can least afford to pay for it.
There are no Medicare managed care basic plans with prescription drug coverage in 15 states. About 2 out of every 5 Medicare beneficiaries lacks this prescription drug option. Medicare managed care plans have, in the recent past, offered prescription drug coverage to attract beneficiaries. However, this coverage is becoming limited. Nationwide, nearly three-quarters of plans cap benefits at or below $1,000, compared to 35 percent in 1998. Similarly, the proportion of plans that limit drug coverage to $500 or lower has increase by 50 percent between 1998 (from 19 to 32 percent).
Most seniors are middle income and would not benefit from a low-income prescription drug benefit. About 15.6 million or half (49 percent) of all elderly have income between $15,000 and $50,000. Only in Louisiana, Mississippi, New Mexico, Rhode Island, South Carolina and Texas are there more poor than middle class seniors. Nationwide, over half of beneficiaries without drug coverage have income above 150 percent of poverty ($12,750 for a single, $15,000 for a couple). Thus, a prescription drug benefit targeted to low-income will not help most seniors.

HEALTH CARE PROVIDERS RELY ON MEDICARE

Health care providers depend on over $200 billion a year in Medicare spending, accounting for one-fifth of all funding. This does not even count beneficiary payments which comprise nearly half of their total health spending. Medicare spending exceeds 20 percent of all health spending in 12 states. Nationwide, over 5,100 hospitals, 800,000 physicians and nearly 15,000 nursing homes care for Medicare beneficiaries.