WASHINGTON — The Concord Coalition today cautioned that a proposal by
President Clinton to expand Medicare risks making the program even more
unsustainable than it is today. However, Concord hopes the proposal will
open a debate over how much Medicare should subsidize health coverage for
people both below and above age 65 and at what age, if any, the existing
subsidy should be universally available, regardless of income.

WASHINGTON — The Concord Coalition today cautioned that a proposal by
President Clinton to expand Medicare risks making the program even more
unsustainable than it is today. However, Concord hopes the proposal will
open a debate over how much Medicare should subsidize health coverage for
people both below and above age 65 and at what age, if any, the existing
subsidy should be universally available, regardless of income.

"Everyone agrees that Medicare is unaffordable in its present form, so it’s
difficult to understand why we should make it even more unsustainable
through this type of expansion," said Concord Executive Director Martha
Phillips. "We are very skeptical of the idea that Medicare can be expanded
to cover those between the ages of 62 and 64 without substantially adding
to the program’s costs."

While the White House claims the cost of the Medicare expansion would be
covered by a steep monthly premium for those who choose to begin coverage
at ages younger than 65, the Coalition is doubtful that the premium could
keep pace with rapid health care inflation over the long run.

The Coalition pointed to Medicare Part B as an example of how difficult it
is for the President and Congress to raise beneficiary premiums to keep
pace with inflation.

When Medicare was established in 1965, the Part B premium was set at a rate
to cover 50 percent of program costs. But as health care inflation greatly
outpaced the economy, the Part B premium did not keep pace. It now covers
only 25 percent of program costs, with the remaining costs ($58 billion in
FY 1987) paid for out of general government revenue.

During the 1995 budget debate, the Clinton Administration opposed a plan to
keep Medicare Part B premiums at 31.5 percent of program costs. As a
result, Part B premiums dropped from a monthly $46.10 to $42.50. Over the
past two years, the premium reduction has cost the government $2.5 billion.

Concord also warned that setting the early buy-in premium high enough to
cover the program’s full costs would make it unaffordable for many middle
and low-income beneficiaries, therefore raising the pressure on policy
makers to subsidize the plan for those who couldn’t afford it.

Phillips said that rather than proposing an immediate expansion of the
fast-growing Medicare program, the Clinton Administration should be
debating how to prepare it for the retirement of the massive Baby Boom
generation.

"Medicare’s short-term funding problems, while substantial, are dwarfed by
its need to accommodate the massive Baby Boom generation," Phillips said.
"Even without this proposed expansion, the burden the Medicare program will
place on future taxpayers will be great."

She said the debate should be expanded to a careful examination of how much
Medicare subsidy working age taxpayers ought to be required to provide to
recipients at various ages and income levels.

The Concord Coalition has long advocated that Medicare’s eligibility age
should be raised to 67 in tandem with the scheduled increase in Social
Security’s eligibility age. Concord also favors means testing Medicare
subsidies according to people’s ability to finance some or nearly all of
their health insurance.

Medicare Part A annual spending already exceeds revenues from the payroll
tax by about $26 billion and is projected to run even greater deficits in
the future. Even when interest income and trust fund assets are added in,
the program is projected to be insolvent by 2010 — before the first Baby
Boomer is eligible (even at age 62).

 

Medicare Part B is even worse shape. Insolvency is not an issue with Part
B because it has an open pipeline to the U.S. Treasury. Any gap between
expenditures and income is automatically filled with general revenues. In
their April 1997 report the Public Trustees of the Medicare system warned,
"Continued [Part B] growth at current rates will ultimately lead to costs
which exceed the capacity of the funding sources — Federal general
revenues and beneficiary premiums — to provide benefits."

 

The combined annual cash deficit for Medicare Parts A and B was
approximately $80 billion in 1997.

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