Dear President-elect Trump,
I am writing this letter to you as a health care provider practicing in Washington state. The following is my opinion regarding your proposals to increase the age for Medicare eligibility, raise premiums and overhaul our current system.
Currently, Medicare provides health insurance to Americans 65 and older who have worked and paid into the system through payroll tax. It also covers younger people with some disabilities such as end stage renal disease. In 2015, Medicare covered over 55 million people; 46 million were age 65 and older, and 9 million were younger people.
As you seek to “modernize Medicare,” keep in mind that raising premiums and the age of Medicare eligibility will put millions of patient at risk without coverage. We know that the number of Americans ages 65 and older is projected to more than double by 2060. Even though older adults are working longer and the ratio of workers to retirees is on the rise, we also see that the aging population requires more health care dollars. Demand for elder care will also be fueled by a steep rise in the number of Americans living with Alzheimer’s dementia, which will triple by 2050.
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Raising the age of Medicare eligibility would save $113 billion over 10 years, but only after accounting for the necessary expansion of Medicaid and state health insurance exchange subsidies under health care reform. This is needed to help those who could not afford insurance to buy it.
If the Affordable Care Act is repealed, something better has to replace it. As an advocate for my patients, I urge you to think twice before making these drastic changes that will affect so many lives.
The Kaiser Foundation found that increasing the age of eligibility to 67 would save the federal government $5.7 billion a year, while raising costs for other payers. It will cost $3.7 billion for 65- and 66-year-olds and $2.8 billion for other consumers whose premiums will increase as insurance pools absorb more risk. We depend on a younger, healthy population, who pay premiums yet are not frequent users of the health care system.
It will also affect people who depend on their employers for health care coverage. Employers offering insurance can expect to shell out $4.5 billion if the Medicare eligibility age is increased. This will absolutely affect employees and their families. Such a plan would raise total society costs by more than twice the savings to the federal government.
Your efforts should be toward helping people afford their medications and maintaining their quality of life. Even though Medicare Part D went into effect in 2006 to help people afford prescription drugs, no part of Medicare pays for all of a beneficiary’s covered cost. Most often the standard options are lacking and require patients to buy double coverage.
Medicare prescription drug plans have a coverage gap called the “donut hole.” Not all, but many Medicare beneficiaries will reach a yearly temporary limit on what their drug plan will cover for medications, which can severely affect patients near the end of the year. The amount patients pay for prescriptions suddenly increases.
Due to health care reform, patients no longer have to pay the full cost of drugs during this hard period. In 2016, there is a 55 percent manufacturer’s discount for brand name and 42 percent discount on generic drugs. Even with these discounts, there are still patients who may go without much needed high-risk medications, such as anti-epileptics and blood thinners that help to prevent blood clots.
The idea of a single-payer national insurance program administered by the government seems like a good idea. It is working for many countries, including Canada and Scotland. The reasons universal health care works is because the government pays for care for ALL its citizens. This includes patients 65 and older as well as those younger. How we care for our aging population speaks volumes. Remember, you are also in this category.
Sincerely, Lan H. Nguyen, MD, MHA.
Lan Nguyen, a primary care physician, is a member of The Olympian's 2016 Board of Contributors. She may be reached via email@example.com