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Letters to health-care Santa: The disabled have waited long enough

Pollack_0810.0080_web.jpgOver the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee, and publishing their responses on the blog. So please welcome Harold Pollack, the Helen Ross Professor at the School of Social Service Administration, and faculty chair of the Center for Health Administration Studies. Pollack is also co-director of the University of Chicago Crime Lab. He has published widely at the intersection of poverty policy and public health.

I would immediately abolish the waiting period before Social Security Disability Income (SSDI) recipients become eligible for Medicare. Recipients are now required to wait two years. These men and women have already been deemed disabled through a rigorous and sometimes lengthy process. Uninsured or underinsured people suffering from multiple sclerosis and other serious conditions burn through life savings or skip pills while waiting for Medicare coverage.

Before the current health reform debate, the Congressional Budget Office estimated that eliminating this waiting period would cost the federal government about $12 billion annually, some of which would be offset by reduced burdens on state governments. (I have sometimes criticized CBO. Yet an issue like this -- which reflects the complicated interplay across different state and federal programs — highlights CBO’s indispensable role.)

Senator Baucus raised this issue in his original health reform white paper. House and Senate bills do not directly address the issue. Expanded Medicaid eligibility will certainly help, but these provisions will not be implemented until at least 2013. The mandatory waiting period reflects a policy rationale that has outlived its usefulness in an era of individual mandates and the aspiration to universal coverage. We should start right now by treating people decently when they face difficult challenges of chronic illness and disability.

Earlier in this series, Diane Archer called for Congress to create national exchanges rather than state exchanges, Alain Enthoven offered some ideas for how to fix the exchanges, David Cutler proposed a soda tax, Austin Frakt argued for competition in the Medicare Advantage program, Jacob Hacker broached letting the public sector help the private sector negotiate lower rates, George Halvorson tried to expand the exchanges to include providers of actual care rather than just insurance coverage, Henry Aaron wants the death panels back, Jon Gruber wants the House's definition of decent insurance coverage to prevail, and Victor Fuchs would like to turn the exchanges over to Ron Wyden.

By Ezra Klein  |  December 23, 2009; 1:23 PM ET
Categories:  Health Reform  
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Next: Life after the first year


I'm curious to see of SSDI applications go down as I know anecdotally of some who only apply to SSDI as an avenue to Medicare. With the removal of denials based on pre-existing conditions, maybe we'll see a drop off.

Posted by: ThomasEN | December 23, 2009 1:31 PM | Report abuse

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