Debating the future of Medicare and Medicaid

    The College of William and Mary may be brimming with 18 to 22-year-olds years away from eligibility for Medicare, but today’s youth still have an important role to play in the issue of Medicare — and Medicaid — reform.

    That was the idea behind Wednesday’s Health care Reform 2009: What Does it Mean for Medicare and Medicaid? forum. A panel of four speakers gave short presentations about health care reform is it relates to both senior citizens and generation Y’ers. The forum was held at the Admissions Office Auditorium and sponsored by the Schroeder Center for Health Policy and the Thomas Jefferson Program in Public Policy.

    While some students were in the audience, members of the Williamsburg community dominated the crowd.

    Although Medicare and Medicaid do not directly affect most college students, panelists stressed that not reforming health care systems could potentially spell disaster.

    “Most uninsured adults are students,” Government and Public Policy Professor Chris Howard said. “People in their 20s and 30s are at the healthiest point in their lives — they’re not married and don’t have kids — and it seems like a rational choice to not have health insurance. But if they get cancer or get in a car accident, the costs of health care can be enormous.”

    Students could also potentially play an important role in reforming health care.

    “If students pay into a system, then those faced with unfortunate health problems will be covered,” Howard said. He added that this increased revenue will also help provide adequate coverage to all Americans.

    The point was raised that this may be a case of younger generations being used as the country’s credit card, but Howard countered that argument by warning that we can’t afford to see the cost of health care continue to rise. Without reform, future graduates might be faced with the choice of saving for a mortgage or paying for health insurance.

    The rising cost of health care led Panelist John Littel, a Vice President at Medicare and Medicaid insurance provider Amerigroup, to speak about the effects of \ health care reform on senior citizens. Littel suggested that the age of eligibility for Medicare could be lowered from 65 to 55. Employees aged 55 to 64 often feel locked into a job because of their employer-based insurance.

    Eligibility for Medicaid could similarly be expanded, Littel said. Medicaid currently insures certain groups like single-parent families, children and low-income families. With health care reform, Medicaid could expand coverage to overlooked groups such as childless adults and raise the qualifying income.

    Littel suggested that reform should focus on long-term home care to prevent unnecessary hospitalizations. The biggest expenditure for Medicaid in state budgets is long-term care, and at the staggering figure of $76,000 a year, nursing home care is too costly for most states.

    Assistant professor of public policy and Director of Community and Health Services Research for the Center for Excellence in Aging and Geriatric Health Dr. Christine Jensen stressed that senior citizens should not be put in nursing homes but given long-term services and support at their homes and clinics.

    To effectively serve senior citizens receiving Medicare, the shortage of geriatric doctors and nurses needs to be addressed, Jensen said. Furthermore, physicians accepting new Medicare patients are in short supply. Nationally, 33 percent of physicians are not accepting new Medicare patients. In Williamsburg, 25 percent of physicians have stopped accepting new Medicare patients.

    As the elderly population in Williamsburg grows and Medicare and Medicaid expenditures increase, the Virginia budget may also increase. But Grant Programs Director at the Williamsburg Health Foundation Rene Cabral-Daniels pointed out that with Virginia’s $300 million budget shortfall and the current economic downturn, appropriations for Medicare and Medicaid are not looking promising.

    “We’re at a saturation point. People won’t opt to participate in Medicare and Medicaid,” Cabral-Daniels said.

    Virginia is ranked as the 48th lowest state by Medicaid expenditures and 44th lowest by Medicaid coverage of low-income families.

    Many preventable health problems, such as adult asthma, are treated in hospitals. Littel advocated for an adequate network of specialty coverage available to Medicaid patients to diffuse an unhealthy dependence on emergency rooms.

    All the panelists agreed that health care reform is needed now.

    “There will be debate over cost and states will need a lot of assistance,” Littel said. “A lot of change won’t happen overnight, but reform will happen.”


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