Why Are Health Reform's Big Winners So Skeptical?

by Dylan Matthews | August 6, 2009

More than any demographic group, American 50 and over are skeptical of health care reform. While those aged 18-49 are equally likely to believe that health care reform will improve or worsen their own medical care, according to a recent Gallup poll those 50-64 are more likely to believe it will worsen their care, 37% to 26%, with the margin even wider (39% to 20%) among those 65 and older.

As health wonks will tell you, there's a certain irony to this. The benefits of comprehensive health care reform are arguably greatest for those between the ages of 50 and 64, who are not yet eligible for Medicare. "I cannot imagine a more vulnerable group of people," Sara Rosenbaum of George Washington University tells me, "who stand to gain more from health reform than almost anybody." If not covered by their employers, people in their 50s and early 60s have to brave the individual market, with its higher costs and limited access, especially for older people with higher medical costs. "If they can get insurance at all, and they may be in a situation where no insurer will sell to them in the individual markets, the price will be absolutely exorbitant," Rosenbaum explains. The health insurance exchange and subsidies included in the tri-committee House bill and most other Congressional proposals would greatly reduce costs for this group. "Those folks are the sob stories of health care. The 61 year-old self-employed worker who can’t get health insurance because of a prior condition, or who is priced out of the market," David Cutler, a Harvard economist and former health care advisor to the Obama campaign, says. "Premiums for those folks ought to fall a lot, they will get more choice in care, and the coverage will be a lot better. This group is one of the single biggest winners."

Why do people who stand to gain so much from health reform opposed it so vehemently? John Rother, the Executive Vice President of Policy and Strategy for the AARP, notes that seniors are already more skeptical of Obama personally than the general public, which may translate into less support for his programs--an argument supported by the Gallup data. But he also emphasizes that seniors, like most of the public, are still unclear on what health reform will specifically entail, and that the media and politicians are not generally helping. "I think for most people this is still early in the debate, and they don’t really understand what’s being proposed, and what they do hear is being, in my view, wildly distorted," he theorizes.

The situation for Medicare beneficiaries is more complicated. Medicare cost-controls are a key element of most health reform proposals, which makes opposition by those 65 and older more understandable. Still, it is doubtful that reform would affect their coverage substantially. "They’re being scared with rhetoric that Medicare is being cut or that it’s going to be a smaller or slimmer program coming out of health reform," says Joseph Baker, president of the Medicare Rights Center. But, as Baker explains, these fears are misplaced. "The cost savings associated with Medicare are cost-savings that make the program more sustainable, that attempt to improve quality in the program at the same time that they lower costs," he argues. Rosenbaum agrees. "The irony here is that all of these changes have been taken to stabilize the program going forward, to make sure that the trust fund remains viable, and instead of people understanding that the changes were made in order to keep the program viable, it has been portrayed as slashing and burning of the Medicare program," she laments. Cutler acknowledges that there will be some reductions in Medicare payments, but argues that these will generally not be noticeable to beneficiaries. "If one wanted to tell the apocalyptic story, you’d talk about access problems that might result, but no one believes those at the levels we are talking about," he explains.

Both Baker and Rother are emphasizing the benefits of health reform to the seniors they represent. Baker focuses on the tangible benefits for Medicare recipients in the Congressional proposals, like increased funding for low-income Medicare recipients and the closing of the "donut hole" in Medicare Part D wherein the program does not pay for seniors' prescriptions. Rother is focused on reassuring AARP members that they will not lose coverage, but believes that Obama needs to focus more on what voters stand to gain from health reform. "I don’t think people understand yet just how much money they would save compared to being in the individual market today," he says. "We’re talking $4,000 to $5,000 a year in savings for some people. Once we get to a point where we can be specific about that, that’ll help people come around."

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