Medicare at 67: The next big change?
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President Barack Obama and House Speaker John Boehner failed to strike a "grand bargain" on the nation's deficit, but they may have pulled off another trick: revolutionizing the debate over Medicare.
When they both accepted the idea of increasing the Medicare eligibility age to 67, they gave a controversial idea more legitimacy and high-profile support than it's ever gotten before.
The White House's Fiscal Commission, led by Erskine Bowles and Alan Simpson, listed the idea of raising the eligibility age with the likes of such dramatic structural changes as the public option, block grants or an all-payer system. Alice Rivlin and former Sen. Pete Domenici didn't even bring up the idea in their deficit report. And the top Democrats in both the House and Senate brushed aside the concept just last month.
But now the idea of raising the eligibility age has gotten the support of Obama and Boehner. While the age change is not expected to be part of the latest debt ceiling compromises, the idea is now likely to be a permanent fixture in the Medicare debate and, someday, to become a reality.
The idea has been loosely supported by Republicans in the past.
When Sens. Tom Coburn (R-Okla.) and Joe Lieberman (I-Conn.) introduced a bill last month gradually moving the eligibility age up by two years, Democrats ran from it. House Democratic
Leader Nancy Pelosi called it "unacceptable" and said, "it is unfair to ask seniors to get less in benefits and wait longer to get onto Medicare."
Senate Republican Leader Mitch McConnell didn't endorse the Coburn-Lieberman proposal but applauded the effort. Grover Norquist's Americans for Tax Reform backed the plan.
The argument in favor of moving the eligibility age is that when Medicare was created in 1965, Americans were not living as long. The program is now one of the nation's greatest cost drivers.
"Because of increases in life expectancy, the average length of time that people are covered by Medicare has risen significantly since the program began in 1965," the Congressional Budget Office wrote in March. "That trend, which increases the program's costs, is expected to continue."
The health care reform law — which in 2014 bans insurers from turning down any patient — could make moving the eligibility age up more politically palatable because 65-year-olds would, in theory, still have access to private coverage.
"But it assumes a lot of things, including that all the changes in the reform law work as advertised," said Eric Zimmerman, a Medicare lawyer at McDermott Will & Emery.
That also means that any change to Medicare eligibility is unlikely to pass until the health law's exchanges and subsidies are in place in 2014 and Americans become comfortable relying on them.
"It's not to say we won't get there eventually," said Mary R. Grealy, president of the Healthcare Leadership Council. But she suggested that changing the Social Security eligibility ages may be politically easier. "People already have in mind that they're working longer. But they worry if they don't have health insurance."
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