Academics Screw Up Medicare in New RomneyCare Research

A "new" academic research article dated October 2011 about Massachusetts health care reform has become available in the last few days on this Austrian-based website. The "new" research has all kinds of problems in general -- in the data it uses, in its methodology, and so forth -- but on page 29, the article contains the following statement about Medicare in Massachusetts (removing some academic references):

“One striking result from the subsample analysis is that the reform appears to have influenced the health of those over 65 despite their access to Medicare. Not all seniors are eligible for free Medicare Part A, only those who have paid Medicare taxes for at least ten years (or whose spouse has done so). Indeed, Kolstad and Kowalski observe a modest but statistically significant decrease in the uninsured rate of those aged 65 to 74 following the reform. Moreover, Part A only covers hospitalization – not physician services or prescription drugs – and has an $800 deductible plus co-payments after 60 hospital days. Filling these gaps in coverage requires the purchase of Medigap, Medicare Part B/Medicare Advantage, and Medicare Part D plans. Kolstad and Kowalski show that Chapter 58 increased the proportion of seniors reporting Medicaid (rather than Medicare) as their primary source of insurance, suggesting that the reform resulted in some seniors obtaining more comprehensive coverage...”

That paragraph contains both incorrect and misleading information and is potentially injurious to senior citizens who might happen to stray across it (or worse -- another bunch of eggheads might think it accurate and use it as their research). 

The paragraph is incorrect because the Part A deductible is $1156 at present, not $800. The authors of the research cannot be held to be accurate about 2012 for an article dated October 2011 but I cannot find any year that the Part A deductible was exactly $800, In 2001 it was $792 and in 2002 it was $812 (see http://archive.hhs.gov/news/press/2001pres/20011019.html). It has continued to rise to its current amount almost yearly. What were they thinking?

This may seem like a small error but it sets the stage for the following misleading and potentially injurious information. In addition, presumably since the authors wrote the paragraph the way they did, the exact wording has some implication for their findings (although I admit I cannot easily find a connection).   

For example, although it is correct to say

 "Not all seniors are eligible for free Medicare Part A, only those who have paid Medicare [payroll] taxes for at least ten years (or whose spouse has done so)..."

I cannot imagine why the authors would say it that way or what it would possibly have to do with RomneyCare. The vast majority of seniors are in the second group (well over 90%). In Massachusetts at least, the rare exceptions tend to be older retired government employees who have government-funded pension/retiree-health plans (and therefore did not pay S/S taxes before the Reagan/O’Neill changes to S/S in 1985 or so) or very rich people who lived off investment income their whole lives. 

 (Also -- and this is most important in terms of how they are injuring senior citizen knowledge of Medicare – Part A covers ONLY hospitalization where the patient has been admitted, not all hospitalization.  If in for observation or outpatient reasons, Medicare Part B is the relevant Medicare plan.)

Furthermore, no one in any way involved with Medicare would say

 

"Filling these gaps in coverage requires the purchase of Medigap, Medicare Part B/Medicare Advantage, and Medicare Part D plans."

The authors have it almost completely backwards:

1. Almost everyone who has A has B. The only reason not to have B (seniors actually do not choose to buy B; they have to opt out of it) is again because a government or private retirement plan already covers doctors visits and outpatient and observation hospital visits, or you are Medicare age but not yet retired (and therefore still get employer sponsored insurance). Part B costs just under $100 a month, covering 25% of the total government outlay per the original Medicare law (B is not some kind of private market afterthought as implied by the academics).
2. Fewer people have Part D drug coverage because again some retiree plans cover drugs, because it is included in C plans, or because the seniors do not take drugs (this third reason could be a financial mistake however because there is a penalty for waiting to sign up for D until you need it)
3. Medicare Advantage is Medicare Part C and is the second most popular way (after retiree insurance) to fill the gaps in A and B. Part C often adds drug coverage, annual physicals, vision, dental and other benefits such as discounts on over the counter medical needs found no where else in Medicare
4. Medigap is the least popular choice as a means to fill the A/B gap, not the first as in the academics' list.  It does not include drug coverage, annual physicals, vision, dental, and other benefits and in Massachusetts is often more expensive than C, especially when a Medigap premim is combined with a D premium.  Most people go to Medigap only if they do not have retiree insurance, do not have a good Medicare Part C choice in their county, or do not qualify for low income assistance to make up for the shortfalls of A and B Medicare (often the low-income assistance is in the form of helping the senior buy a Medigap policy)
5. Over 90% of seniors in Massachusetts fall in to categories 2-4 above. Less than 10% of Medicare-eligible beneficiaries choose only A and B

The academics' sentence about more seniors reporting Medicaid as their primary source of insurance does not make any sense given federal and Massachusetts dual-eligible rules. They cannot find any more comprehensive coverage because of RomneyCare since RomneyCare has nothing to do with Medicare.   

Finally IF – although I think it unlikely – there is anything to their predictive model as it relates to those under 65 and IF that model also applies to those between 65-74, there is a much more obvious and direct reason. Rather than indirectly concocting a forced tie-in between the alleged improved health of Massachusetts’ pre-elderly seniors to RomneyCare, which had no relation to Medicare because Medicare is a Federal program, any improvement (should there turn out to be one) would be more likely tied to the massive changes in Medicare that happened coincidentally at the same time as RomneyCare under the sponsorship of George Bush.  

But again – as with all the research's stretched findings about RomneyCare and Medicare -- everyone has to just wait and see.  Especially because RomneyCare has been changed three times since it was passed because even the Democrats here in Massachusetts think it is a failure.