Younger adults no doubt have other things to think about besides today’s 56th anniversary of Medicare and Medicaid. Earning a living wage, buying a home, raising children — or even pursuing adventure and self-exploration — naturally may be more front of mind. Indeed, today’s younger adults were decades away from being born when President Lyndon Johnson signed both landmark social programs into law on July 30, 1965.
“Medicare isn’t really on my radar at all,” says Charlotte, a 27-year-old youth educator from Dallas, whose unfamiliarity with the nation’s largest federal health care program may be typical of many young adults. “I’m just trying to think about the next few years. I only recently learned what a 401K is!”
But that doesn’t make Medicare — or Medicaid — any less relevant to younger people, because they most certainly will need at least one of those programs during the course of their lives, most likely in older age. In fact, Medicare and Medicaid were built to last — to provide health security for generations of Americans to come.
Millennials with aging parents may already be aware of the crucial role that these programs play. Behnam, 36, a digital media specialist from McLean, Va., says Medicare was there for his 78 year-old father when he needed a pacemaker. “Medicare paid most of his hospital bills. Without it, the cost to my parents would have been crazy. Now, I have a better appreciation of what Medicare does.”
For 56 years, Medicare has provided health insurance to Americans 65 and older. It was enacted because private insurers typically wouldn’t cover older people at a reasonable price, leaving too many seniors desperately lacking health care. Its sister program, Medicaid, was created to provide health insurance to lower-income Americans who couldn’t afford private insurance. Medicaid also covers long-term care for lower-income seniors — like nursing homes and, more recently, home and community- based care (a healthier and safer alternative). In fact, Medicaid pays more than 60 percent of long-term care costs in America today.
By 2050, there will be 81 million people over age 65 in America. Seniors will make up nearly 20 percent of the population. With the adequacy of retirement savings in doubt and health care costs ever-rising, these future seniors most certainly will rely on Medicare and Medicaid even more than the current generation does. (Medicare will have some 30 million more beneficiaries by the time older Millennials become eligible.)
“With health care so unaffordable right now, I’m sure Medicare will be crucial to my health going forward,” says Lance, 30, a grassroots coordinator in Washington, D.C. Charlotte from Dallas agrees. “Just because Medicare doesn’t directly affect you today doesn’t mean it’s not important for the future.”
But to truly meet the health care needs of future (and current) seniors, both Medicare and Medicaid must be expanded. As substantial as Medicare is, it still does not cover basic dental, vision, and hearing care — which many older Americans simply cannot afford on their own. Not only do seniors need coverage for their eyes, ears, and teeth just like everyone else —inadequate dental, vision, and hearing care can cause serious and sometimes fatal health outcomes.
At long last, there is movement in Congress to add these vital coverages. In fact, Medicare expansion is part of President Biden’s 2022 spending package now making its way through the legislative process. This is a ripe opportunity (which may not soon recur) to finally give seniors health coverage from the ‘neck-up’ that they so obviously lack.
Democrats also are angling to give Medicare the power to negotiate drug prices with Big Pharma, which could help lower soaring costs at the pharmacy counter for older and younger adults. The VA health system, which has been negotiating drug prices for years, pays 40 percent less than Medicare in annual drug costs.
Thirty-six year-old Benham says that the campaign to reduce drug prices has helped bring Medicare’s importance into sharper focus for people his age. “Big Pharma price gouging resonates on social media. If Medicare drug price negotiation knocks the drug industry down a peg, I’m for that.”
Tomorrow’s Medicare beneficiaries also will not want to contend with excessive out-of-pocket costs for prescription drugs. A new Kaiser Family Foundation survey found that “nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period.” The catastrophic cap is $6,550. That’s too high. There were bipartisan efforts in the last Congress to significantly lower the cap for patients’ out-of-pocket costs. Reviving those efforts should be a high priority for the current Congress.
The expansion of Medicaid also is crucial for younger adults. Before the Affordable Care Act expanded Medicaid eligibility to 138 percent of the federal poverty line, Millennials were the most uninsured age group in the country. Since the ACA went into effect, Millennials have outpaced every other age group in obtaining health insurance. (Unfortunately, younger adults still exceed other age groups in the amount of medical debt they carry.)
Thirty-nine states (including D.C.) have adopted Medicaid expansion since the ACA went into effect. But twelve states have so far refused, preventing millions of people from acquiring affordable health care. Those states should put their citizens’ health above political ideology and expand Medicaid now.
Some younger adults may not realize that many of their peers rely on Medicaid for health care. Claire, 37, a single mother in Gaithersburg, Md., who didn’t have employer-provided insurance, enrolled in Medicaid when she developed MRSA — a staph infection that is difficult to treat. “Medicaid really helped me,” says Claire. “I wouldn’t have been able to get care otherwise. I had my daughter’s tonsils removed last year and didn’t have to pay a dime.”
Unfortunately, too many of our elected leaders claim that, instead of expanding Medicare and Medicaid, both programs must be cut in order to address the federal debt. (Never mind that Medicare, to a large extent, is funded by workers’ payroll contributions and beneficiaries’ premium payments.) These same politicians were perfectly willing to give the wealthy and big corporations a nearly $2 trillion, deficit-swelling tax cut in 2017. This is not only cynical, but incredibly short-sighted. Providing younger adults with affordable, quality health care now will save the federal government money when these same people get older.
The belief that affordable health care is a right, not a privilege, has underpinned our federal health care programs since they were enacted 56 years ago. The future of Medicare and Medicaid is a moral issue – and an existential one. Just as we grapple with climate change and the question of what kind of world we leave our children and grandchildren, we must ensure that America’s younger generations have the health care they will need in the mid-21 st century.
Younger adults must also play a role in this effort, because their future health depends on it. They, like all other Americans, have lived through a historic pandemic that has taken a toll on beloved family members and friends — especially the elderly. They have witnessed firsthand that affordable, quality health care can literally mean the difference between life and death. Whether Gen X, Millennial, or Gen Z, our younger generations must be engaged in a political process that affects their future. They should stay informed, vote for candidates who support expanded health care, and contact their elected leaders to demand action.
“You can’t take these things for granted,” says Lance, the 30-year-old grassroots organizer. “Politicians respond to public pressure. We’ve seen it many times before. You have power.
So get organized, and get involved.”
Max Richtman is president and CEO of the nonprofit National Committee to Preserve Social Security and Medicare. He is former staff director of the U.S. Senate Special Committee on Aging.