The tentative House-Senate compromise on a Medicare bill reportedly includes a provision for wealthier Medicare recipients to pay larger premiums for their doctor and other out-of-hospital coverage. The idea that wealthier Medicare recipients should pay more for their healthcare than lower-income recipients do -- referred to as "Medicare means testing" -- is controversial.
An Oct. 24-26 Gallup Poll* reveals that Americans' opinions are about evenly split on this concept. When asked whether Medicare payments should be based on the patient's income, or if they should be the same regardless of income, 48% said payments should be based on income and 50% said they should be the same regardless of income.
The percentage of Americans who believe that Medicare payments should be the same regardless of income has increased since 1990, from 37% to 50%. At the time of the 1990 poll, adverse public reaction had recently forced the repeal of 1988 Medicare legislation to protect against catastrophic health expenses, which had included Medicare means testing. Before passing new legislation, lawmakers would do well to remember the impact that public opinion had on this issue over a decade ago.
Division in Support
An examination of the groups most likely to support Medicare means testing helps explain why the concept has been so divisive, yet so resilient. Americans younger than age 65 are evenly divided in their views -- 50% favor payments based on income and 50% favor equal payments regardless of income. Older Americans, on the other hand, show a slight preference for equal payments (52%) over payments contingent on income (40%), while the rest are undecided.
Seniors, many of whom have seen low interest rates and a weak stock market cut into their incomes, are more likely to want to protect Medicare benefits. Means testing is bound to be less popular among older Americans, who fear they will face increased medical costs in the face of a fixed or declining income. On the other hand, younger people are not yet facing these types of expenses, and many may already be concerned about the future financial viability of Medicare. Surprisingly, support for Medicare means testing does not vary significantly according to respondents' household income.
Level of formal education is a factor, however, with differences observed between those who have a high school education or less, and those with more education. Fifty-three percent of Americans with at least some college education support Medicare means testing, compared to just 39% of those with a high school education or less. Opinion also differs slightly by political affiliation. Fifty-three percent of Republicans favor making Medicare payments contingent on a patient's income, while just 41% of Democrats share this view. Fifty-six percent of Democrats favor equal Medicare payments regardless of income.
An early November Gallup Poll shows that 25% of the U.S. population feels that access to healthcare is the most important health problem facing the country today. Opponents of Medicare means testing contend that creating more obstacles to healthcare access within Medicare could set a bad precedent, leading to an overall trend toward reduced healthcare access for the population as a whole.
But despite the divisive nature of public opinion on Medicare means testing, it is easy to understand why legislators continue to revisit it. What will be the cost of providing the same Medicare access for all seniors? The aging baby boomer generation will soon be eligible for Medicare, and as life expectancy increases, this group will be collecting Medicare longer. This bubble will dramatically increase the overall cost of Medicare. Where will the money come from? Furthermore, what will happen once needed additions to the Medicare program -- such as prescription drug coverage -- are added?
It looks unlikely that Congress will pass legislation on this controversial issue in the remaining days of its current session. But the issue of means testing will still be waiting when Congress returns.
*Results are based on telephone interviews with 1,006 national adults, aged 18 and older, conducted Oct. 24-26, 2003. For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error is ±3 percentage points.