Health care plan for 'near elderly' considered 3 million Americans aged 55 to 64 years have no coverage now


Having succeeded in extending health care coverage to millions of children, the White House and some members of Congress are now turning attention to another group of uninsured Americans -- the 3 million who are 55 to 64 years old.

The people in this age group, called the "near elderly," are too young for Medicare, the insurance program for those 65 and over, and not poor enough for Medicaid, the program for the indigent and disabled. Many have chronic illnesses such as diabetes, high blood pressure, ulcers and bladder and kidney conditions that require extensive and costly care.

Administration officials say President Clinton may propose a means of aiding this group in the 1999 budget that he will introduce early next year, though the specifics of a plan have not been reached. With little room for new spending, one possibility might be to allow those who want Medicare coverage before they are 65 to have it in return for lower Social Security checks after age 65.

But any proposal is likely to get a cool reception in the Republican-led Congress. In view of the commitment to tight budgets and the Republican leadership's reluctance to start new programs, a senior Republican aide said: "I find it hard to imagine that Congress would at this time enact a new entitlement. Even if the beneficiaries shared in the cost, it would still be very costly."

Many of the uninsured near elderly lost jobs and health benefits in the corporate downsizing this decade, while others, often self-employed, have never had insurance. Private coverage that costs $500 a year for children costs $5,000 for the healthiest among those 55 to 64. The unhealthiest are simply denied coverage unless they have it through current or former employers.

"A high percentage are involuntary retirees," said Ronald Pollack, president of Families USA, a health care advocacy group representing people of all ages. "They've been laid off, induced into retirement or they're unhealthy. They're not likely to be white collar professionals. At this juncture, there are no safety valves for these folks."

With last summer's budget agreement allocating $24 billion over five years to extend coverage to half the nation's 10 million uninsured children, "the near elderly are the next bite of the apple," said a spokesman for Rep. Pete Stark of California, the ranking Democrat on the health subcommittee of the House Ways and Means Committee, and a leading proponent of aiding the near elderly.

But some health care experts question whether, in a period of

fiscal restraint, this group should be the first to follow children among the nation's 41 million uninsured to receive help with their health coverage. According to the Employee Benefits Research Institute in Washington, 13.4 percent of those aged 55 to 64 lack insurance, about half the percentage for people 21 to 29.

"I don't think they're the most deserving," W. David Helms, president of the Alpha Center, a health care research organization in Washington, said of the near elderly. "We have a class of uninsured low-income adults, regardless of age."

"But when we didn't get national health care reform," Helms said, "we did not have the conversation of what will we do for those people who don't have coverage."

Advocates for the elderly are raising the alarm in part because one obvious option facing a bipartisan commission on keeping Medicare solvent is phasing in a raise in the eligibility age for Medicare from 65 to 67, thus adding millions more to the ranks of the uninsured.

Raising the age has some appeal in Congress, which has already approved a phased-in rise in the eligibility age for full Social Security benefits from 65 to 67 to keep that program afloat.

For some lawmakers and lobbyists, the issue of medical coverage for the near elderly has become urgent. That is because, with members of the baby boom generation entering their 50s, the number of near elderly will surge to 30 million by 2005 from 21 million now.

Pub Date: 11/24/97

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