Honor Women’s History Month: Preserve a Strong Medicare Program

March is Women's History Month, honoring generations of women who have made, and are making, invaluable contributions to society. The Medicare program has been a critical lifeline for American women and their families for decades, contributing to lower poverty rates and providing health and economic security. Because women constitute the majority of beneficiaries on Medicare, depend on the program longer, and live on lower incomes than men, the implications of Medicare changes being discussed by policymakers are of significant concern for women who currently rely on, or expect to rely on, this very successful community program.

Women Rely on Medicare for Health Care Needs

Older and disabled women disproportionately rely on Medicare. Women make up over half of total Medicare beneficiaries, and 70% of beneficiaries over the age of 85.[1] Women have longer life expectancies (an average of five years longer than men in 2010) leading them to depend on Medicare for longer periods than men. They also have greater health care needs that render Medicare coverage a critical lifeline for themselves and their families.[2] Women experience higher rates of chronic health conditions including arthritis, hypertension, and osteoporosis, and are more likely to report having three or more chronic conditions (recent data shows 49% of women have three or more chronic conditions, compared with 38% of men).[3] More women have physical limitations and cognitive impairments which affect their ability to live independently in the community.[4] Additionally, women are more-often widowed than men (46% of older women are widowed compared with 14% of men).  All these factors combine to mean that women require long-term care in greater numbers.[5] Over three-quarters (77%) of Medicare beneficiaries in nursing homes, assisted living, and other long-term care facilities across the country are women.[6] Thus, for these women, and their families, the importance of Medicare as a source of health coverage cannot be over-emphasized.

Women Rely on Medicare for Financial Protection

Along with greater health needs, women's health care is further complicated by their lower incomes.  Overall, Medicare beneficiaries live on an average of $22,000 a year. Women with Medicare, however, live on much less than that – $15,000 a year.[7] Their Social Security benefits are also significantly lower – $12,000 compared to nearly $16,000 for men.[8] This is due primarily to lower-paying jobs and lower wages during their working years, combined with time spent away from the workforce to raise families or take care of aging family members (women comprise the majority of caregivers in the United States).[9]  Women are also more likely to live in poverty, accounting for over two-thirds of beneficiaries with incomes below the poverty-level, and are twice as likely as older men to have incomes below $10,000.[10] African-American women and Hispanic women are at further risk: 56% of African-American women and 58% of Hispanic women live on incomes below $10,000.[11] For these and other low-income women, Medicaid provides critical assistance with Medicare's cost-sharing and other expenses. 70% of those dually eligible for Medicare and Medicaid are women.[12] These women are among the most vulnerable individuals, and have significant and complicated health needs for which Medicare and Medicaid are critically important.

Women spend increasingly-greater amounts of their incomes toward out-of-pocket health care costs.[13] They spend a greater proportion of their incomes on cost-sharing than do men, spending an average of $4,500 a year out-of-pocket.[14] Medicare's coverage of key for women protects them from skyrocketing health care costs and provides dependable coverage. Medicare beneficiaries are less likely than those with private insurance to report going without care because of cost, and are also less likely to report problems paying medical bills.[15]

The Affordable Care Act Improves Medicare for Women

Along with expanding and improving access to health care for all Americans and providing new consumer protections for women of all ages and incomes, the Affordable Care Act makes key improvements for women with Medicare. Many preventive services that are key to women's health, including mammograms, Pap smears, and other cancer screenings, are now offered free of cost-sharing as a result of ACA.[16]

In addition, ACA closes the Medicare Part D Donut Hole, which required many beneficiaries, particularly those with higher health care needs, to spend more for prescription drugs. In 2007, 64% of those affected by the Donut Hole were women.[17] Already, over 2 million women with Medicare have saved an average of over $600 on their prescription drugs.[18] By emphasizing preventive health and wellness and removing some financial obstacles to key services, ACA is a landmark step forward for women's health.

Women Have Much at Stake in Proposed Changes to Medicare

Proposals in Washington aimed at cutting Medicare under the guise of deficit-reduction would disproportionately and significantly harm current and future female Medicare beneficiaries and their families. Because women have lower incomes, fewer resources, and greater health needs, cuts to Medicare would most seriously harm women's health and finances.[19]

Proposals to increase Medicare's age of eligibility from 65 to 67, or even 70, mean women could be forced to work longer without Medicare, and some would be left uninsured.[20]^,[21] Increasing their costs and removing access to the comprehensive coverage that Medicare provides would not lower overall costs and would lead to poor health outcomes.

Changes to Medigap plans, which beneficiaries purchase to help with out-of-pocket costs, could remove key financial protection and planning resources that help women with Medicare manage costs, and would create barriers to the needed care ordered by their health care providers.

Privatizing the Medicare program through vouchers, also called "premium support", would leave beneficiaries with $6,000 more in out-of-pocket costs, which would be significantly more harmful for women, who already pay greater shares of their incomes toward cost-sharing, and have greater health needs.[22] Women cannot afford a privatized Medicare system.  It would endanger their health and their budgets.

Decimating the safety net through privatization and cost-shifting will leave more women in or near poverty, and create barriers to receiving needed health care.  This, in turn, will only increase overall health care costs. Polls indicate that the vast majority of Americans reject harmful changes to Medicare, and do not believe they are necessary for addressing the deficit.[23] Women and their families depend on a strong Medicare program.  Future generations of women, who are expected to retire with fewer savings and resources, will need Medicare's valuable health and financial protections more than ever.

Conclusion

As we honor Women's History Month, it is critical to acknowledge the role that access to health care plays in the lives of women and their families. Medicare has helped provide health and economic security for millions of women.  Many of the proposed changes to the program have serious consequences for them.

Arbitrary cuts in benefits and increases in cost-sharing ignore the needs and realities of women.  Women need a stronger, enhanced Medicare program, not a weaker, unaffordable one. Issues which disproportionately impact women, like long-term care and other gaps in coverage, must be addressed.

Addressing the overall costs of health care, not Medicare, is the best way to improve care and tackle budgets. As we remember and honor women who have helped move our world forward, women, their families, advocates, and policymakers should continue fighting to ensure that their health care, including Medicare, does not move backwards.