The Medicare Catastrophic Coverage Act: A Post-Mortem

Prologue: The saga of the Medicare Catastrophic Coverage Act from its initial unveiling in President Reagan's 1986 State of the Union address to its congressional repeal in November 1989 represents a remarkable chapter in the history of federal health policy making. The seeds of its destruction seemed to lie in the unwillingness of elderly individuals who already were protected against the economic consequences of catastrophic illness to accept a new tax that would have financed such coverage for the entire Medicare population. But this article that reports on the attitudes of elderly individuals indicates they had other reservations as well. Authors Tom Rice, Katherine Desmond, and Jon Gabel discuss the results of a survey of elderly individuals that sought their views about the Medicare catastrophic law nearly six months before Congress repealed the measure. The elderly's reluctance to accept a tax is clearly reflected in the survey results, as is their lack of knowledge about the law. Rice, an associate professor of health policy and administration at the University of North Carolina School of Public Health, recently completed a project for the Health Care Financing Administration on the impact that supplemental private health insurance coverage has on Medicare costs. He has studied the Medicare supplemental health insurance market for almost a decade. Rice spent the last year at the Physician Payment Review Commission during a sabbatical leave. Desmond is a candidate for a master of science degree in biostatistics at the University of North Carolina. She was previously employed by the Department of Health and Human Services, SRI International, and the Research Triangle Institute. Gabel, an economist, is the associate director for research at the Health Insurance Association of America (HIAA). Since Gabel joined the association in 1986,HIAA has sharply increased its commitment to health services research based on a belief that private interests can most effectively influence public policy making through analysis and data.