Ensuring affordable healthcare for vulnerable Rhode Islanders under 65 | Opinion

David Morales, a Democrat, is state representative from District 7, Providence.

Age should never be a barrier to accessing essential health care. Yet for many Rhode Islanders facing life-altering diagnoses before turning 65, age can be an obstacle to affordable health care.

People are typically eligible for Medicare when they are 65 or older. However, there are special exemptions for those diagnosed with conditions like amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) kidney failure, who can access Medicare immediately upon diagnosis. This exception amplifies the urgent need for more equitable health care access.

Despite the essential coverage Medicare provides, it only covers 80% of medical expenses. That leaves beneficiaries with ALS and ESRD facing the financial burden of the remaining 20% of upfront costs, which are often prohibitively expensive and can soar as high as $250,000 a year for ALS patients.

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That is why access to Medigap, supplemental insurance that assists in covering out-of-pocket expenses associated with Medicare, is essential. In Rhode Island, thanks to the leadership of state Rep. Brian Kennedy, all Medigap insurers were required as of 2023 to offer Medigap Plan A to all applicants under 65. However, Plan A only provides limited coverage and comes at a significantly higher cost compared to those who are 65.

Currently, these individuals face premiums that are two to three times higher than those for individuals aged 65. This discrepancy places an undue financial strain on people already grappling with a devastating diagnosis.

That’s why I am championing bipartisan legislation, H7433, that would rectify this disparity by ensuring that individuals under 65 pay the same price for Medigap as those who are 65. This adjustment aims to make essential health care coverage more accessible and affordable for those who need it most.

Specifically, this bill will help about 300 Rhode Islanders under the age of 65 with ALS and ESRD who are covered by Medicare but not Medicaid, enabling them to purchase affordable Medigap plans.

It’s important to note, this initiative is not about seeking preferential treatment for individuals with ALS or ESRD; rather, it’s about promoting equity and fairness in health care. No one should face financial hardship simply because they were diagnosed with a debilitating condition before reaching the age of 65. The legislation also aligns with the precedent set by 14 states that have already successfully adopted Medigap access and affordability laws.

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Making Medigap more affordable for those under 65 has broader implications for state budgets, which will not be impacted as state budget dollars are not required. Additionally, many people and families living with ALS and ESRD are often forced to choose between paying medical bills and rent, food, or other expenses. Some spend down their assets or dip into savings earmarked for retirement or education expenses to qualify for Medicaid.

By making Medigap more accessible we can alleviate this financial strain, which could potentially reduce the reliance on state-funded health care programs like Medicaid and safeguard the financial futures of people struggling to afford accessible health care.

Ensuring access to affordable Medicare for individuals under 65 isn’t only a matter of fairness — it’s about recognizing that health care is a fundamental human right. By enacting policies that remove barriers to essential health care coverage, we can create a more equitable and compassionate health care system for all Rhode Islanders.

It’s time to prioritize the well-being of our most vulnerable residents and ensure that health care remains a fundamental right — one that is not restricted by age.

This article originally appeared on The Providence Journal: This legislation is about promoting equity and fairness in health care.