Can't work? Need health care? Take a number

By RICARDO ALONSO-ZALDIVAR

updated 4:52 p.m. ET Dec. 23, 2008

WASHINGTON - Master toolmaker John McClain built machine parts with details so small they couldn't be seen with the naked eye. Then a lump on his neck turned out to be cancer.

Shalonda Frederick managed a bakery, and decorated cakes for special occasions. One day her face and hands, and her arms and legs, started clenching up. Then she fell off a ladder at work. It turned out to be multiple sclerosis.

McClain, 56, and Frederick, 33, are unlucky enough to have gotten seriously ill in their most productive years. Theirs is a daily struggle against life-changing circumstances.

As if that weren't enough, after years of counting on employer medical benefits, they are uninsured — and trapped in one of the most troubling gaps in the nation's health care system.

After reviewing their cases, the government declared McClain and Frederick too sick to work and started issuing them monthly Social Security disability checks. Then they found out they'd have to wait two years to get health care through Medicare. Even though workers and their employers pay the payroll taxes that fund Medicare, federal law requires disabled workers to wait 24-months before they can begin receiving benefits.

McClain and Frederick are far from alone. An estimated 1.8 million disabled workers are languishing in Medicare limbo at any given time. And about one out of eight dies waiting.

As many as one-third of those waiting are uninsured.

'Screwiest insurance company I ever saw'
Frederick needs an expensive injection to control her symptoms; McClain, a scan of a new, and potentially problematic, spot. Neither can afford it. Instead, they fend off creditors, sink deeper into debt and fume that a system they paid into all those years isn't available when they need it.

"The government is the screwiest insurance company I ever saw," said McClain, of Allen, Texas. "What is it that I was paying for out of my check every pay period? They have taken the charge for Medicare out of my paycheck, and now that I need it, I can't have it."

With President-elect Barack Obama promising to guarantee health care coverage for all, advocates for the disabled are hoping that repeal of the Medicare waiting period is finally at hand.

"The current law is really indefensible," said Sen. Jeff Bingaman, D-N.M. "There is no logic behind requiring people who are determined to be disabled to wait two years before they become eligible for Medicare." Bingaman introduced a bill to phase out the waiting period, and as a senator Obama co-sponsored it.

It turns out there is a simple explanation for the waiting period: cost.

Congress, Nixon created waiting period
In 1972, Congress and President Richard Nixon agreed to expand Medicare to cover not only seniors but the disabled. They created a waiting period to minimize costs and discourage people from gaming the system.

Over time, the consequences of the waiting period — and the costs of repeal — have only grown.

In the 1970s, there wasn't a whole lot medical science could do for many cancer patients. Now cancer is thought of less as a death sentence, and more as a manageable disease.

But as drugs and treatments for serious illnesses have improved, the cost of closing the Medicare gap has ballooned. Estimates range up to $12 billion a year. And that gives lawmakers pause.

"When it comes to people dying of cancer, you can't help but be sympathetic," said Sen. Charles Grassley, R-Iowa. "But at a time when we have a big downturn in the economy, it may be questionable what can be done in a lot of these areas." Grassley, the senior Republican on the Senate committee that oversees Medicare, said he hasn't made up his mind about a repeal of the waiting period.

A possible compromise that could save taxpayers money would be to subsidize a continuation of employer coverage for disabled workers during the 24-month wait. Many can keep their benefits now, provided they pay the full premium, which not all can afford.

But that wouldn't help those without job-based coverage.

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