The short life and painful death of the Medicare Catastrophic Coverage Act

This article draws upon a combined political and moral economy theoretical framework to explicate the rise and fall of the Medicare Catastrophic Coverage Act (CHI). Underlying factors, including the legacy of Medicare, the politics of austerity, and the declining political legitimacy of the aged in the 1970s and 1980s, are seen to have heavily shaped the unique characteristics of the legislation, such as its unpopular self-financing mechanism. Moral economy concerns with reciprocity, fairness, and just taxation are used to help explain the intensity of the "senior revolt" against CHI, which ultimately led to the legislation's repeal. The "Catastrophic catastrophe" is seen as having further eroded the political legitimacy of the old, while at the same time demonstrating the raw political muscle of this population group. Implications of the repeal of CHI for future health coverage legislation, and the impact of repeal on the states and other stakeholders, also are discussed.