Will the care be there? Vulnerable beneficiaries and Medicare reform

The Medicare program is on the verge of major change. The proof of the value of reforms will not rest in how well the program meets the needs of the healthy and wealthy, but rather in whether they preserve or improve upon protections for those who would not be well served by an unregulated private sector--persons with low incomes and/or substantial health problems. This paper examines four key issues: Which beneficiaries will likely be best served by a system oriented around choice; what role traditional Medicare should continue to play and what changes will be needed; what protections are necessary for persons with low and moderate incomes; and how these reforms could be incorporated into broader changes to make Medicare more viable over time.