Ezra Klein is reporting that lawmakers may be considering replacing the opt-out public option in the Senate health bill with a provision that would open Medicare to Americans under 65 years of age. “Sources who have been briefed on the negotiations say that Medicare buy-in is attracting the most interest,” Klein reports. “Expanding Medicaid is running into more problems, though there’s some appeal because, unlike increasing subsidies, expanding Medicaid actually saves you money.”
The Congressional Budget Office has concluded that allowing uninsured Americans 62 to 64 to buy into the Medicare program and charging the buy-in population a regular premium plus a 5 percent administrative fee, would not add to long-term Medicare outlays. Dick Gephardt and John Edwards both offered a buy-in option during the 2004 presidential campaign and, in November 2008, Sen. Max Baucus (D-MT) proposed expanding Medicare in the short term and phasing it out once the Exchange became operable (in 2013). More recently, Rep. Mike Ross (D-AR) — who led a group of seven centrist Blue Dogs who objected to a public option that reimbursed providers based on Medicare rates — floated a proposal to open-up Medicare to Americans under 65, “but at a reimbursement rate much greater than current Medicare rates.”
But some point out that expanding Medicare to a younger population is not without its problems. Jacob Hacker predicted in an interview with the Wonk Room, that seniors would oppose opening the program to younger Americans and explained that Medicare was not designed “to provide health security to a younger than 65 population.” “There are a lot of holes in the Medicare program that should be fixed but which aren’t going to be fixed immediately. One of the important reasons to have a separate insurance plan is to make sure you’re providing the kind of good coverage that you know younger Americans need,” Hacker said.
“Ultimately though, we should understand the public health insurance plan idea, and Medicare as being very much interrelated. That over time, we should see this public health insurance plan and Medicare as a way of improving the cost effectiveness and the quality of care delivered to both younger Americans and to those over 65.”
Senators are floating around a proposal that would allow Americans 50-65yo (or 60-65yo) who are purchasing coverage through the state-based exchanges to enroll in Medicare. It’s unclear if care for this population would be reimbursed at Medicare or competitive rates.