A Medicare Option for the Uninsured

http://www.nytimes.com/2016/05/12/opinion/a-medicare-option-for-the-uninsured.html

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Health policy experts have long argued that Congress should let older Americans buy into Medicare before they become eligible for it at 65. Hillary Clinton said this week that she supports this option, which could help expand coverage and cut the cost of insurance for some people.

Many lawmakers, as well as former President Bill Clinton, have said in the past that people between 55 and 65 should be allowed to buy into Medicare, which has lower administrative costs than private insurance because it pays lower reimbursement rates to doctors and hospitals and does not have to turn a profit. Congress even considered this provision when it was debating the Affordable Care Act, but did not include it in the law because of opposition from Republicans, conservative Democrats and former Senator Joseph Lieberman, the Connecticut independent.

At a campaign stop in Virginia on Monday, Mrs. Clinton discussed the Medicare buy-in idea, suggesting that it might be cheaper than buying coverage in the health care exchanges for people who don’t qualify for a public subsidy. Senator Bernie Sanders has gone further in arguing that all Americans should be eligible for Medicare, a proposal that would be very hard to enact. Donald Trump, the presumed Republican nominee, has promised to repeal the health care reform law but has not offered a detailed plan for what he would put in its place.

The Congressional Budget Office estimated in 2008 that premiums for a Medicare buy-in program would be $7,600 a year for individual coverage. That price could be reduced if the government offered the same kinds of subsidies it offers to lower-income people on the health exchanges. Mrs. Clinton did not say whether she would support such subsidies for a Medicare option, but she has talked about extending health insurance subsidies to people who earn too much to qualify for them now.

It will be difficult for Mrs. Clinton to convince Congress to create a Medicare buy-in program. Doctors and hospitals would be very likely to oppose the idea, because they prefer the higher reimbursement rates of private insurance companies. Insurers would also fight it because they don’t want to compete with the government program for customers. Those were the reasons Congress rejected the buy-in idea in 2009 and also dropped proposals for a public option in the health law even when Democrats had majorities in both houses.

That said, it is important to talk about what could be done to expand health coverage and make premiums more affordable. The Affordable Care Act has helped millions, but 33 million people, or 10.4 percent of the population, remain uninsured.