“Medicare for All” became a popular rallying cry during the recent midterm elections — especially for Democrats. Last fall, the Trump Administration’s top Medicare official, however, warned that Medicare has enough problems as it is. Exactly what does Medicare-for-all mean, and how would such efforts affect people who are already enrolled in Medicare?
Medicare-for-all historically has meant a single-payer, national government-run health program that covers every American and replaces private health insurance, similar to government run programs in Canada and some European countries. But today the term is sometimes being applied more loosely, to include proposals that would allow Americans younger than 65 to buy into Medicare as an option, along with private health insurance.
The fact is, that Medicare along with private insurance, is the way that Medicare is structured today. Medicare is a national government-run program, but almost all beneficiaries also get benefits through private insurance companies that provide some portion of the coverage. Medicare alone doesn’t cover all out-of-pocket costs, leaving significant costs the responsibility of beneficiaries, who otherwise must either purchase additional supplemental coverage and a free-standing Part D plan for prescription drugs, or get their coverage through a private Medicare Advantage plan that also covers prescription drugs. Low-income Medicare beneficiaries may also qualify for Medicaid, which is a joint state and federal program, the coverage for which in many states is supplied by private managed care health plans.
A year ago opinions on “Medicare for All” seemed to be mixed among participants in TSCL’s 2018 Senior Survey. When asked whether the eligibility age for Medicare should be gradually reduced to allow all Americans to enroll in Medicare, 43% were opposed, versus 31% who supported the idea. On the other hand, 59% of survey participants supported allowing people age 55 to 64 the option to buy-in to Medicare, if more affordable than other coverage. Only 21% were opposed.
TSCL agrees that Medicare has some problems that need to be addressed. Of particular concern is the upward spiral of costs that have contributed to Part B premiums rising, on average, 11% per year since 2000. TSCL supports legislative changes that include:
- Limiting the amount of Medicare Part B premium increases to no more than 30% of an individual’s cost-of-living adjustment (COLA).
- Allowing Medicare to negotiate the price of prescription drugs.
- Restricting out-of-network healthcare providers from surprise balance billing, particularly when the care is received from an “in network” facility or provider.
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Sources: “Don’t Get Too Excited About Medicare For All,” Elisabeth Rosenthal and Shefali Luthra, The New York Times, October 19, 2018. “Medicare For All? CMS Chief Warns Program Has Enough Problems Already,” Phil Galewitz, Kaiser Health News, October 16, 2018.