Hillary Clinton last month dusted off a long-standing proposal of hers to expand health care coverage by allowing uninsured people 55 and older to qualify for Medicare – the government health care program for the elderly.
Her proposal potentially could help nearly 13 million Americans below the age of 65 who are currently without insurance. It also provided the former secretary of state with a rejoinder to rival Sen. Bernie Sanders’ call for supplanting Obamacare with a European-style national health insurance program he called “Medicare for All.”
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Whether Clinton is serious about pursuing this proposal or putting it back on a dusty bookshelf after she finally prevails over Sanders in the battle for the Democratic presidential nomination remains to be seen. Clinton and presumptive Republican presidential nominee Donald Trump have sharply differing views on health care issues – especially given Trump’s call to “repeal and replace” Obamacare.
The looming bruising general election campaign between Clinton and Trump is likely to focus more on national security, trade, immigration, the economy, Clinton’s email woes and allegations that the defunct Trump University defrauded thousands of students than on the finer points of health care reform.
Clinton late last week denounced Trump as dangerous and unfit to lead the country, while Trump has labeled her “Crooked Hillary” and vows if elected president to seek her indictment for mishandling top-secret government emails.
But for now her idea is generating substantial buzz among health care experts and professionals, some of whom question whether it would be a panacea for millions of uninsured Americans or a “bad fit” for a health care system that has been revolutionized by the Affordable Care Act.
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Margo Sanger-Katz, writing last week in The New York Times, noted that much has changed since the passage of the 2010 Obamacare legislation -- “leading health policy experts to wonder whether a Medicare buy-in would be a welcome new option, or a confounding misfit.”
Creating a completely new tier of younger beneficiaries in the half-century old health insurance program for seniors would have a major ripple effect on the existing Obamacare insurance markets. For instance, Sanger-Katz wrote, it would require “significant adjustments” to the Obamacare markets for calculating and awarding federal subsidies, and it could risk destabilizing those markets.
Other experts agree. “If you went forward with this, I think there are more questions than there are answers,” Joseph Antos, a health care expert for the American Enterprise Institute, said in an interview on Friday.
The Clinton campaign has yet to release specific details of her plan, although she has offered a number of other proposals to increase the availability of heath care, reduce premiums and out of pocket expenses and rein in the cost of prescription drugs. Caroline Pearson, a senior vice president of the health care consulting firm Avalere Health was the first to raise serious doubts about the feasibility of Clinton’s Medicare expansion plan when viewed within the context of the Affordable Care Act and other federal regulations.
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Pearson warned in an analysis that although traditional, fee-for-service Medicare tends to offer broader access to physicians than many other plans, “Costs to beneficiaries may be higher than other coverage options, including plans purchased through the federal or state insurance exchanges.”
According to Avalere, some people who currently purchase their coverage on the Obamacare exchanges but then move to an expanded Medicare program would "have higher costs and more benefit limits" than their existing health plans "because of the unusual structure of the Medicare fee-for-service program."
“While Medicare is widely popular among Americans, Avalere experts say it is not immediately evident that Medicare coverage would be a better option for all people over 50,” Pearson wrote.
A Medicare buy-in potentially could work, Pearson said, but it wouldn’t be an easy fit with existing federal health insurance policies. “It’s an approach that is somewhat inconsistent with the Affordable Care Act,” she said.
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Antos is even more skeptical of Clinton’s plan, questioning whether it was designed more as a political fig leaf to placate liberals than a practical solution to expanding health care coverage. What’s more, he said, an expanded Medicare program would attract primarily the sickest and most costly patients, greatly adding to Medicare’s cost burden and possibly forcing a reduction in benefits for traditional Medicare beneficiaries.
If Clinton and other Democrats are eager to expand health insurance coverage, Antos said, they would be better off finding ways to increase funding for Obamacare subsidies than creating a whole new Medicare program.
“Why not just cut through the baloney and admit that your problem is that you are not putting enough subsidy into the exchange plans?” Antos said. “So put money into the exchange plans. That would be the simple, undoubtedly non-politically attractive way to do it. But it really is a matter of money.”
Clinton, the former first lady and long-time advocate of national health care reform, has been unflinching in her support of the Affordable Care act and has dismissed Sanders’s call for a new “single-payer” national program that would guarantee all Americans health care.
Related: How Obamacare Could Backfire on Hillary Clinton
Clinton has argued that Sanders’ proposal is too costly and impractical – claims that prompted many of her liberal critics to charge she was a status-quo politician incapable of thinking outside of the box. But on May 9, as criticism grew, Clinton suggested during a campaign stop in Virginia that she would be open to allowing some people under the age of 65 to buy into Medicare as an alternative to Obamacare or employer-provided coverage.
The highly popular Medicare program provides comprehensive hospitalization, physician care and drugs to virtually all seniors 65 and older. Seniors are obliged to pay premiums to receive health care coverage, but a substantial portion of the cost is picked up by the federal government.
However, Medicare has its shortcomings. Unlike those covered by Obamacare, Medicare patients are asked to pay unlimited out-of-pocket costs. They may also be asked to pay a daily fee when they are hospitalized, and must pay 20 percent of the cost of a doctor’s visit.
Many seniors are forced to purchase supplemental health insurance – so-called Medigap policies – to cover those onerous added costs.
