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Many of his plans to expand insurance coverage. President-elect Biden’s simplest strategy is to lower the age of 65 medical insurance eligibility to 60.
However, even if Democrats can seize control of the Senate in two final elections in Georgia, the plan will certainly face great difficulties.
Republicans are not the biggest obstacle. They Republicans founded Medicare in the 1960s and they usually oppose the entitlement plan to expand the government. Instead, the nation’s hospital-a powerful political force-is bound to undermine all efforts. Hospitals worry that adding millions of people to health insurance will cost them billions of dollars in income.
Jonathan Oberland, professor of health policy and management at the University of North Carolina at Chapel Hill, said: “The hospital will certainly not be satisfied with this.”
On average, the medical insurance reimbursement rate for hospitalized patients is half of the costs paid by commercial or employer-sponsored insurance plans.
“This will be a huge improvement [in Congress] Because the reality of lowering the medical insurance reimbursement rate will inspire some powerful benefits,” said Josh Akenbart, senior researcher at the Conservative Government Accountability Foundation.
Biden turns 78 this month, and he said his plan will help Americans who retire early, the unemployed or those who cannot find health benefits.
Biden wrote in April: “This reflects the reality that even after the current crisis is over, it may be difficult for older Americans to find work.”
Lowering the age of medical insurance eligibility is very welcome. According to a follow-up survey conducted by the Kaiser Family Foundation from January 2019, approximately 85% of Democrats and 69% of Republicans are in favor of allowing people under 50 to purchase Medicare. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)
Although opposition from the hospital community is expected to be fierce, this is not the only obstacle to Biden’s plan.
Critics, especially Republicans on Capitol Hill, will point to the US budget deficit of $3 trillion and the bleak outlook for the Medicare Hospital Insurance Trust Fund. The fund is expected to reach bankruptcy in 2024. This means that there will not be enough money to cover the entire cost of hospitals and nursing homes to provide hospitalization for Medicare beneficiaries.
It is unclear whether expanding health insurance fits the crowded health agenda of the Democrats, including responding to the COVID-19 pandemic, which may save the Affordable Care Act (if the Supreme Court repeals some or all of the law in the current case) and expand Obamacare Subsidies and reduce the cost of medicines.
Biden’s proposal is a tribute to the liberals of the Democratic Party. The Democratic Party advocates a government-run “Medicare for All” health system established by Senator Bernie Sanders, which will provide Universal coverage. Biden opposed this effort, saying the country could not afford it. He wants to keep a private health insurance system covering 180 million people.
In order to expand the coverage, Biden proposed two main measures. In addition to changing medical insurance eligibility, he also hopes that Congress will approve a government-run medical plan that people can buy instead of buying insurance from insurance companies or through the Obama medical market. In the 2009 Congressional ACA debate, insurance companies helped thwart this “public choice” initiative.
The appeal of lowering medical insurance eligibility to help those without insurance is to take advantage of popular government programs with lower management costs.
Oberland said: “It is difficult to find reform ideas that are more popular than opening up medical insurance to 60-year-olds.” He said that retirees, like employers, hope that retirees retire because as workers move to medical insurance, They can save medical expenses.
Since the establishment of health insurance in 1965, the age has been set at 65, which is part of President Lyndon Johnson’s plan for major social reforms. Its design coincided with the age at which people were eligible for social security. Nowadays, people are usually eligible for earlier, lowered social security benefits at the age of 62, but all benefits depend on your year of birth, ranging from 66 to 67 years old.
People can qualify based on other conditions (such as having a disability or end-stage kidney disease), but 85% of the 57 million Medicare enrollees are only because they are old enough.
According to the analysis of consulting company Avalere Health, lowering the age to 60 years old may add 23 million people to Medicare. However, it is not clear whether everyone who is eligible to participate will sign, or whether Biden will limit the extension to the 1.7 million uninsured people in this age group and 3.2 million people who purchase insurance on their own.
Avalere said 3.2 million people in this age group bought insurance for a single market.
Cristina Boccuti, director of health policy at West Health, a non-partisan research organization, said that although the uninsured rate for people aged 60 to 65 is the lowest among adults (8%), it has the highest medical costs and the highest cost of insuring for individuals . group.
According to Avalere, about 13 million people between the ages of 60 and 65 have obtained insurance through their employer. Although they do not have to give up participating in Medicare coverage, they may choose to pay to join a federal program and use it as an alternative to existing coverage. Then, medical insurance may increase the cost of certain services that some consumers must bear.
Approximately 4 million people between the ages of 60 and 65 are enrolled in Medicaid, a state federal health insurance program for low-income people. Moving them to Medicare will make them a major health insurance company, a move that will save the state money because they split the cost of Medicaid with the federal government.
Chris Pope, a senior researcher at the conservative Manhattan Institute, said that getting support from the medical industry, especially from hospitals, is critical to expanding medical coverage. He said: “The hospital is very aware that generous commercial rates have been replaced by lower medical insurance rates.”
He said: “Many members of Congress are near the hospital and don’t want to see that they have income loopholes.”
President Barack Obama reached an agreement with the industry to pass the ACA. In order to obtain millions of paying customers and reduce their unpaid care by billions of dollars, the hospital industry agreed to abandon future medical insurance funds designed to help them deal with the uninsured. Congress demonstrated the strength of the industry on Capitol Hill, delaying these funding cuts for more than six years.
Yale University political scientist Jacob Hacker pointed out that expanding health insurance will reduce the number of Americans who rely on employer-sponsored insurance. Millions of people have lost their jobs and workplace health insurance, which highlights the pitfalls of the employer system in 2020.
Even if they can win two seats in Georgia and control the Senate if the vice president breaks any relationship, Democrats are unlikely to pass major legislation without Republican support unless they are willing to abandon their long-standing stubbornness. Ideological rules so that they can pass majority legislation with a simple majority of 51 votes instead of 60 votes.
Hackers say that the meager profits will make it difficult for Democrats to deal with many health problems at once.
The hacker said, “Congress is not good at parallel processing.” “And the window is relatively short.”
Corning (Kaiser Health News) is a non-profit news service covering health issues.it is KFC (Kaiser Family Foundation) (not related to Kaiser Permanente).