- Medicare at 55 Act - This bill would let people buy into Medicare if they are 55 or older. It is from Sens. Debbie Stabenow (D-MI), Sherrod Brown (D-OH), Tammy Baldwin (D-WI), Sheldon Whitehouse (D-RI), Patrick Leahy (D-VT), Jeff Merkley (D-OR), Jack Reed (D-RI), and Al Franken (D-MN).
- Medicare buy-in, but only for Affordable Care Act exchanges with three or fewer insurers - This plan is from famous health care policy analysts Gerard Anderson, Jacob S. Hacker, and Paul Starr.
- "Medicaid Buy-in," which is just an option to buy into a new state public insurance option called "Medicaid" from Sen. Brian Schatz(D-HI). While the details are vague, the plan seems to let states have the option to allow people to buy into a new public health insurance that would be called "Medicaid" even though it would not have Medicaid's benefits or super low costs.
Politically, the health care industry is likely to fight each of these proposals as strongly as they would a universal public option. First, all of these plans would cut the industry's profits by billions, so it's a given they will oppose any of them. Second, the industry isn't stupid. They would see any of the plans as a path toward a universal public option so they would fight it with as much force as they would a fully universal proposal.
While limiting public insurance proposals will likely do nothing to reduce industry opposition, it does reduce popular support. All of these plans would potentially benefit fewer people than a universal public insurance plan, which means fewer regular people will have a reason to fight hard for them.
In addition, the message for a public option/universal Medicare buy-in is simple: private insurers suck, so we will let you buy public insurance instead. The messaging and logic behind these plans make little sense.
If private insurance doesn't work well for people at age 55, why isn't it a problem at age 54 or 53? Why shouldn't everyone else get also get to buy into Medicare?
Similarly, if we think people would benefit from a "Medicaid buy-in," why are we leaving it up to the states? This is an especially important question after we saw so many red states reject the Medicaid expansion.
Limiting the proposals isn't going to generate Republican approval either. As we just saw with Obamacare, Republicans will attack any proposal as a "big government takeover" regardless of what it does.
I understand making tough compromises to achieve goals and broaden the coalition, but there seems to be zero logic behind these compromise proposals. These plans are needlessly limited but gain nothing.
These limits won't fool the industry. They won't fool Republicans. They will only excite less of the base. And they will make it harder to sell, since the plans now lack simple, cohesive logic.
Can someone point to one reason why any of these plans would be politically easier? Can someone name one powerful industry lobbying group or bloc of voters that you gain by imposing needless limits on a Medicare buy-in? An universal Medicare buy-in already has overwhelming support.