Donald Trump and Republicans Are Botching Health Care
We need to build on the gains of the Affordable Care Act, not go backward. Medicare for anyone, or Medicare Extra, is a path to universal health care.
Congressional Republicans missed their best and probably last chance this year to stabilize the Affordable Care Act when they passed a government funding package without a health deal. As a result, repeal of the individual mandate and the Trump administration’s proposal to expand non-ACA plans are projected to spike premiums by 18% beyond medical inflation next year.
At the same time, the Trump administration is encouraging waivers to the Medicaid program that put up barriers to enrollment, limit benefits and increase costs for the poor.
States can take action to mitigate coverage losses and premium increases, and most of the ACA’s historic coverage gains will persist. But it is imperative to chart a path forward for the health care system — a path of expansion and greater security rather than retrenchment. That path is the idea of “Medicare for anyone.”
Medicare for anyone means that all individuals would have the right to enroll in a Medicare plan. The federal program now serving mostly seniors would be enhanced to include important benefits: dental care, reproductive health care and a limit on out-of-pocket costs. This improved Medicare plan could be called “Medicare Extra.” Premiums and other out-of-pocket costs would be zero for families with income up to 150% of the federal poverty level and would rise with income.
Individuals who are currently covered by other insurance — such as the current Medicare program or Veterans Affairs medical care — would have the option to enroll in Medicare Extra instead. Newborns, people turning 65 and individuals who don’t have other coverage would be automatically enrolled in Medicare Extra. Premiums would be automatically collected through tax withholding and on tax returns.
Medicare for anyone would not eliminate employer-based coverage for 152 million -workers, most of whom are satisfied with their coverage. At the same time, with deductibles rising faster than wages, employer coverage is becoming increasingly unaffordable for many workers.
Medicare for anyone balances these factors by allowing employers to continue to offer their own coverage, while allowing workers to enroll in Medicare Extra instead. Alternatively, employers could offer Medicare Extra as their employer plan. In either case, employers would continue to contribute a share of the premium, just as they do now.
Medicaid and the Children’s Health Insurance Program would be integrated into Medicare Extra. Medicare Extra would strengthen the guarantee of health care for low-income families and ensure continuity of care when their income changes. Although Medicare Extra would assume the costs of coverage for low-income families, states would make payments to Medicare Extra equal to the amounts they currently spend on Medicaid and CHIP.