Expansion of Medicare in health care compromise faces challenges

The expansion of Medicare included in a Senate compromise hailed as a breakthrough in the discussions of health care overhaul earlier this week is now encountering some friction. Politico reports, "Senate moderates who are the linchpin to passing a health care reform bill raised fresh worries Thursday about a proposed Medicare expansion, complicating Majority Leader Harry Reid's hopes of putting together a filibuster-proof majority for the legislation in the coming days."

Three key moderate in particular voiced criticism of the plan. Sen. Joe Lieberman, I-Conn., said he is "increasingly concerned" about the prospect of growing Medicare. Sen. Ben Nelson, D-Neb., said he thought the proposal, which would open Medicare to people aged 55 to 64 if they choose to buy-in, may be a first step toward an entirely government-run health system. Sen. Olympia Snowe, D-Maine, suggested it could make an "already-serious problem" worse by forcing doctors to accept more low payments from the program (Budoff Brown, 12/10).

The Associated Press/Washington Post reports that "Senate Democrats are considering changing a proposed expansion of Medicare to address complaints from doctors and hospitals and defray costs for consumers, officials said Thursday." Both the American Hospital Association and American Medical Association criticized the proposal after it was announced Tuesday night, "saying the program pays health care providers less than private insurance companies, and warning against increasing the number of patients" (Werner, 12/11).

The objections of hospitals and doctors also have left Snowe uneasy, Roll Call reports. She signaled Thursday that she would probably oppose the plan. She said lowering "the eligibility age for Medicare was 'on the same level of concern' as her opposition to the public option that is currently in the Senate bill." Snowe explained that she was on her way to meet with health care providers yesterday afternoon, and that they were anxious about the prospect of facing lower rates for patients who may choose Medicare, especially in rural communities (Pierce, 12/10).

And moderates aren't the only senators who are unhappy with the plan. TIME magazine warns, "don't expect a Medicare expansion to skate by. Even though they have spent much of the week arguing on the Senate floor that Democratic plans to dramatically cut Medicare funding would imperil a vital program, Republicans are already objecting to growing a government program that, while effective, is not perfect." However, the impact on the program, TIME writes, would depend much on details that are not yet known. Would it attract sicker patients? Drain the trust fund that supports Medicare? Or, on the bright side, help lower premiums for other Americans by attracting older patients away from their insurance pools (Pickert, 10/11)?

The New York Times reports on the plan's potential consumer impact: "Senate Democrats have provided few details about their latest health care proposal, but this much seems clear: Anyone who wants to buy the same health benefits as members of Congress, or to buy coverage through Medicare, should be prepared to fork over a large chunk of cash."  The Medicare expansion proposal, which would begin in 2011, would also allow some people ages 55 to 64 to 'buy in' to Medicare at the cost of "about $7,600 a year per person or $15,200 for a couple, according to a budget office analysis of an earlier version of the concept. No subsidies would be available until 2014." The intent of the buy-in plan is "to fill a gap in the social safety net for millions of people nearing retirement who are unable to obtain or afford insurance. In general, the new Medicare option would be available only to people who are uninsured. People 55 to 64 who have employer-sponsored insurance would be expected to keep it." But early calculations indicate the difficulties Senate Democrats face "as they await a new cost analysis of their plan" (Herszenhorn and Pear, 12/10).

McClatchy/The Kansas City Star reports, "few specifics are expected until the nonpartisan Congressional Budget Office assesses potential cost and impact, probably early next week. ... In the meantime, said Senate Budget Committee Chairman Kent Conrad, D-N.D., 'I know enough to ask all these questions, but I don't know the answers. This is not simple stuff'" (Lightman, 12/10).