In Parts 1 and 2 of our “Medicare for All” series, we provided an overview of how universal healthcare is defined, and what the “Medicare for All” proposal put forth by Senator Bernie Sanders would entail. In our third installment, we take a closer look at the alternatives proposed by Sanders’ Congressional colleagues, known as the Medicare Buy-In bills.

Seeking Compromise
The Medicare for All plan proposes comprehensive, federally-funded health insurance coverage for all Americans and eliminates the need for private insurance plans. Medicare Buy-In bills, by contrast, would give individuals the chance to purchase (buy into) Medicare or insurance coverage similar to Medicare. Eligibility for some buy-in plans might be limited to adults over a certain age, such as 55, and to people who don’t currently receive health insurance coverage from their employer.

One advantage of buy-in plans is that they are voluntary. People could still choose coverage in plans sponsored by their employers or in private insurance plans. Another selling point for the buy-in plans is that people who choose to buy in would be paying for the benefits themselves; taxpayers would not be asked to foot the bill.

Many Options to Choose From
Several buy-in bills were introduced during the last session, and it’s anticipated they will be re-introduced for the 116th Congress. While each proposal shares the common goal of expanding eligibility for public health insurance plans to a larger number of people, there are many key differences among the bills.

• The Choice Act, sponsored by Rep. Schakowsky and Senator Whitehouse, is closely modeled after the Affordable Care Act, offering premium tax credits and the same cost-sharing reductions currently available to individual marketplace consumers. It calls for three types of public plans (Bronze, Silver, and Gold) with tiered out-of-pocket costs.
• The Medicare-X Choice Act, sponsored by Rep. Higgins and Senators Kaine and Bennet, would open up Medicare eligibility to all individuals regardless of age, with two standard levels of coverage, and the option to create additional tiers at the discretion of the Secretary of Health.
• The Choose Medicare Act, sponsored by Rep. Richmond and Senator Merkley, keeps things simple, offering one premium tier of coverage, while also capping out-of-pocket expenses for Medicare enrollees ages 65 and over. Employers that agree to this plan would allow their employees the flexibility to choose a company-sponsored insurance plan, or sign up for Medicare.
• The Medicare at 55 Act, sponsored by Senator Debbie Stabenow, would expand eligibility for Medicare enrollment to individuals aged 55-64, with an enrollment period to be established by the Secretary of Health and Human Services.
• The Medicare Buy-In and Health Care Stabilization Act of 2017, sponsored by Reps. Higgins, Larson, and Courtney, allows individuals aged 50-64 to enroll in Medicare. It also would allow employed individuals in that age bracket to switch from their employer-sponsored plan into Medicare, while allowing their employers to continue contributing to the employee’s insurance premiums on a pre-tax basis.

A State-Run Medicaid Option
Another option worth noting is Senator Schatz’s State Public Option Act, a.k.a. the Medicaid for All bill, which would allow individuals to purchase coverage in a state-run Medicaid program as their sole insurance, regardless of age. Medicaid offers more comprehensive coverage than Medicare, but some have expressed concern that leaving the control of the program up to individual states could lead to inconsistent coverage for lower income individuals, even though the bill specifies that the Agency for Healthcare Research and Quality would establish standardized metrics.

Avoiding Possible Pitfalls
Whenever the topic of expanding universal healthcare is discussed, concerns are raised over the number of doctors that will agree to the limited payment scale that Medicare offers, and whether the influx of new enrollees will result in longer wait times for office visits. Several of the buy-in bills seek to address these issues by expanding the list of providers eligible to participate in Medicare, mandating participation for those currently in the network, and giving the Secretary of Health the power to negotiate more favorable rate schedules and increase provider payment rates by as much as 25 percent in rural areas. Another option for buy-in bills is giving doctors the ability to bill patients for an additional balance above the negotiated rate.

Working Towards Consensus
With such a wide variety of buy-in plans to choose from, reaching a consensus among Congressional leaders is expected to be a challenge. While the Medicare for All plan championed by Sen. Sanders has faced resistance, recent studies reveal that a greater majority of Americans are voicing support for the buy-in concept than ever before, and Democrats in the House of Representatives are expected to use their newly-established control to get public healthcare upgrades moving.

One thing is certain: with more than 27 million uninsured Americans under the age of 65, proposals to expand access to public health care plans are sure to be a key campaign issue heading into the 2020 election cycle.