Payers, providers push back on Democrats' Medicare buy-in plan

Calculator that says "Medicare" on it on top of money, next to bottle of pills
The Medicare at 50 Act is receiving flak from many healthcare organizations. (Getty Images/liveslow)

Earlier this week, Democrats introduced a bill that would allow people ages 50 and over to buy in to Medicare coverage, and the plan is already getting pushback from payers and providers.

Under the most recent proposal, people between the ages of 50 and 65 could buy a Medicare plan and qualify for subsidies and tax credits under the Affordable Care Act (ACA). The Medicare at 50 Act, led by Sen. Debbie Stabenow, D-Mich., would fund enrollment through premiums and would eventually lower costs for younger people by moving more people into the higher age bracket, its sponsors argue. 

However, David Merritt, executive vice president of public affairs and strategic initiatives at America’s Health Insurance Plans (AHIP), called the proposal a “slippery slope to government-run healthcare for every American.”  

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

Merritt told FierceHealthcare that U.S. healthcare is not a one-size-fits-all system and that a vast majority of Americans are satisfied with the coverage they have today, whether it be through Medicare Advantage, Medicaid or private coverage. 

“They have choice and control over their coverage, options, and treatment,” Merritt said. “Instead of taking away the coverage that works for them today, let’s focus on protecting and improving what’s working and fixing what’s not. That’s the most effective way to guarantee that every American has affordable coverage and high-quality care.”

RELATED: Verma, Azar take aim at 'Medicare for All' proposals

The Federation of American Hospitals (FAH) shares similar concerns, saying in a blog post that the bill “would harm more Americans than it would help." The post said that allowing more people into the Medicare program would weaken the system for those who are already in it.

Instead, the FAH suggests that “Congress should work to sustain and expand affordable private coverage.”

In a recent blog post, the American Hospital Association’s (AHA) president and CEO, Rick Pollack, reiterated his support for strengthening the existing Affordable Care Act and expanding Medicare, but cautioned not to resort to a one-size-fits-all approach.

He argues that this form of government-run coverage poses risks to many U.S. citizens.

"If Congress controls all payments to providers, delivery system reforms to improve care, enhance quality and reduce costs may no longer be a priority as the government would be able to simply ratchet down reimbursement,” Pollack wrote in a blog post earlier this year. 

In addition, relying more fully on Medicare and Medicaid would be costly for hospitals, the AHA said. According to the AHA’s fact sheet on the underpayment of Medicare and Medicaid, hospitals received only 87 cents for every dollar spent caring for Medicare and Medicaid patients in 2017. 

Despite the concern from the industry, plans to expand Medicare are popular with voters. According to a recent poll from the Kaiser Family Foundation, 77% of the public supports offering Medicare to those 50 and older.

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