Antidote to the ACHA: 100% Medicare buy-in

In the past week or so, President Trump, Speaker Paul Ryan, and Republican leaders in Congress finally laid out the American Health Care Act [AHCA], their repeal-and-replace legislation for the ACA [Obamacare].

The nonpartisan Congressional Budget Office scored it, with the result that 24 million people, recently insured under Obamacare, would lose their coverage over the next 10 years under the AHCA.

Hardest hit would be low- and moderate-income, middle-aged adults. Insurers would be allowed to charge them five times what a twenty-something would pay, but their tax credit would only be twice that of the younger person. And we’re talking about working Americans here, people putting in their time, stuck at low wages, and paying payroll taxes that cover the Medicare and Medicaid of other folks only slightly worse off or slightly older than they are.

Gone is the income-based subsidy that has made it possible for these folks to buy the insurance they have needed through the ACA Marketplace. This includes insurance with no pre-existing condition exclusion and no lifetime caps; prescription drugs; rehab therapy and mental health services. Real insurance coverage.

Middle-age is when many chronic diseases start to take a health toll: heart disease, high blood pressure, diabetes, joint problems. These are conditions that can have minimum impact if attentive monitoring and management of a patient’s health is maintained, and the patient is kept healthy. This is when primary, preventive care is so important; costly crises later can be avoided.

So what would be a real solution to this problem? One thing that was missing from Obamacare: a public option.

Medicare sits there as the one big shining possibility in the middle of this whole debate. Why can’t we buy into Medicare?

Medicare has always been very effective at covering all the elderly, most of whom seem to love it. I know I do! It has been effective at keeping health care costs down. Medicare reforms established in the ACA have also saved hundreds of millions in fraud cases and extended its trust fund’s life.

As a Medicare enrollee, I still have to pay for my Medigap and prescription plan, for me a couple hundred a month, to cover the 20 percent or so that Medicare does not cover. But what if I could pay that money to Medicare and get 100 percent coverage, including long-term care?

Or if someone age 50 to 65 could buy in by paying a percentage of their earnings, with a slightly higher, voluntary payroll tax? We’d avoid having to figure out how much anybody’s subsidy is, which insurance plan to choose and what would it cover, whether our doctor is in the network, and just how much copays and deductibles would take out of our pocket. You know, all those insurance hassles.

Another looming problem is all the soon-to-retire baby-boomers who lack adequate savings for retirement and/or have no pensions. They will end up on Medicaid when assets are used up and they need long-term care. Medicaid expenses for indigent elderly are the real budget problem for state budgets. Full Medicare at the federal level would alleviate this, by assuming coverage for those with no other income but Social Security.

Let’s stop trying to make this so complicated. Let’s move to a simpler solution.

Let folks buy into a 100 percent Medicare coverage plan, at a cost that is based on their income level. So they can get the comprehensive, low out-of pocket, choose-your-own-doctor, cost-effective coverage that Medicare has always been.

Jill Shaffer Hammond lives in Peterborough.