Senate Possibly Looking At Early Medicare Buy In

There has been multiple unsourced reports that at least some Senate Democrats are considering a possible early Medicare buy in for older Americans. The numbers I have seen indicate that the idea would be to allow people over 55 or 60 to buy into Medicare.

It is unlikely, but possible, that this Medicare buy in would be open to everyone above 55 or 60. Most likely this will only be an option for the people above 55 who would be eligible for the exchange (i.e. the uninsured, self insured, and people who work for small businesses). While this is a very small subset of Americans, they are also the people who currently have the hardest time finding affordable health insurance. This proposal might be very helpful for this small group of Americans.

Of course, the devil is always in the details. Would this Medicare buy in program only be temporary, as a stopgap until 2014 when the exchange starts, or would it be permanent? How much would premiums be for those who buy in, and how would those premiums be calculated? Would it be open to everyone over 55, only on the individual market, or only those who could not find affordable insurance anywhere else? Would people who buy in need to pay a full actuarially sound premium? Would people who qualify for affordability tax credits on the new exchange be able to use them toward the cost of buying into Medicare early?

Put simply, there are many ways to design an “early Medicare buy in program.” It could be a relatively open and useful program that would be a big help to a small segment of the population that has had a lot of trouble finding decent, affordable insurance. It is also possible that due to stringent qualification restrictions and high cost, the program would only be a fig leaf that helps almost no one.

Until details are known, it is impossible to judge whether there is any policy merits to the proposal. Unless Reid finally decides to use reconciliation or the nuclear option, any idea will need 60 votes. On a political level, until at least one ConsveraDem or Republican (Ben Nelson, Blanche Lincoln, Olympia Snowe, Susan Collins, etc.) publicly endorses the idea, I cannot believe that it has a serious chance of making its way into the final bill.

As a simple, stand-alone proposal, unrelated to any deal, does this general concept possibly have merit? Yes. But, without more concrete details about exactly what the proposal is, I will not really know if it has value. (It could be another completely worthless idea that just sounds nice.) Until I hear at least one conservative Democratic senator says something positive about the idea, I will remain fairly pessimistic that the idea has traction. Right now, my recommondation to progressives is don't hold your breath.