The National Academy of Social Insurance regularly convenes top experts to examine pressing issues. After a year of analysis, findings from the Academy’s Medicare Eligibility Study Panel will be highlighted at the upcoming March 2020 policy conference on Healthcare Coverage and Costs: Assessing Medicare-Based Approaches. Academy Member Patricia (Tricia) Neuman has been serving on the Study Panel as chair of the Medicare Buy in Working Group. A senior vice president at the Henry J. Kaiser Family Foundation (KFF) and director of the Foundation’s Program on Medicare Policy, Neuman brings a great deal of expertise to the topic of Medicare as a coverage expansion platform for the healthcare system.

Q: At the conference, you will be moderating a break out panel titled, Establishing a Medicare Buy-in or Public Option: Balancing Beneficiary Choice and Administrative Feasibility. Why are discussions like this valuable?

The idea of a public option or a Medicare buy in has been gaining traction because the public is eager for policy changes to address the high cost of health care and because people are concerned that nearly 30 million Americans are still uninsured despite gains in coverage from the Affordable Care Act. The introduction of Medicare for All set in motion a discussion about several policy proposals that we will be discussing to address health care costs and improve coverage, including the public option and a Medicare buy-in. For now, policymakers and others are talking about these issues at a fairly conceptual level, but if these proposals move forward, a number of specific decisions will need to be made that could have a big impact on how many people gain coverage and how much their coverage would cost.

The work of the Study Panel over the past year was to break down big policy ideas and lift up the more technical issues that could be important when putting the pieces of a policy proposal together.

I am looking forward to the panel discussion because we’re going to hear from people with different perspectives, and these different views can be enormously helpful for understanding how the proposals may actually play out in practice. Ideally, the discussion will help us all understand how well these proposals are likely to achieve the main policy goals—meaning affordability and coming closer to universal coverage—while taking a closer look at specific program features and policy decisions that could make these proposals most effective.

Q: Who would benefit from the findings that will be presented at the conference and in the final report?

Policymakers at the federal and state level could benefit from discussions about the public option and Medicare buy-in, assuming these ideas stay on the agenda in the coming year. Reporters who cover the presidential campaigns, and also Senate and Congressional campaigns, may also benefit from these discussions, since candidates are talking about a public option and Medicare for All. It would be useful for reporters to understand some of the issues involved so they could frame questions for candidates to help the public understand key differences among the proposals. This will also be a great forum for students and academics who are interested these issues. 

Q:  Your panel at the conference will discuss a Medicare buy in or public option. How would you describe the difference between Medicare for All and a Medicare buy in?

Like night and day! These proposals may sound similar but they are quite different. At the highest level, Medicare for All would be a national program that covers all U.S. residents from birth to death. Medicare for All would replace current sources of health insurance, including employer-sponsored coverage, private insurance and public programs, including Medicare. Medicare for All proposals typically cover comprehensive benefits, with no premiums or cost-sharing requirements. Medicare for All envisions a major redistribution in how health care in our country is financed.

In contrast, Medicare buy-in and public option proposals typically leave current sources of health insurance coverage in place, while offering eligible individuals an option to choose coverage under the Medicare-like plan or the new public option. Medicare buy-in proposals tend to limit eligibility to marketplace-eligible adults ages 50-64, so would cover a much, much smaller subset of the U.S. population than Medicare-for-all. Public option proposals vary in eligibility criteria, which means some would cover more people than others, but none would cover all U.S. residents, at least not initially. 

As for benefits, Medicare buy-in proposals typically cover Medicare benefits, whereas public option proposals tend to cover ACA defined essential health benefits – neither of which are as comprehensive as benefits covered under Medicare for All.  

And, there are many differences between Medicare buy-in and public option proposals that warrant careful consideration. An important take-away is that it would be a mistake to generalize too much across these proposals. They may sound alike, but they differ in many ways that could have significant implications for how many people gain coverage, premiums and other costs, provider revenues, and national health spending.

Q: Do you have any advice for health care consumers who are seeking information they can trust about health care coverage proposals?

That’s a great question. It is difficult for the public to tease apart differences among the candidates’ proposals at this stage in the political debate not only because proposals are being discussed at a fairly high level, but also because it is hard to tease apart “spin” from truth. Our goal at KFF is to produce trusted information to help explain complex policy issues, like these.

People care deeply about these issues because they care about their own health care coverage, and are concerned about costs. Our polls confirm that health care is a top priority issue in the coming election. In the end, the public is likely to want answers to straightforward questions: Will a given proposal lower premiums and other health care costs? Will patients be able to choose their doctors and hospitals when they get sick? Will they be able to keep the coverage they get from an employer? What happens to the current Medicare program? What happens to the current Medicaid program, which is so important for low-income people, people with disabilities, and seniors? Will it mean higher taxes? These are basic questions which need answers, but again, it’s a bit early to be sure what the answer are.

More about Tricia Neuman

As a senior vice president at the Henry J. Kaiser Family Foundation and director of the Foundation’s Program on Medicare Policy, Neuman oversees the Foundation’s policy analysis and research pertaining to Medicare, and health coverage and care for aging Americans and people with disabilities. A widely cited Medicare policy expert, Neuman focuses on current policy topics such as Medicare for All and public option proposals, prescription drug costs, the health and economic security of older adults, the role of Medicare Advantage plans, Medicare and out-of-pocket spending trends, and policy options to strengthen Medicare for the future.

Neuman is the co-author of several articles and policy reports including: “Medicare Advantage Checkup” (New England Journal of Medicine); “Medicare Part D Update—Lessons Learned and Unfinished Business” (New England Journal of Medicine); “How much ‘Skin in the Game’ Do Medicare Beneficiaries Have?” (Health Affairs); and “Financing Care for Aging Women in the U.S.: International Perspectives” (Aging).

Before joining the Foundation in 1995, Neuman served on the professional staff of the Ways and Means Subcommittee on Health in the U.S. House of Representatives and on the staff of the U.S. Senate Special Committee on Aging, working on health and long-term care issues. Neuman received a doctorate of science degree in health policy and management and a master of science degree in health finance and management from the Johns Hopkins School of Public Health. She has been a Member of the Academy since 2000.

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