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Wednesday, 11 January 2017 07:22

OK, Republicans, How About Allowing ACA Enrollees to Go on Medicare?

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6289639278 e6336deb12 zConvert Obamacare enrollees to Medicare? (Photo: Michael Fleshman)

As Republicans continue to push for the repeal of the Affordable Care Act, it's crucial that we discuss progressive alternatives that would ensure access to insurance for as many people as possible. In an opinion piece in The Hill, Robert Hockett, Edward Cornell professor of law and public policy at Cornell University, proposes that those committed to repealing Obamacare need not look far for a replacement. Just let Obamacare enrollees and eligible individuals enroll in Medicare:

[Republican] Congressional leaders have said that their first order of business upon reconvening this week is to repeal and, at some point, replace the Affordable Care Act (ACA) — the 2010 legislation that President Obama often is said to regard as his signature achievement....

The impediment...which the leadership and the president-elect alike have noted, is that as yet there is no agreement on what should replace the ACA. Simply throwing millions of newly insured Americans off of their plans would cause hardship among working Americans on a nearly unprecedented scale....

Why not, in the very same legislation that repeals Obamacare, instantly entitle all who lose their insurance coverage under the ACA immediately to enroll in Medicare?

Medicare is probably the most popular health insurance in the United States. Even Tea Party senior citizens have issued a definitive demand at rallies: "Don't touch my Medicare!"

In June of 2016, CNBC predicted -- based on an Urban Institute study -- that 24 million people would lose health insurance coverage if Obamacare were repealed and not replaced. Moreover, that estimate was made before Obamacare hit a record enrollment level at the end of 2016, according to CNN Money:

Although President-elect Donald Trump has vowed to repeal Obamacare..., a record number of people have signed up for coverage for 2017....

"Today's enrollment numbers confirm that some of the doomsday predictions about the marketplace are not bearing out," said [US] Health Secretary Sylvia Burwell. "American people don't want to go backwards. They don't want to gamble with their healthcare during a repeal and delay."

Remember, Obamacare includes Medicaid expansion in many states, guarantees coverage despite pre-existing conditions, and has had other positive effects, including enhancing Medicare. Indeed, if Obamacare is repealed, Medicare recipients will pay billions of dollars more in prescription costs and lose significant preventive care benefits. A recent article in The Washington Monthly also contends that Obamacare has made the Medicare trust fund more solvent.

At this point, let us also remember a key way that President Obama tried to make the Affordable Care Act more palatable to those zealots who oppose government programs that benefit the common good: He allowed private insurers to capture the ACA market. As a result, the cost efficiencies of Medicare or a single-payer program for all were lost. In addition, plans offered via the ACA exchanges generally have high deductibles, out-of-pocket payments and prescription costs.

These are major reasons why it makes so much sense, if Obamacare is repealed, to allow those insured under the Affordable Care Act to enroll in Medicare, as long as a public outcry can keep the GOP from privatizing Medicare.

Can the Republicans, if they repeal Obamacare, be backed into supporting a single-payer system -- Medicare -- for Obamacare enrollees? As Robert Hockett argues, it makes sense from a number of different perspectives: moving toward Medicare for all, squeezing private insurers out of Obamacare, and helping to ensure Medicare's solvency and enhanced benefits under Obamacare. Most importantly for many Americans, moving to Medicare will allow them to continue to receive health coverage.

Of course, there is another option, as Hockett drolly comments:

Well, actually, I can see one other possibility that might be as good. That would be immediately to enroll anyone thrown off of Obamacare in Congress's own health insurance plan.

However, when it comes to moving the nation's health care system in the direction of a single-payer model -- and guaranteeing coverage for those currently benefitting from the Affordable Care Act -- converting Obamacare into Medicare offers Republicans the repeal that they promised while moving the nation one step closer to Medicare for all.