Medicare Part E for All – An Idea Whose Time, Perhaps, Has Still Not Come

Since the Fall of 2017, the Trump Administration has used its executive and regulatory authority to roll back coverage requirements for Affordable Care Act[1] (ACA) health plans and expand access to association health plans that would be offered outside of ACA’s exchanges to small businesses and self-employed individuals. In response to the Administration’s efforts to diminish ACA, which include repealing the individual mandate penalty in the Tax Cuts and Jobs Act, Congressional Democrats, on April 18, 2018, released the Choose Medicare Act, a legislative proposal that would permit, but not require, non-Medicare age individuals and businesses to opt into health insurance coverage offered under a new Medicare Part E program financed by premium payments just as private insurance is today. The Choose Medicare Act would not replace “ObamaCare” exchange plans. Instead, new Medicare Part E plans would be offered on the ACA exchanges alongside other private exchange plan options.

The Choose Medicare Act is intended to build on ACA’s protections and is not an ACA replacement bill. Some of the key features of the Act are as follows:

• The Act would make available new Medicare Part E plans to individuals of all ages in every part of the Country.
• The Act opens Medicare to employers of all sizes and allows them to purchase health coverage for their employees without the need to replace employment-based health insurance.
• The Act would give employees the option to choose Medicare Part E over their employer coverage.
• The Act would mandate coverage of essential health benefits plus all items and services covered by Medicare.
• The Act increases the generosity of premium tax credits and extends eligibility of these credits to middle-income earners.
• The Act would allow Medicare to negotiate prices for prescription drugs (a proposal that enjoys bipartisan support as well as support from the Trump Administration).

The Choose Medicare Act is the fifth Democratic proposal to fix the ailing ACA as concerns continue unabated that ACA’s exchange plans eventually may collapse without legislation to stabilize the exchange marketplace. Despite the Choose Medicare Act’s focus on freedom of choose over the mandate-laden ACA – an approach which might garner some bipartisan support in the right political climate – this latest legislative proposal has no chance of moving through Congress anytime soon. Perhaps, the Choose Medicare Act could gain track if the Democrats regain control of the House of Representatives later this year, but even then, the prospects for the Choose Medicare Act or any other Democratic ACA fix remain highly uncertain. At this juncture, Medicare Part E may be destined to be a talking point for Democratic candidates running for President in 2020.

[1] The Patient Protection and Affordable Care Act (Pub. L. No. 111-148), enacted March 23, 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152), enacted March 30, 2010.