Michigan Democratic Sen. Debbie Stabenow (right) nd Sen. Tammy Baldwin (D-Wisc.) speak during a news conference to announce legislation giving people between the ages of 50 and 64 the option of buying into Medicare on Feb. 13. | Mark Wilson/Getty Images health care Push for Medicare buy-in picks up with '50 and over' bill

House and Senate Democrats unveiled a plan Wednesday that would allow anyone over age 50 to buy into Medicare — an incremental step to expand health coverage beyond Obamacare's gains that offers an alternative to the ambitious restructuring progressives envision in their push for Medicare for All.

"I have always supported universal health care but we are not there yet," said Tammy Baldwin (D-Wis.), one of the co-sponsors. "Medicare at 50 is a very bold step in the right direction."


The bill by Baldwin, Sen. Debbie Stabenow (D-Mich.) and Reps. Brian Higgins (D-N.Y.) and Joe Courtney (D-Conn.) would enable people between ages 50 and 65 to buy a private Medicare plan and obtain the same tax credits and cost-sharing subsidies available on the Obamacare exchanges.

The sponsors said the plan will pay for itself with premiums from the new enrollees. And more of the money collected would pay for patient care because of the relative lack of overhead and profit requirements in Medicare compared to the private insurance market, they said.

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"The money paid into Medicare goes to health care. It doesn’t go to paying high salaries," Higgins said.

But for-profit hospitals quickly blasted the legislation. The Federation of American Hospitals warned in a statement that the buy-in would increase financial pressure on its members that already serve large Medicare populations and need the higher reimbursements they get from private insurers.

"Expanding the program with hospitals facing the lowest Medicare margins in history will make it more difficult to provide the critical care that all Americans expect and deserve," said FAH President and CEO Chip Kahn.

Advocates for Medicare for All point to industry opposition to such incremental plans as a reason to push for something much more ambitious.

"The opposition, the insurance companies and pharma, they will come out against anything, whether it's a half-measure or even a one-quarter measure," Bonnie Castillo, the executive director of National Nurses United, told POLITICO. "That's why we have to aim high."

But several supporters of the buy-in plan have also endorsed Medicare for All, and maintain the partial expansion represents a more politically palatable, less disruptive way to reach that eventual goal. They point to recent polling that shows much higher support for a public insurance option that would compete with private plans than for mandatory Medicare for All.

The legislation's backers also tout its potential to broadly lower costs — younger consumers on the exchanges could see their premiums go down if the 50-to-65-year-olds are removed from the risk pool, and current Medicare enrollees could see the same with the addition of the younger cohort to the program.

The plan seeks to keep the expansion separate from traditional Medicare, to blunt anticipated Republican and industry attacks that it will undermine seniors' care. It would funnel premiums paid by new enrollees into a "Medicare Buy-In Trust Fund" that would be used to provide cost-sharing assistance for those in need, without tapping Medicare's traditional trust funds.

The bill would target $500 million a year for outreach to the newly eligible group, five times what the Department of Health and Human Services spent in the Obama administration to encourage a much broader population to enroll in the individual market.

The proposal and others like it are sure to exacerbate tensions within the Democratic caucus in the months ahead. Die-hard Medicare for All supporters say they'll reject anything that leaves the private insurance market in place, and Democratic leadership remains hesitant to move forward on any Medicare expansion while the Affordable Care Act is still under administrative and legal threat.

Top Democrats have instead worked to keep their conference united behind calls to shore up Obamacare’s patient protections and reverse the Trump administration’s health policies — messages that proved essential to winning control of the House and could be potent issues ahead of the 2020 election.

The buy-in bill was introduced the same day a House health subcommittee debated a package of four bills designed to strengthen Obamacare and blunt the Trump administration’s influence over the health care market.

The bills, which are unlikely to survive in the GOP-controlled Senate, would restore Obamacare outreach and enrollment funding that President Donald Trump cut in 2017 and reimpose Obama-era restrictions on skimpy short-term health plans and states’ ability to circumvent certain Obamacare regulations.

Adam Cancryn contributed to this report.