On the campaign trail, each former President Donald Trump and Vice President Kamala Harris have sought to portray themselves as guardians of Medicare. Each presidential candidate accuses the opposite of supporting spending cuts and other policies that will harm the medical health insurance program for older Americans.
But the election consequence could change the character of the nearly 60-year-old federal program. More than half of Medicare enrollees are already enrolled in plans called Medicare Advantage run by business insurers, and if Trump wins, that share is anticipated to rise — even perhaps dramatically.
Trump and lots of Republicans in Congress have already taken steps to aggressively promote Medicare Advantage. And Project 2025, a policy wish list from the conservative Heritage Foundation for the subsequent presidency, calls for making insurer-run plans the default enrollment option for Medicare.
Such a change would effectively privatize this system because people are inclined to keep on with the plans they were originally enrolled in, health analysts say. Trump has repeatedly tried to distance himself from Project 2025, regardless that the document's authors include many people who worked in his first administration.
Conservatives say Medicare enrollees are higher off in popular Advantage plans, which supply more advantages than the standard, government-run program. Critics say giving insurers more control over this system would lock consumers into health plans which might be costlier for taxpayers and might limit their care, including by imposing burdensome costs prior approval requirements for some procedures.
“Traditional Medicare is going to die,” said Robert Berenson, a former official within the Jimmy Carter and Bill Clinton administrations who’s now a senior fellow on the Urban Institute, a left-leaning research group.
While the fate of Medicare has received little attention within the election campaign, different visions under Trump and Harris show that much is at stake.
A candidate's position on protecting Medicare and Social Security is a very powerful or some of the essential health issues, determining 63% of Americans' vote within the presidential election, in keeping with a September poll by Gallup and West Health, a family of nonprofit and nonpartisan organizations. that concentrate on health care and aging.
Medicare, which serves about 66 million people, is funded largely by payroll taxes. At age 65, most Americans mechanically enroll in Medicare coverage for hospital stays and doctor's visits, often known as Part A and Part B. However, others must register. Consumers must also enroll in other features of Medicare, particularly drug coverage (Part D) and supplemental plans from insurers that cover costs not covered by traditional Medicare, comparable to prolonged stays in expert nursing facilities and price sharing.
Medicare recipients pay premiums and as much as 20% of the price of care.
Medicare Advantage plans typically mix hospital and outpatient treatment and prescription coverage, eliminating the 20 percent coinsurance requirement and capping customers' annual out-of-pocket costs. Many of the plans don’t require a further monthly premium, but some include a deductible – an amount that patients must pay every year before coverage takes effect.
Sometimes plans include extras like coverage for eye exams and glasses or gym memberships.
However, they control costs by limiting patients to networks of licensed doctors and hospitals with which the plans negotiate payment rates. Some hospitals and doctors refuse to do business with some or all Medicare Advantage plans, making these networks narrow or limited. In comparison, traditional Medicare is accepted by almost every hospital and doctor.
The popularity of Medicare is one reason each candidates are promising to expand it. Last month, Harris released a plan that included additional advantages comparable to hearing and vision care and long-term home health care. The costs can be covered by savings from expanding Medicare's negotiations with drugmakers, reducing fraud and increasing the rebates drugmakers pay for certain brand-name drugs in this system. in keeping with Harris' campaign.
Trump's campaign said he would do it Prioritize home care services and support unpaid family caregivers through tax credits and reduced bureaucracy.
The Trump campaign noticed this too Extensions to Medicare Advantage Plans During his term as president, for instance, he improved access to telemedicine and expanded additional advantages for seniors with chronic illnesses.
But far less attention has been paid to the query of whether private insurers ought to be given much more control over Medicare. Joe Albanese, a senior policy analyst on the Paragon Health Institute, a right-wing research group, said “a Trump administration and a GOP Congress would be more welcoming to this idea.”
The concept of leaving Medicare to personal insurers is just not recent. Former House Speaker Newt Gingrich, a Republican, claimed in 1995 that the standard Medicare program would disappear if its beneficiaries could choose from the unique program and personal plans.
The transition to Medicare Advantage was accelerated by a law in 2003 that established Medicare drug advantages and gave private health insurers a much larger role in this system.
Lawmakers believed that personal insurers could higher contain costs. Instead, the plans have turn into costlier. In 2023, Medicare Advantage plans will cost the federal government and taxpayers about 6% – or $27 billion – more than original Medicare, although some research shows they supply higher care.
“It helps bring needed competition to a state program and has proven more popular with those who switch,” said Roger Severino, lead architect of the Department of Health and Human Services portion of Project 2025. He served as director of the HHS Civil Rights Office in the course of the Trump administration.
But enrollees who want to change back to traditional Medicare coverage may not give you the chance to. If they fight to get supplemental insurance for the 20% of costs that Medicare doesn't cover, they could should pay a prohibitive premium. Unless they enroll within the plans shortly before they first turn into eligible for Medicare, normally at age 65, insurers selling these supplemental plans may deny coverage or charge higher premiums based on pre-existing conditions.
“More and more members of Congress are hearing from constituents who are appalled and realizing they are trapped in these plans,” said Andrea Ducas, vp for health policy on the Center for American Progress, a liberal public policy organization.
(KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one in all the core operating programs of KFF – the independent source for health policy research, surveys and journalism.)
©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
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