Bringing Younger Population Into Medicare a Priority for Clinton

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By Adrianne Appel

Oct. 24 — Hillary Clinton is serious about her proposal to let people 55 and older buy into Medicare if she is elected president, a former Clinton aide said.

“It is something we are looking at. It’s a policy worthy of serious consideration,” Chris Jennings, a former senior health adviser under President Bill Clinton, said.

Clinton announced in the spring that she would expand Medicare, the federal health program for people ages 65 and older, to those age 50 or 55. At the time, Clinton was locked in a tough fight for the Democratic nomination with Sen. Bernie Sanders (I-Vt.), whose plan to allow all Americans to participate in Medicare proved popular.

“It would lower the costs for everyone,” Jennings said. He spoke Oct. 24 at a Harvard Law School forum.

Many individuals who now buy insurance through Affordable Care Act insurance exchanges using federal subsidies would instead use the subsidies to purchase Medicare, Jennings said.

Health-Care Landscape in 2017

At the forum, Jennings and Joseph Antos, with the American Enterprise Institute, debated what the 2017 health-care landscape would look like following the November elections. Both assumed Clinton, who is ahead in the polls, would be elected and that Republicans, even if they lose control of the Senate, would continue to hold significant power in Congress.

Shifting the over-55 population from the exchanges into Medicare might help lower Medicare costs, Jennings said. The younger people could be expected to be healthier and use fewer services. It might also make exchange coverage cheaper for the younger people left in it, for the same reason, Jennings said.

“The details are yet to be worked out,” said Jennings, who is expected to have a role on the Clinton health-care transition team. Jennings currently is a health-care consultant with his own firm.

“I hope to help them get off to a good start,” Jennings told Bloomberg BNA Oct. 24 following the event. But Jennings said he would not expect to be part of the Clinton administration permanently.

Not a Good Idea to Grow Medicare

Antos doesn’t back expanding Medicare, he said during the debate. “It seems impractical for many reasons,” he said. Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI.

“You could just do the same thing through the exchanges, and provide more subsidies,” according to Antos, who made it a point to say he was a conservative, not a Republican.

“Would Republicans go along with this? Possibly,” Antos said. It depends on what policy compromises they would receive in return, not necessarily in health care, Antos said.

Congressional Republicans wouldn’t try to repeal the Affordable Care Act, Antos said. It would be too disruptive and unpopular to do so, he said.

Exchanges: a Republican Idea

The exchanges, or insurance marketplaces, are an old idea, and a Republican one, to give people choices and let them buy what they want, Antos said.

Many exchanges don’t offer enough choice as to plans that can be purchased, and federal rules limit the types of plans insurers can offer, Antos said.

Insurers should be able to offer less generous plans, especially to young, healthy people, Antos said. This may entice more young people to purchase health insurance, Antos said. Many young adults have chosen to pay a federal fine instead of purchasing Affordable Care Act insurance, he said.

“The idea that you must buy a particular type of coverage that is very generous is a very bad sales policy,” Antos said.

“The single most important issue is to find a way to slow down the growth in costs,” Antos said. “The government has to worry about the problem and the solution.”

Exchanges a Small Slice of Health-Care Pie

“Do not make this all about the ACA. It’s a very small population of the general public,” Jennings said. “Only 6 percent of those with insurance are enrolled in the individual market, on and off the exchange, yet the exchange gets 90 percent of the media coverage,” Jennings said.

Clinton would also make it a priority to address the rising cost of prescription drugs, Jennings said. As president, she would have congressional support to take action, he said.

“Both Democrats and Republicans are upset about this. There will be a demand for Congress to act,” Jennings said. Just as important, “stakeholders are coming to Washington and saying ‘You have to do something,’” Jennings said.

Medicare to Negotiate Prices?

Clinton would want to allow Medicare to negotiate directly with pharmaceutical companies over prescription drug prices in the Part D benefit.

“Giving Medicare the authority to negotiate that would not be agreed to by Republicans,” Antos said. “If you need legislation to do it, it’s not going to happen in the next four years,” Antos said.

Clinton believes that a lack of competition in the marketplace among prescription drug companies is one reason for the high prices of drugs. She would work to speed up approval of generic and biosimilar drugs by the federal Food and Drug Administration, Jennings said. A biosimilar product is a biological product that is approved based on a showing that it is highly similar to an already-approved biological product, known as a reference product. The FDA approved the first U.S. biosimilar in 2015.

“This is a really complicated question,” Antos said. Drug manufacturers, patients and insurance companies all define affordability differently, Antos said.

To contact the reporter on this story: Adrianne Appel in Boston at aappel@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

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