The Medicare Buy-In Option

The other night on the PBS Newshour, our colleague Jacob Hacker, who was briefly at UC Berkeley and has now returned to Yale, said that the Senate compromise on the public option was a bit Dickensian, a tale of two public options, the best of times and the worst of times—that is a public option that was an expansion of Medicare to a new population, those aged 55 to 64 was the best of the public option while he was disappointed by the trigger on a public option available in the exchange. (He’s also not impressed with another part of the deal, national nonprofit plans offered by the Office of Personnel Management.)

What would a Medicare buy-in mean for California? Courtesy of, we took a look at how many Californians might benefit. Of the 3.7 million Californians ages 55-64, almost 12% are uninsured and another 7% buy their own insurance. That means that almost 20% of Californians aged 55-64 might benefit from a Medicare buy-in, especially if (or when) affordability credits are made available to help them afford that coverage.

This is a very big deal for those aged 55-64. In the current individual insurance market, these are exactly the people that are all too often uninsurable—precisely because by that age, most people have one chronic condition or another or have had an illness or surgery that made them uninsurable. And while 65% of those aged 55-64 have employment-based coverage, losing that coverage is a devastating life event at an age when most people expect to need health care. The Medicare buy-in would eliminate that fear.

We are somewhat bemused by the reaction of doctors and hospitals to the expansion of Medicare. The 4 million Californians who rely on Medicare today seem to have ready access to doctors and hospitals. Would an increase from 4.1 million Californians with Medicare coverage to 4.8 million undermine the ability of doctors and hospitals to provide care? The protests seem especially odd to us when a majority of those who might benefit from a Medicare buy-in are uninsured.

Health Access California promotes quality, affordable health care for all Californians.

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