KHI News Service

Kansans weigh in on Medicare expansion idea

Senate proposal would open the program to people age 55 and older

By Dave Ranney | December 14, 2009

A proposal to allow people between ages 55 and 64 to buy into Medicare is a “step in the right direction,” according to the state’s largest senior citizen group.

“One of the things we hear all the time is how hard it is for people in this age bracket to get health insurance that’s affordable,” said Dave Wilson, president of AARP Kansas.

But the Kansas Hospital Association and others oppose the plan, which was floated last week by 10 Democrats in the U.S. Senate as they worked to find a compromise among members divided over the current bill’s language for a public health insurance plan.

“We’re not in favor of any pubic option – which is what this is -- that’s based on existing Medicare payment rates because for a majority of Kansas hospitals, those rates don’t cover the cost of care for seniors,” said Cindy Samuelson, an association spokeswoman.

If the plan does pass, Samuelson said, the state’s hospitals would “ to be able to negotiate rates rather than have them locked in or mandated. If this is going to work, the rates are going to have to cover the costs of care. Right now, they don’t.”

AARP Kansas officials also said they wanted to know more about the details of the plan before offering a full-throated endorsement. The organization has more than 360,000 members over age 50.

“We don’t know the details yet,” said Mary Tritsch, the group’s associate state director. “We want to make sure that Medicare remains fiscally solvent and that it remains affordable for those it already covers and as well as for those it might be expanded to cover.

“Before we say much more,” she said, “we need to know more.”

But Tritsch and Wilson said AARP has long supported calls for expanding Medicare eligibility to include Americans age 50 and older.

“I’d rather they take it down to 50,” Wilson said, “but 55 would be OK, too.”

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Wilson said people over age 50 not in an employer group plan often find it difficult to secure affordable health insurance.

“They might be able to get it,” he said, “but it’s going to cost them through the nose. If they have a pre-existing condition, they may not be able to get it at all or if they can, it’s going to be outrageously expensive.”

According to the U.S. Census Bureau’s latest American Community Survey data, about 303,000 Kansans are between ages 55 and 64. Of these, about 24,000 – almost 8 percent – are uninsured.

These numbers do not include people living in institutional settings such as nursing homes, state hospitals, or prisons.

Cost concerns

Others worry that the plan could drain the treasury.

David Landwehr, who owns an independent insurance agency in Wichita, questioned the costs.

“Basically, this would open up Medicare to just about all the baby boomers. That’s huge,” said Landwehr, who describes himself as a fiscal conservative. “I’d have to see how they intend to pay for it. Otherwise, I’d say it’s just a backdoor way of getting everybody on a single-payer program.”

Landwehr is married to State Rep. Brenda Landwehr, R-Wichita, chair of the Health and Human Services Committee in the Kansas House.

U.S. Sen. Pat Roberts, R-Kan., agreed with Landwehr.

“I cannot believe anyone is seriously considering expanding Medicare to tens of millions of people aged 55 and over as a compromise to the government-run or so-called public option,” Roberts said on the Senate floor last week. “It doesn’t take a genius to see that a huge expansion to Medicare is, as one single-payer advocate in the House dubbed it, “the mother of all public plans;” an “unvarnished and complete victory” for advocates of single-payer health care and socialized medicine.”

U.S. Sen. Sam Brownback, R-Kan., also has questioned the proposed expansion’s cost.

"Nobody knows the cost of the overall program," Brownback said during a conference call with reporters last week. "Medicare is not currently actuarially sound. ... I fail to see the expansion of Medicare as anything that's going to make that program any more fiscally solvent."

Devil in the details

Kansas Insurance Commissioner Sandy Praeger said she was glad the idea was being discussed by senators.

“The concept is good, the approach is good,” she said, “but that’s not an endorsement because at this point, really, the devil’s in the details. There are lots of questions.”

The idea, she said, is not new.

“A lot of people don’t know this, but the Children’s Health Insurance Program, which was passed back in 1996, started out as a discussion on how to cover adults 55 to 64,” Praeger said. “It got to be so hard that people threw up their hands and said, ‘Let’s go with kids instead.’”

Praeger said she, too, is waiting to see how the expansion would be financed.

“Medicare, now, is subsidized for those over 65,” she said. “What’s not yet clear is how – or whether – that subsidy would apply to those coming in who are between 55 and 65.”

She said it also was unclear how the plan would affect private health insurance companies, which would no longer be able to deny coverage due to pre-existing conditions, if current provisions in both the House and Senate reform bills remain intact.

“I don’t think we know the answer to that yet,” Praeger said.