Fact-Checking Hillary Clinton's Medicare Buy-In Proposal The Democratic presidential candidate this week floated the idea of allowing people over 50 to "buy in" to Medicare. NPR looks at how that would affect health care costs for everyone else.
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Fact-Checking Hillary Clinton's Medicare Buy-In Proposal

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Fact-Checking Hillary Clinton's Medicare Buy-In Proposal

Fact-Checking Hillary Clinton's Medicare Buy-In Proposal

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ARI SHAPIRO, HOST:

Hillary Clinton has a plan to lower people's health care costs. She says she wants to allow younger people to buy into the government's Medicare program, which is now limited to those 65 and older. The idea may sound simple, but as NPR's Alison Kodjak reports, keeping costs low could be complicated.

ALISON KODJAK, BYLINE: Clinton floated the idea of opening up Medicare to people under 65 at a campaign event earlier this week. She was responding to a woman who had complained that her insurance premiums had jumped $500 last year.

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HILLARY CLINTON: If you were able to move people 55 or 50 and up who are the biggest users of health care into the Medicare program, they would have to buy in, but they would be buying into such a big program that the cost would be, you know, more distributed.

KODJAK: Clinton hasn't offered a detailed plan, but in a few sentences, she suggested that letting people over 50 buy in to Medicare would cut their costs and could also help reduce insurance premiums for younger people. Jacob Hacker says Clinton's idea could slow down health care inflation because Medicare is good at controlling spending. He's a professor of public policy at Yale.

JACOB HACKER: While Medicare is often criticized as not being effective enough at cost control - in fact, Medicare has done a better job than private plans over the last generation in restraining health care prices.

KODJAK: And he says restraining those prices is crucial to the country's overall budget health.

HACKER: Dealing with our health care cost crisis - and that is a crisis; it's the No. 1 threat to our budget - is going to require putting very significant pressure on the medical industrial complex.

KODJAK: Hacker says a government-run insurance plan like a Medicare buy-in could apply that pressure. He championed a different government plan called the public option in the Affordable Care Act debate back in 2010. The idea was to have the government compete with private insurance, but that plan was blocked. As part of her campaign, Clinton has said she supports adding the public option to Obamacare, and Hacker says letting people buy into Medicare could be a first step in that direction.

HACKER: If you go into the health insurance exchange, you could conceivably choose between a range of private plans and the Medicare program.

KODJAK: The idea may also appeal to Bernie Sanders' supporters who like his proposal to offer a government health plan to everyone, which he calls Medicare for All. That plan has been criticized because of its potential costs, and a new analysis by the Urban Institute says it would add trillions to the deficit. Linda Blumberg is a health policy fellow at the Urban Institute. She says the Clinton Medicare buy-in may not be as simple as it sounds.

LINDA BLUMBERG: What happens when you take the 55- to 64-year-olds and you pool them with people who are older than them whose average cost tend to be higher than theirs? Are you going to do something to offset potential increase in cost for that population?

KODJAK: Tom Miller, a resident fellow at the American Enterprise Institute, also sees potential unintended consequences. He says doctors and hospitals charge private insurers more to make up for the low payments they get from Medicare, and Clinton's idea would just move more of the cost from one group to another.

TOM MILLER: That's like saying, you know, let's move this pothole over to another place where you're not driving, and someone else will run into it. You can't hide the problem. You can move it around to a different set of pockets.

KODJAK: Miller says health care for people over 50 just cost a lot of money, and he says any plan that lowers costs for one group will likely end up including fewer benefits or being subsidized more heavily by taxpayers. Alison Kodjack, NPR News.

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