Lets fight for Medicaid for All!
(yes, a teaser title)
Recently a post asked if we should start fighting for expanding Medicare to anyone 50 years old or older, maybe starting with moving the age to 60 over the next three years and then every two years brining it down a year till we reached 50. (So by 2026 people who turned 50 could sign up for Medicare.)
I did not think that was a good idea, nor would it help with the issue we have with health insurance…mainly the lack of affordable coverage.
My recommendation is not to fight for Medicare for all, but to fight for Medicaid for all.
More after the squiggle.
First off, 50+ is not that old, most will be in their peek job level. So it won't sell well. People will say "why should you mid-level manager making $60k a year get 'free' Medicare when the rest of his younger workers are paying $400 a month for health insurance and making less?
You can see the unfairness in that. Those who earn the least would still be paying the most and using far less. While older, higher paid workers, would be getting a "taxpayer handout" - to put it in GOP terms.
I would say a better idea, and more sellable idea is that we need to be expanding Medicaid. Work it from the bottom up to give a break to low income workers. It is an easier argument to say we should allow Medicaid to anyone making 150% of the poverty level - $35,300 for a family of four, then 200% - $47,100, then 250% -$58,800, then 300% -$70,650. At that point, why not Medicaid for all?
At each level, it is easier to point out that expanding Medicaid lets low income earning people keep more of their pay so they need less other aid - food stamps, housing aid, etc. And as people start out working, they will by definition be earning less, they will be part of the Medicaid system. As they progress in their jobs and careers, they will approach the cut off number and will be much more inclined to support increasing the cut off %.
Example: Sue graduates from High School, goes to Community college but is on her parents plan. She gets her Associates and gets her first "real" job making $1,300 a month. ($15,600 a year). For a single person, this is under the 150% over poverty level, so she qualifies for Medicaid. She works hard for the next three years, in that time gets married and has a kid. The families new income is just under $29,000 a year, and they still qualify for Medicaid. However, now the child is about to go to school and Sue is planning on going back to work full time which would bring the family income to $38,000 a year, above the 150% level over poverty.
Sue will certainly not want to have to start paying $300 a month for insurance that has high deductibles and co-pays. Her family will support moving Medicaid coverage to 200% of poverty level - $39,200 a year. While Sue was working part time, she nearly completed her BA. Over the next two years she graduated and with that degree began the career change search to make the most of her education. She also had another child, but since she was now working as a supervisor, she could return to work quicker while finishing up the degree. She finds a good job that will bring the family income up to $55,000 a year, over the 200% limit.
Again, she and her family don't want to pay through the nose for insurance that has major restrictions on where you can go and what is covered. Medicaid is accepted by all hospitals and any doctor that takes Medicare. As more people have Medicaid and as more Baby Boomers go on Medicare just about all doctors take it. Can't say that about any brand name insurance. This means she will support and work for increasing the Medicaid coverage to 250% over poverty level, or $59,000 for a family of four.
Now, this is the advantage of using over poverty level for Medicaid expansion, you are helping those who can least afford insurance, it covers the young who have the lowest medical costs, and would make taking those starter jobs easier. It also would break the idea of your employer controlling your health insurance.
People above the poverty levels would see the lower cost of Medicaid (The max Medicaid can charge is 5% of family income in a quarter. Far less than the ACA allows before tax credits.) The lack of employer screwing around with insurance. The portability with moves and job changes, and would soon be asking to see it raised to the 300% or 400% over poverty level. (personally I think that at 300%, everyone except the radical multimillionaire, would be demanding it. You would have a single payor system set up simply by increasing the range above poverty level covered by Medicaid at its next logical step. You prevent the counter argument I started with.
And since it is base on income, any 50+ who gets laid off and has to take a low wage job will still be covered.
Another point in favor of this idea is that insurance companies don't want to cover low income earners anyways. Are they going to fight to cover these people over covering the high paid employee who thinks nothing of a $50 co-pay?
Not at first. By the point they realize younger, low income earners are growing up with "single payor" Medicaid for all, they won't be able to sell to them the idea a young workers should pay a lot for less coverage.