President Joe Biden (Trevor Bexon via Shutterstock) Credit: Trevor Bexon / Shutterstock

Part of President-elect Joe Biden’s plan to expand health insurance coverage for older Americans is lowering the Medicare eligibility age from 65 to 60.

The proposed change — which Biden said will aid early retirees, the unemployed and those who don’t have jobs with health benefits — has already received heavy pushback from the hospital and insurance industries, as well as from critics pointing to the nation’s $3 trillion deficit.

But 85% of Democrats and 69% of Republicans are in favor of lowering the Medicare age to as young as 50, according to a Kaiser Family Foundation poll. So if the proposal is popular, why would it be hard to pull off?

“It’s an idea worth exploring as with any proposal that can help insure and improve access to affordable coverage,” said Andrew Scholnick of AARP’s Government Affairs team. “Any time you have a population that can’t afford coverage or doesn’t have access to coverage, it presents a problem for society.”

Right now, Medicare covers over 60 million people, including those with certain disabilities. Biden’s expansion could add 23 million more under the program.

Medicare is a combination of plans, both federal and private. “Traditional” Medicare is federally run and includes Plans A, B and D, which cover hospital care, medical care and prescription drugs, respectively. Patients can choose any provider who accepts Medicare under this version.

The Medicare Advantage plan, Plan C, is the private insurance alternative. Private insurers bundle parts A, B and D into one plan with set providers.

“It’s a little patchy. It’s not awesome,” State of Connecticut Healthcare Advocate Ted Doolittle said. “But it’s still better than what came before.”

Doolittle said adding people under Medicare coverage would help the program financially, as that means more patients paying premiums. The 60-65 age bracket would also, generally, be composed of the cheapest patients because they’re the healthiest, meaning the risk pool would become healthier and cheaper to insure as well.

Medicare needs that monetary assistance badly, as its Hospital Insurance Trust Fund won’t have enough funds to cover all benefit costs beginning in 2024.

“It would considerably strengthen the program financially,” Doolittle said, adding that expanding Medicare would create more competition against job-based insurance. 

Dr. Elizabeth Rocco, a retired ophthalmologist, agrees that younger patients would bolster Medicare financially, but said that expansion would encourage people to retire early and therefore shrink the workforce. She’s against lowering the age, except for in cases when an individual is too sick to work and get job-based insurance.

“I would rather see a fair minimum wage [and other incentives to keep people working],” Rocco explained.

Rocco continued that there’s disparities in care that should be addressed before Medicare is expanded. She saw it while practicing as a physician — rather than equal coverage, patients who could pay additional fees got better services than those who couldn’t afford them, primarily people of color, she said.

“I see this idea about people who have money getting better technology with Medicare as separating classes of people,” Rocco said. 

Addressing the gaps is something Judith Stein, executive director of the Center for Medicare Advocacy, also said is crucial prior to lowering the eligibility age. “Traditional” Medicare and Medicare Advantage don’t have the same ease of enrollment, coverage and allocated resources per beneficiary, and Stein believes there should be an out-of-pocket cap added to “traditional” Medicare. 

“We need to make sure that there’s complete parity between those two programs, which there isn’t now,” she said, stressing that the Biden administration needs to fully support the Elijah E. Cummings Lower Drug Costs Now Act, which would add the out-of-pocket cap, lower drug costs and direct resulting savings to adding oral, vision and audiology services.

Stein said it’s “too soon to tell” if all of this is even possible. The Democrats’ forthcoming majority in the Senate is slim, and though Biden’s incoming health secretary, California Attorney General Xavier Becerra, supports health care expansion, it’s unclear if he and the Democrats can overcome the hurdles. 

Doolittle is more pessimistic. He thinks that the proposal is going to have to jump through too many hoops, like hospital lobbyists and drug companies.

“It’d be politically a very heavy lift,” Doolittle said. “Maybe we can have this conversation in four or eight years.”