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What is Medicare-X, Michael Bennet’s big idea to fix the American health insurance market?

Michael Bennet sees the plan as more likely to succeed than Democrats’ proposals for single-payer health care

U.S. Sen. Michael Bennet speaks at a campaign event for Colorado Democrats in Denver's Washington Park on Tuesday, Oct. 23, 2018. (Jesse Paul, The Colorado Sun)
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Amid rumblings that he might be considering a run for president — and amid his not exactly saying “no” to questions of whether he is — Colorado U.S. Sen. Michael Bennet is giving a new push to his grand idea for fixing America’s health insurance market.

He calls it Medicare-X — “the best name I ever came up with,” he says. Bennet, a Democrat, touted the idea last week at the Colorado Health Institute’s annual Hot Issues in Health conference, then spoke about it afterward with reporters.

On the political spectrum of health-policy ideas, Medicare-X sits somewhere in the middle — a more moderate and incremental approach than the single-payer plans many of his fellow Democrats have been endorsing, but with plenty of federal involvement to draw fire from Republicans skeptical of government meddling in the marketplace.

So, how would Medicare-X work and why does Bennet think it’s the best idea out there?

Here are some answers:

It would allow people to buy Medicare coverage, regardless of their age

Medicare-X is, essentially, a basic buy-in plan for government health care coverage — a public option, in health wonk speak. People of any age shopping for their own health insurance would have the choice of buying insurance plans from private companies or, instead, buying into coverage through Medicare. (Medicare is normally the government health insurance program for those age 65 and older.)

The bill doesn’t set any prices — that would come later — so it’s difficult to know what this coverage would cost.

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It would exist within the current health insurance structure — not replace it

This is, perhaps, what distinguishes Medicare-X most from other big health ideas floating around Washington, D.C.: While Democrats like Sen. Bernie Sanders of Vermont are pushing for big government-run health insurance programs that cover everybody out of tax revenue, and Republicans like Senate Majority Leader Mitch McConnell continue to hope for opportunities to repeal the Affordable Care Act, Medicare-X would leave the existing insurance structure in place while adding another element to it.

So, the law would still require people to have health insurance (though the Trump administration has stopped enforcing that mandate). The law would still provide states with the option of expanding Medicaid eligibility (which Colorado has done). It would still require employers of a certain size to offer health insurance to their employees, and it would still have private insurance marketplaces where people can buy plans and receive tax credits to help pay for them.

That means Medicare-X wouldn’t directly impact most Coloradans. Currently, about half the people in the state receive health insurance through an employer, while another third have coverage through Medicare or Medicaid. About 8 percent of Coloradans, then, shop for health insurance in the individual market, where Medicare-X would be offered. Another 6.5 percent are uninsured and could, in theory, also take advantage of the option.

To Bennet, this is the key to Medicare-X’s appeal and potential success — it makes major changes but it doesn’t change everything.

“Look, I do think we should have universal health care in this country. I absolutely do,” Bennet said. “I do not think you can get there by taking away insurance that people get from their private employer to accomplish your objective.”

He also made this potentially fateful promise: “It would be a choice. It would be an option. So if you have insurance through your employer and you love your insurance through your employer, you could keep it. But if you wanted something else, you could get something else.”

It would launch first in rural areas

Sunrise on the eastern plains of Colorado in an undated photo. (Mark Reis, Special to The Colorado Sun)

Bennet said the idea for the plan — which he hatched with Virginia Sen. Tim Kaine, also a Democrat — came to him after meetings across rural Colorado, especially in the mountains, where insurance premiums are some of the highest in the nation.

Bennet said he had one meeting in Jackson County with a couple dozen local leaders where only three people in the room were insured. Recalling another meeting, in Routt County, Bennet told the conference crowd about a guy who asked him: “Why would you force me to buy insurance that is so expensive and has such a high deductible that it is not there when I need it?”

In addition to high prices, rural areas in Colorado and across the country also struggle for choice. In 14 Colorado counties, there is only one insurer offering plans in the individual market.

Bennet said Medicare-X would give people in those areas more choice and give the insurers who currently hold a monopoly a little price competition. After a few years, Bennet said Medicare-X would be rolled out to the rest of the country.

It would pay doctors the same rates that Medicare does

This one could be a sticking point with medical providers. Medicare generally pays better than Medicaid across the country. But it still pays well below what doctors and other providers can get from private insurance companies. The bill would, though, allow for payments 25 percent above normal Medicare rates to doctors and hospitals in rural areas.

Its finances would be separate from the Medicare trust fund

This is another point of potential consternation that Bennet is hoping to avoid. He says Medicare-X wouldn’t dip into traditional Medicare’s trust fund to make ends meet.

“It’s not actually in the Medicare trust fund, which gives seniors a lot of concern when they hear people talking about Medicare for All,” he said, referencing Sanders’ single-payer proposal.

It is something Bennet hopes both parties will rally around

Whether the result of presidential aspirations or not, Bennet spoke at length at the conference about the need to change America’s political culture “root and branch” and to work together. And, not coincidentally, he cited Medicare-X as the kind of idea he thinks both parties can get behind.

“I find that when you engage people around their kitchen table, that this is not a political matter for them,” he said. “They could care less. The people who like President Obama, tend to be for the Affordable Care Act. The people who don’t like President Obama hate the Affordable Care Act. But everybody hates the way their lives intersect with America’s health care system. And we need to construct some politics that addresses that instead of just repeating the stuff that’s not going to make progress and hasn’t made progress over the last 10 years.”

MORE: Read more politics and government coverage from The Colorado Sun.

It might have more luck in the House than the Senate

The proposal has yet to live up to that hope for bipartisan support, though. The current version — introduced last year in the Senate — has 10 co-sponsors, all Democrats. It also has yet to receive a committee hearing in the Republican-controlled Senate.

A version in the House, though, might fare somewhat better in the coming session. Only Democrats have signed onto that bill, too. But the party will control the chamber starting next year — meaning it could actually get a hearing.

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