Action 180. Medicare Option in the ACA
Background: When Trump was first elected, Republicans fantasized about alternatives to the Affordable Care Act but have produced nothing in the nine years since. (1) The recent government shutdown, which was fought over the extension of the Affordable Care Act subsidy, has made health care the #1 issue in American politics at least through the 2026 elections, if not beyond. Democrats need to embrace this as their central issue and propose to DO something about it that will make a profound difference for all Americans. That “something” has been clear for some time, which is to incorporate a Medicare option as an amendment to the ACA, a measure supported by the vast majority of Americans according to numerous polls.
Americans balk at mandates, but embrace options, and are especially likely to do so in response to the compelling economics of a Medicare option. Gradual, but probably inevitable, adoption of a Medicare option by most Americans will put us on the path toward a sensible health care policy enjoyed by the rest of the developed nations. Compared to those countries, we bear on average almost twice the cost for health care as well as shorter life expectancies. (2) With a Medicare option open to all, personal bankruptcies due to medical costs (the primary cause of such bankruptcies (3) would become a thing of the past. In addition, companies which currently provide commercial insurance for their employees would be able to lower their costs and/or increase wages. (4)
The primary objection to the Medicare option is purported cost. However, that cost would not be born entirely by the government. People under age 65 (the current age of eligibility) opting to enroll in Medicare would presumably pay premiums, but ACA subsidies would still be available to offset those costs. In addition, the initial cost of the premiums is expected to be considerably lower than currently paid to commercial, profit-driven insurance providers simply due to the lower cost of Medicare administration – about 2 % for Medicare vs. 17% for private insurance. (5)
Putting this proposal on the table NOW by the Democratic Party would send a clear message to the American voters of Democratic intentions once returned to the majority, and provide a stark contrast to the Republicans who, by their actions, obviously could not care less about the well-being of average Americans. It should be a litmus test for Democratic aspirants to elected office and a core tenant of party identity into the future.
The recent budget bill passed with only a “pinkie promise” from Republicans to vote sometime in December whether or not to extend the ACA tax credits. If they are not extended, insurance costs will rise to unaffordable levels for millions of us. (6) Since the Dems are supposedly going to write the terms of the ACA extension bill promised by Republicans, NOW would be a good time to include the Medicare option. It is high time for Democrats to make a few, big, transformative promises like this and commit to sticking with them until victory is achieved, even if it takes decades. Think of it as building a new party identity with a foundation in the party’s past.
Action: Write to your Democratic representatives and all the aspiring Democratic candidates at any level of government, as well as to the party leadership, and urge them to declare publicly that they are in favor of the concept of a Medicare Option Amendment to the Affordable Care Act. Let’s change the focus from the ongoing Trumpocalypse and get something positive going, starting with health care. We’ve had enough of letting Republicans set the terms of debate! Golden could leave office as a champion of the Medicare Option Amendment. King could somewhat restore his badly tattered reputation by doing the same.
Contacts:
Current National legislators:
Senator Angus King: Email www.king.senate.gov/contact
Phone: (202) 224-5344 (DC office), (207) 945-8000 (Bangor office)
Representative Jared Golden: Email: golden.house.gov/contact
Phone: (202) 224-3121 (DC office), (207) 249-7400 (Bangor office)
Representative Chellie Pingree: Email: https://pingree.house.gov/contact/
Phone: (202) 225-6116 (DC office), (207) 774-5019 (Portland office)
National Candidates: For Democratic candidates for office, a simple online search for their campaigns should give you contact info. For Matt Dunlap, see Amy Fried’s article about him here.
Current state legislators and party leaders: The state party chair is Charles Dingman, devon@mainedems.org. You already have your current Democratic state legislators in your files. If you have a Republican legislator, you might want to skip over them. Other Maine state legislators outside of Hancock County to contact could include:
Ryan Fecteau, Speaker, Maine House: Ryan.Fecteau@legislature.maine.gov
Mattie Daughtry: Mattie.Daughtry@legislature.maine.gov
Teresa Pierce, Senate Majority Leader: Teresa.Pierce@legislature.maine.gov
Jill Duson, Senate Assistant Majority Leader: Jill.Duson@legislature.maine.gov
Matt Moonen, House Majority Leader: Matt.Moonen@legislature.maine.gov
Lori Gramlich, House Assistant Majority Leader: Lori.Gramlich@legislature.maine.gov
Urgency: The ACA issue is hot. Now is a good time to put a “bee in their bonnets” (7).
Extra Credit:
Amid all the distractions in the media are rumblings that Trump is about to propose self-funded medical insurance savings accounts as an ACA alternative. These already exist, and benefit wealthy individuals while doing nothing to help the rest of us. https://www.cbpp.org/blog/expanding-health-savings-accounts-would-do-little-to-improve-access-to-affordable-health-care
(2) AI says “Healthcare costs and outcomes vary across the developed world, with the United States spending significantly more per capita ($13,432 in 2023) than other high-income nations, while often experiencing worse health outcomes like lower life expectancy and higher infant/maternal mortality rates. For comparison, the average spending in other developed countries was around $7,393 per capita in 2023, with countries like Switzerland ($9,688) and Germany ($8,441) having high costs, but still lower than the U.S.” See also:
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
(3) AI again: “Medical costs are a primary driver of personal bankruptcies in the United States, with a widely cited 2019 study reporting that 66.5% of people who file for bankruptcy blame medical bills as a key reason. This makes medical debt the leading cause of bankruptcy in the U.S., exceeding credit card debt and mortgage problems.”
(4) Advantages include reduced cost, simplified administration, and improved competitive ability to attract employees by directing the cost savings into higher wages.
(5) Center for American Progress https://www.americanprogress.org/article/excess-administrative-costs-burden-u-s-health-care-system/
(6) See the Status Kuo: https://statuskuo.substack.com/p/the-surrender-caucus for an in-depth analysis. See also https://shaystewartbouley.substack.com/p/call-it-obamacare-and-they-wont-notice
(7) https://www.mentalfloss.com/language/bee-in-your-bonnet-phrase-origins
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