En español | Every poll, debate and coffee-shop conversation about the top issues in the upcoming elections will likely include health care — how to cut costs and cover more people. And inevitably, the talk will turn to “Medicare for All."
That three-word phrase doesn't refer to how to strengthen the 55-year-old program that provides health care to most Americans over age 65 and those with disabilities. Instead, supporters of bringing all health care coverage in America under one system use the phrase “Medicare for All” to link their proposals to a program most Americans trust.
How the current Medicare program would fit into some of the Medicare for All proposals is not yet clear. That's where voters come in.
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"Voters need to think about who they want to be making decisions about the future of Medicare,” says Tricia Neuman, senior vice president of the Kaiser Family Foundation.
AARP has not taken a position on the overhaul proposals. “But I would ask candidates for specifics,” says Bill Sweeney, AARP senior vice president for government affairs. “What exactly is your plan? How would it affect me?"
So is Medicare itself a hot topic this election? Not so much. Medicare remains one of the most popular federal programs. Workers pay into it throughout their careers (for 2020, the Medicare payroll tax is 2.9 percent, split between worker and employer); in return, people 65 and older get health insurance for the rest of their lives. Like those with other types of insurance, Medicare beneficiaries pay for a share of their costs and for services Medicare doesn't cover, often including routine dental, vision and hearing care. That adds up to thousands of dollars a year for some people.
While concerns bubble up about the health of the Medicare trust funds, it's not a major topic of discussion among candidates. “Congress has always taken steps to keep the program financially sound,” Neuman says. That's probably because Medicare, along with Social Security, has long been seen as the untouchable third rail of American politics. About 64 million Americans are now enrolled; that number should reach almost 80 million by 2030. Americans over 65 vote at higher rates than any other age group. Over the years neither Congress nor the White House has diminished the program.
"Medicare is strong,” says Lindsey Copeland of the Medicare Rights Center. “It's not in danger of going bankrupt.” Still, she notes, “People may use scare tactics or use Medicare to advance their political agendas.”
One looming issue is the growing federal deficit. “At some point, Washington will turn its attention to reducing the deficit, and it could be very difficult to avoid making potentially significant changes to Medicare,” says Neuman. “That's where the money is. Medicare is 15 percent of the federal budget."
Advocates for Medicare say politicians need to look at the root cause of rising program costs — namely, overall increases in the cost of health care. “The answer isn't to cut Medicare,” says Sweeney. “The answer is to lower the costs that are driving up Medicare costs."
Even if candidates don't talk about Medicare much, the outcome of November's elections will steer the debate over whether to overhaul the entire health care system, make adjustments to the Affordable Care Act or leave things mostly the same. All scenarios could influence Medicare's future.
The House of Representatives has already passed the Elijah E. Cummings Lower Drug Costs Now Act (HR 3), which would tackle prescription drug costs, one of the biggest drivers of Medicare costs. The bill would require the federal government to negotiate the prices of some high-cost drugs on behalf of Medicare and use the savings to fund dental, vision and hearing benefits.
"We need to build on what has been working in the Medicare program and strengthen it,” says Megan O'Reilly, AARP vice president for health and family issues. “The solution is not to just shift costs on to the people who have paid into this program their whole lives and rely on it."