What You Need to Know
- Medicare is a public health insurance program that was established in 1965 for older adults and people with disabilities
- Medicare insurance includes both public and private options with their own benefits and risks
- While many private plans offer good coverage, traditional Medicare is a public good that must be protected
- Medicare’s long-term solvency is at risk
- The next presidential administration needs to commit to strengthening and protecting Medicare
A commitment to health equity means ensuring access to quality affordable health care for everyone—and at every stage of life. Ahead of the general election in November, many candidates and their supporters have been debating the future of Medicare, a federal public health insurance program for adults ages 65 and older as well as people with disabilities and qualifying medical conditions.
At the Health Foundation, we believe that Medicare is a public good that should be both supported and enhanced. This can be accomplished in several ways, including improving transparency and efficiency in the current program and expanding coverage options for older adults.
It is imperative that our next president prioritizes the health and longevity of the public Medicare program.
Keep Medicare Strong—For Everyone
Medicare is a popular and important program, but its financial sustainability is at risk. By 2030, all Baby Boomers will be at least 65 years old. Add to that the fact that Americans are living longer, and it’s clear that our elected officials need a proactive plan to ensure the long-term sustainability of the Medicare program.
More than 50 percent of Medicare spending is driven by enrollees in Medicare Advantage, private market plans that offer alternative, often more expansive, coverage options compared to traditional Medicare.
For example, public Medicare does not cover hearing, vision, and dental care, but many Medicare Advantage plans do. This all-inclusive packaging makes the private plans an attractive option for many older adults.
But like many other private health care programs, not all Medicare Advantage plans are created equal. Many offer excellent coverage. But the data also show that Americans living in the poorest counties are less likely to have access to five-star Medicare Advantage plans and more likely to have the choice of low-rated plans with a lower level of care.
Some Medicare Advantage plans have been criticized for overbilling the Centers for Medicare and Medicaid Services (CMS) for reimbursement, further draining federal Medicare funds. Bipartisan calls for greater oversight have inspired proposals to increase data transparency for Medicare Advantage programs.
How We Support Strengthening Medicare
High-quality health coverage should be available for older adults, regardless of where they live, what their socioeconomic status is, or whether they have access to private coverage.
We support several methods of strengthening Medicare and achieving more equitable coverage for older Americans:
- Increase data transparency for Medicare Advantage plans to guard against overbilling
- Add dental, vision, and hearing benefits to make traditional Medicare more competitive
- Significantly expand Medicare’s ability to negotiate the prices of prescription drugs
Proposed Solutions Across the Political Spectrum
Public officials have been discussing how to protect the future of Medicare for years, and these discussions will continue as we approach the November presidential election. We encourage voters to read up on their candidate’s proposed policies on Medicare before heading to the ballot box.
Some proposals currently in discussion include the following:
- In their federal budget proposal for 2025, the Biden-Harris administration has outlined specific recommendations for strengthening Medicare solvency. These include raising the Medicare tax rates for people earning more than $400,000, closing loopholes in existing Medicare tax laws, and redirecting revenue from the Affordable Care Act’s Net Investment Income Tax (NIIT) into the HI trust fund.
- Project 2025, prepared by the Heritage Foundation and serving as a blueprint for some conservative politicians and policymakers, recommends that Medicare Advantage be the default option for all Americans and traditional Medicare be converted into a voucher program.
- CMS has stated the focus should be on a “value-based care strategy” to strengthen all of Medicare.
- Other health policy advocates recommend taking a hard look at both approaches and addressing key shortcomings, such as overpayments to Medicare Advantage insurers and the lack of vision, dental, and hearing benefits in traditional Medicare.
As we approach another consequential election, we encourage our candidates, public officials, and of course, voters, to consider how any proposed changes to Medicare will affect millions of Americans for generations to come.
