Since the Fall of 2017, the Trump Administration has used its executive and regulatory authority to roll back coverage requirements for ACA health plans and expand access to association health plans that would be offered outside of ACA's exchanges to small businesses and self-employed individuals. In response to the Administration’s efforts to diminish the ACA, which include repealing the individual mandate penalty in the Tax Cuts and Jobs Act, Congressional Democrats, on April 18, 2018, released the Choose Medicare Act, a legislative proposal that would permit, but not require, non-Medicare age individuals and businesses to opt into health insurance coverage offered under a new Medicare Part E program financed by premium payments just as private insurance is today. The Choose Medicare Act would not replace ACA exchange plans. Instead, new Medicare Part E plans would be offered on the ACA exchanges alongside other private exchange plan options.
The Choose Medicare Act is intended to build on ACA’s protections, key features are:
• Make available new Medicare Part E plans to individuals of all ages in all fifty states;
• Opens Medicare to allow all employers to purchase health coverage for employees without replacing employment-based health insurance;
• Provide employees an option to choose Medicare Part E over their employer offered coverage;
• Mandate coverage of essential health benefits plus all items and services covered by Medicare;
• Increases the generosity of premium tax credits and extends eligibility of these credits to middle-income earners; and
• Allow Medicare to negotiate prices for prescription drugs (a proposal that enjoys bipartisan support as well as support from the Trump Administration).
The Choose Medicare Act is the fifth Democratic proposal to support the ACA as some concerns remain regarding the long-term viability of the ACA’s exchange plans without legislation or Trump Administration initiatives to stabilize the exchange marketplace. Despite the Choose Medicare Act’s focus on freedom of choice over the mandate-laden ACA – an approach which might garner some bipartisan support – the general consensus is this latest legislative proposal has little chance of passage by the current Congress and enactment into law.