My kids, Elise and Brennan, are 8 and 5. They are usually happy go lucky kids who have typical pediatric medical concerns. I am still slightly amazed that my son has not had an orthopedic emergency room visit. Brennan is convinced that if he jumps hard enough, he will defeat gravity. So far, gravity has won every time. Elise has had a broken leg and a broken wrist already in her life, but other than that she is healthy.
My parents are 64. My dad is a retired electrician. He worked on concrete and rebar for over thirty years. Construction beats up on people. His knees are shot. He is starting to slow down but he is in reasonable health all things considered. My mom was a floor nurse for twenty years until she retired this summer. She has a decade of odd conditions. Mass General Hospital attending physicians like to use her as a teaching tool.
Since my dad retired, he has become an avid genealogist and a persistent and occasionally competent golfer. My mom is reveling in being a full-time grandma as her youngest granddaughter is within driving distance.
My kids or my parents: which pair sounds more similar to current Medicare beneficiaries?
Yeah, my parents look a lot like current Medicare beneficiaries.
The Sanders single-payer bill has a four-year rolling transition. Section 106-B-1 says that everyone under the age of 19 is immediately eligible on the first January 1st after the bill is signed into law. Title 10, specifically Section 1001 begins lowering the enrollment age for Medicare.
In the fantasy universe where this bill was signed into law tonight, my kids and my parents would become Medicare eligible at the same time. My wife and I would have several years to wait.
Does this sound plausible to you?
To me, it is not a plausible plan.
Enrolling my parents into Medicare or Medicare Advantage in January instead of sometime next summer is a minor tweak. They’ll get their ID cards several months earlier than they otherwise would have. All of their doctors would be in network and they would be familiar with how Medicare works as that is what they talk about with their friends at the Owl Diner on Jackson Street in Lowell. The Medicare Advantage insurer or the Traditional Medicare ACO would have plenty of experience covering and managing people that are very similar to them.
Medicare and Medicare Advantage has no expertise in enrolling and covering kids. They don’t know how to administer EPSDT screening visits. They don’t know how to manage developmental delays and pediatric behavioral health problems. They don’t know how to deal with puberty. They don’t know how to deal with teenagers and reproductive health. Retirees and near-retirees are a very different universe of people with a distinctive medical profile to manage than kids and teenagers.
New networks would need to be built. New customer service groups would need to be trained. New training would need to be developed for utilization and care management practices. That expertise sometimes could be internal transfers. At UPMC, where I used to work, that knowledge transfer would mean several dozen people would have a new VP as they were transferred from CHIP and Medicaid to move to Medicare Advantage. But CMS and Medicare Advantage carriers that are not multi-line carriers would need to develop that knowledge base and rebuild their claims systems. It will take time; it is not an impossible task but it is not an immediate task.
If one wishes to cover every single kid as soon as possible, there is an easier route. If every kid was presumptively enrolled into either Medicaid or CHIP for the first two or three years while the Medicare system has enough time to adapt and adapt to the changing populations that work. Grabbing programs that are available with the relevant expertise to act as a bridge towards the desired end-state of a single all-encompassing system is an easy and more likely to succeed pathway than throwing millions of kids into Medicare when Medicare could not handle being a pediatric insurer.