AMA Report Offers Alternatives to Offering Medicare at 60

Marcia Frellick

November 15, 2021

The American Medical Association House of Delegates today adopted a report that includes outlining alternatives to proposals in Congress to lower the age of Medicare eligibility from 65 to 60.

As Congressional Democrats propose reducing the eligibility age as part of a budget reconciliation bill under debate, the Council on Medical Service was asked by the AMA Board of Trustees to develop a report on the issue after the House of Delegates in the Special Meeting in June identified individuals aged 60-64 as a key group to target for reducing lack of insurance. The issue was part of the report on "Covering the Remaining Uninsured." 

The report states some of the downsides of a Medicare-at-60 plan. They include:

  • People in that age group would lose access to other health plan choices, including subsidized marketplace plans.

  • Lower-income people who currently get marketplace subsidies could face higher premiums with Medicare.

  • People would still likely have to get supplemental insurance as they often do with Medicare, which has limited benefits.

  • Physician and hospital payment rates from private plans are typically higher than those paid by Medicare.

Report authors note that lowering the age of Medicare eligibility to 60 has been projected by the Kaiser Family Foundation to shift nearly 12 million people with employer coverage and 2.4 million with nongroup coverage into Medicare, which would significantly alter the payer mix of physician practices.

Dr Erick Eiting

One of the report authors, Erick Eiting, MD, MPH, with the American College of Emergency Physicians, said, "Our council specifically looked at the uninsured for patients age 60-64 and we have heard the previous discussions on this issue loud and clear. While roughly 1.6 million people in this age category remained uninsured, many have a pathway to existing insurance mechanisms."

Insurance Breakdown for Those 60-64

The current insurance status breakdown for the 20.8 million people in the US in the 60-64 age group, according to KFF, is as follows:

  • 56.3% enrolled in employer-sponsored coverage

  • 14.5% in Medicaid

  • 11.3% enrolled in nongroup coverage

  • 10.1% have other public coverage (Medicare and military coverage, for example)

  • 7.8% are uninsured

Of the uninsured ages 60-64, nearly half are eligible for premium tax credits. Nearly 20% are Medicaid-eligible; 15% are ineligible for ACA financial assistance as a result of having an "affordable" offer of employer coverage; 10% fall in the coverage gap; and 7% are ineligible for ACA financial help because of their immigration status, according to the report.

Abby Dillaha, a delegate from Cincinnati, Ohio speaking on behalf of the Medical Student Section (MSS), said the MSS supports lowering Medicare eligibility to age 60.

"We know women, people who work lower-wage jobs, and people with lower levels of education are more likely to retire early and find themselves in a state of uncertainty with insurance coverage," she said. "We also know that poor health is often cited as a reason for early retirement. Lowering the age of Medicare eligibility is an issue of equity for those currently uninsured and underinsured."

Dillaha continued, "The council has proposed several options that will allow the uninsured to obtain coverage and would allow those with suboptimal coverage to have a better option. We believe Medicare should be one of those options for patients beginning at age 60."

Douglas Myers, MD, with the American Academy of Otolaryngology, speaking for himself, said at the reference committee hearing Saturday, "We hear about the 7% of people between the age of 60 and 65 who are uninsured but that also implies that there are 93% who are insured.

"My concern is that if Medicare is opened up to this age group it won't just be the 7% who take advantage of it. The other 93% could very well switch over to Medicare, which would deplete our reserves."

Council Report Proposes Alternatives

The Council report says current AMA policy and additional recommendations will benefit the uninsured population ages 60-64 "without causing health system disruptions."

Proposals from the report include advocating that any federal approach to cover uninsured people who fall into coverage gaps in states that do not expand Medicaid make coverage available at no or little cost with cost-sharing protections.

Report authors also call on the AMA to support legislation or regulation "to fix the ACA's 'family glitch,' thus determining the eligibility of family members of workers for premium  tax credits and cost-sharing reductions based on the affordability of family employer- sponsored coverage and household income."

The delegates also ask that states that have expanded Medicaid get additional incentives to maintain their expansions.

Marketplace Coverage for Undocumented Immigrants

Another part of the recommendations proposes extending eligibility to purchase ACA marketplace coverage to undocumented immigrants and Deferred Action for Childhood Arrivals (DACA) recipients, with the guarantee that health plans and ACA marketplaces won't collect or report information on immigration status.

The report also recommends that AMA recognize the potential for state and local initiatives to provide coverage to immigrants regardless of immigration status.

"In implementing initiatives to improve the coverage rates of immigrants, the Council believes it is critical that entities overseeing these programs do not collect and/or report data regarding enrollee immigration status."

Rheumatologist Shawn Baca, MD, speaking on behalf of the Florida delegation, commented on an item related to the undocumented immigrants. He added comments on item 4 of the report, which states that the AMA should "recognize the potential for state and local initiatives to provide coverage to immigrants without regard to immigration status."

"I run a free clinic once a month in my office for rheumatology patients and it's a little disconcerting that we still have issues for patients who are citizens and now we're expanding [insurance coverage] out to people who are noncitizens," said Baca, who practices in Boca Raton. "Many of my patients feel this is very unfair since they play by the rules, so we suggest that item 4 get referred back. We're in support of the rest of the document."

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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