Rich Pedroncelli/AP Photo
After reaching an all-time low in 2016, the national uninsured rate among children has been on the rise. Today, over four million children are uninsured.
Presumptive Democratic presidential nominee Joe Biden has proposed expanding Medicare to more Americans by lowering the eligibility age from 65 to 60. It was widely seen as a gesture toward supporters of Sen. Bernie Sanders (I-VT) and his signature policy, Medicare for All. Just days later, Sanders officially endorsed Biden for president.
Biden’s support for expanding Medicare is noteworthy, if modest. But there may be a better approach he could take to expand health care to more Americans and to win over Sanders supporters: expanding Medicare to cover children. In fact, not only would this do more for Sanders’s core supporters than lowering the eligibility age incrementally, but it also enjoys broad public support, according to a new poll.
A “Medicare for Kids” program would give automatic government-provided health insurance to all Americans from birth up until some defined age in early adulthood (perhaps 26, the current cutoff for young adults to remain on a parent’s health care plan). Such a program has been a goal of health reformers since Lyndon Johnson’s administration planned “Kiddicare” as a follow-up to the original Medicare. Politicians have occasionally picked this up over the ensuing decades, most recently Sen. Kirsten Gillibrand (D-NY), who proposed universal coverage for all children through the Children’s Health Insurance Program during her presidential campaign.
Medicare for Kids may now be an idea whose time has come. After reaching an all-time low in 2016, the national uninsured rate among children has been on the rise. Today, over four million children are uninsured, due in part to the Trump administration’s relentless efforts to undermine the Affordable Care Act and other safety-net health care programs.
Medicare for Kids has the support of a staggering 71 percent of people under age 45, a demographic that Biden has particularly struggled to excite.
The number of uninsured children will undoubtedly rise precipitously during the coronavirus crisis. When parents lose or change jobs, their children’s health coverage is often lost or disrupted too. But already during the coronavirus economic shutdown, a stunning 52 percent of people under age 45—that is, around the age when people are raising a family—have either lost a job, been put on leave, or had their hours reduced.
Beyond solving a concrete policy problem, Medicare for Kids also enjoys popular support. In a just-released poll by Data for Progress, 60 percent of those surveyed supported Medicare for Kids, while just 32 percent were opposed. The proposal won positive reviews among people without a college degree (+30 percent net support), suburbanites (+24), and people living in rural communities (+5).
Perhaps most important for Biden, Medicare for Kids has the support of a staggering 71 percent of people under age 45. That is a demographic that Biden has particularly struggled to excite. These voters are more likely to rally around a health care expansion tilted toward people their own age than their parents’ age, as well as something they would benefit from as young parents. Medicare for Kids thus creates greater opportunities for Biden to expand his electoral coalition than Medicare for 60-somethings does.
And for Medicare for All supporters, Medicare for Kids would set in motion a strong political-economy dynamic for future expansion. As Vox’s Matt Yglesias has noted, “if the beneficiaries of Medicare for Kids liked the program, they would end up having a direct personal incentive to favor its expansion.” If advocacy for Medicare for Kids raised turnout among the under-45 set, it could transform the electorate. Young adults nearing the age cutoff of Medicare for Kids would advocate to keep expanding eligibility, which may ultimately produce a program approximating Medicare for All.
That’s a big reason why Medicare for Kids would make for a more effective olive branch from Biden to Sanders supporters. In fact, Medicare for Kids is baked into Sanders’s Medicare for All transition plan, which would ease the country toward full single-payer coverage by beginning with covering all children. And while Sanders quickly endorsed Biden, some of his high-profile supporters weren’t overly impressed by his policy gesture. Rep. Alexandria Ocasio-Cortez called Biden’s Medicare expansion for those over 60 “almost insulting,” pointing out that Hillary Clinton embraced lowering the Medicare age to 50 back in 2016.
If advocacy for Medicare for Kids raised turnout among the under-45 set, it could transform the electorate.
Even those concerned with deficits after the multitrillion-dollar spending in pandemic response should favor Medicare for Kids. Children are cheaper to cover with health insurance than 60-year-olds. Plus, state and federal governments already pay for some coverage through the Children’s Health Insurance Program, and that money could be rechanneled toward Medicare for Kids. One estimate finds that the total additional financing needed to cover all kids would be $425 billion (1.7 percent of gross domestic product) in 2022, offset entirely by what it already costs to insure this group in the private markets. The proposal would also add millions to the Medicare rolls—far more than the alternate expansion over age 60—giving the program more bargaining power over provider rates and prescription drug costs.
There is a core philosophical divide between expanding Medicare for near-retirees and opening Medicare up to children. Medicare for those over 60 still retains the existing underlying assumption that guaranteed health care is something you earn after paying your share through a lifetime of work or by approaching senior-citizen status. It’s treated more like an earned benefit than a basic right. Yet like Sanders, Biden says he “believe[s] deeply that health care is a right for all—not a privilege for the few.” Short of embracing Medicare for All, there is perhaps no better way to put that value into practice than by automatically providing guaranteed health care coverage to American children from the moment they are born.
UPDATE: An earlier version of this story indicated that a study of Medicare for Kids found it would cost $425 billion over ten years. It has been updated to reflect that this would be the cost of the program in 2022.
Any expansion of public health care coverage is a welcome policy improvement. Biden is on the right track with his plan to open Medicare up to more people, but he might be better off starting at the other end of life. If health care is a right for all, Medicare for Kids may be the place to start.
