Group floats ‘Medicare by Choice’ as a Democratic health care alternative

A coalition of former congressional staffers and federal health leaders is putting forward a health care policy proposal around which it hopes Democrats will coalesce ahead of the 2028 campaign, a position it is calling “Medicare by Choice.”

“Medicare for All,” the proposed single-payer national health care system that would replace private health insurance, proved to be a politically testy item during the 2024 election. Former Vice President Kamala Harris left it off her agenda when she became the Democratic nominee for president, despite having previously pushed for such a system.

So a group of policy experts encompassing the Center for Health and Democracy (CHD), American Economic Liberties Project and a former head of the Centers for Medicare and Medicaid Services (CMS) is putting forth its policy proposal for Democrats, Medicare by Choice. 

This proposal allows everyone the option of enrolling in traditional Medicare regardless of age, even allowing employers to select Medicare by Choice as their employees’ workplace benefit. 

“What we’re trying to do here is find a path forward from the [Affordable Care Act] enhanced premium subsidy debate, now those have expired, and find something that in 2028 can kind of unite folks behind it,” CHD Executive Director Rachel Madley, who formerly worked as a staffer for Rep. Pramila Jayapal (D-Wash.), told The Hill. 

Along with expanding who can buy into Medicare, the proposal calls for improvements to the existing program.

“What our proposal would do is improve traditional Medicare to add out-of-pocket cap and dental, vision and hearing benefits as well,” Madley said.

“And it would also simplify enrollment. And so, it would combine parts A, B and D, so that when you enroll, you’re only enrolling in one program,” she added. “Because again, even though the Medicare program is very trusted and very successful, it does trip a lot of people up when they go to enroll.” 

While some “good conversations” have been held, no lawmakers in Congress have yet to put their backing behind this policy. 

For some in the Democratic sphere, this proposal is somewhat too forward-looking. 

“I would just say to groups who are making policy proposals and sweeping changes, I would remind everyone that you cannot govern if you do not win, and losers do not legislate. And so, the first priority for us has to be winning the 2026 midterms so that we have the ability to enact change and to save health care in this country,” Democratic strategist Antjuan Seawright told The Hill. 

“I think our first part has to be to save Medicare because Republicans are trying to take a blow towards the Medicare and Medicaid. First save it and strengthen the program and then take an honest assessment about what changes would be good for the whole of the program,” Seawright added. 

Medicare for All retains popularity among congressional progressives. In April, a bicameral group of progressive lawmakers, including Jayapal, Rep. Debbie Dingell (D-Mich.), Rep. Alexandria Ocasio-Cortez (D-N.Y.) and Sen. Bernie Sanders (I-Vt.), introduced the Medicare for All Act. 

The Hill has reached out to their offices for comment on the Medicare by Choice proposal. 

The bill introduced last year provides health coverage with no premiums, no co-payments and no deductibles. Polling commissioned by the Medicare for All PAC found that a slight majority of voters say they favor such a proposal — at 54 percent nationally, as well as 56 percent in battleground states. 

But as was seen in 2024, Medicare for All leaves candidates who support it vulnerable to attacks by the GOP of being too radical because it calls to eliminate private insurance plans. 

“We see this as a real path forward in 2028 because it attacks the problems of affordability that a lot of constituents are feeling and members of Congress want to attack,” Madley said. “I think that’s at that gap between the ACA, Medicare for All — where there’s not a lot of other proposals.”

Medicare has been providing coverage for about 60 years now. Recent projections indicate that the program’s finances are at risk of faltering in the near future. 

Last year’s annual report by the Medicare Trustees projected that the Medicare Hospital Insurance trust fund would be insolvent by about 2033, which would lead to spending cuts, projected at 89 percent of scheduled benefits as opposed to the 100 percent that’s now paid out. 

Adding more enrollees would naturally lead many to be concerned about higher spending for a program that’s already facing financial uncertainty. Madley said Medicare by Choice accounts for these realities. 

“It keeps the trust funds separate from any new beneficiaries who are buying into Medicare. So, beneficiaries who are buying into Medicare through this program will be paying premiums that are calculated to keep the program financially solvent. So, they will be kind of siloed in financing,” she said. 

Madley said the writers of Medicare by Choice view it as a potential solution to the solvency issue, as it could drive more people to enroll in traditional Medicare than Medicare Advantage, the private alternative to the original program.

A report released by the Senate Joint Economic Committee this month found that overpayments to Medicare Advantage plans potentially cost seniors exceedingly more than if they had been enrolled in traditional Medicare to the tune of about $84 billion. 

Other policy voices were complimentary of the proposal but said it still fell short of what U.S. health care needs to improve.

“While Medicare by Choice is better than Medicare for All because it doesn’t force everyone in the nation into a new health plan, it’s still not an ideal solution,” Lily Cohen, press adviser for the centrist policy Third Way, told The Hill in a statement.

“Medicare by Choice doesn’t provide direct relief for the millions of Americans who like their coverage but hate the high costs. Bringing down costs for everyone with private coverage should be the top priority.” 

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