Joe Biden According to Joe Biden,his plan "reflects the reality that, even after the current crisisends, older Americans are likely to find it difficult to securejobs." (Photo: Tiffany Hagler-Geard/Bloomberg)

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In one of his first proposals since becoming the presumptiveDemocratic presidential nominee, Joe Biden is wading back into theroiling waters of health policy.

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In a nod to the effects of COVID-19 on the economy, and what isclearly an overture to supporters of the "Medicare for All" planpushed by Vermont Sen. Bernie Sanders, who suspended hispresidential campaign Wednesday, Biden wants to lower the age ofeligibility for Medicare from 65 to 60.

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Related: Biden doubles down on ACA with new health careplan

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"It reflects the reality that, even after the current crisisends, older Americans are likely to find it difficult to securejobs," the former vice president wrote in a post on the website Medium. Details on the plan arefew, but Biden made clear that those ages 60 to 64 who haveemployer health coverage could keep it if they wanted to, or couldjoin Medicare earlier.

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In addition, he said, "the Biden Medicare-like public option —as well as other subsidized private plans available to individualsthrough the Affordable Care Act — would remain available."

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Some people think Biden's new proposal doesn't go farenough. Tweeted RoseAnnDeMoro, former head of the National Nurses United union and alongtime Medicare for All supporter: "Now if he will only erase the60 we have #Medicareforall." Agreed the Physiciansfor a National Health Program, which also favors a Medicare forAll plan: "Why the unnecessary 6?" implying that Biden should lowerthe eligibility age to 0.

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But just as Biden's earlier health proposal from last summerseemed incremental compared with more liberal candidates' plans touproot the nation's health care system in its entirety, thisproposal is also more significant than it seems.

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Since it was a thousand news cycles ago, let's review what Bidenproposed in July. That blueprint would uncap federal subsidiesfor plans purchased through the Affordable Care Act's marketplaces,so that no one would be required to pay more than 8.5 percent oftheir income toward health insurance premiums. It would also createa comprehensive new "public option" health insurance program thatanyone could purchase, including those who don't like or can'tafford what their employer offers.

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At first glance, Biden's latest plan (which was coupled with astudent loan forgiveness plan aimed at younger voters) seems muchlike many other proposals that surfaced during the Democraticpresidential campaign to let people younger than 65 "buy in" to the popular Medicare program or asimilar program.

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But this is not at all the same thing. Even though it isoptional, "it literally means you're in Medicare at 60," saidRodney Whitlock, a health care consultant and former GOPcongressional aide.

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Such a plan would also be far simpler to implement than a buy-inprogram. Most of those proposals call for people not to enroll inMedicare itself, but a parallel, Medicare-like plan run by thefederal government.

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"The proposals in Congress are totally different," said TriciaNeuman, who heads the Medicare policy program for the Kaiser FamilyFoundation. "This is so much easier," Neuman said. (KaiserHealth News is an editorially independent program of KFF.)

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Easier to implement, maybe, but Biden's latest proposal islikely to be more controversial, too. While the few availabledetails of Biden's proposal pledge that federal funding would comefrom regular tax revenues rather than the dwindling Medicare trustfund (projected to reach insolvency in 2026), Republicans are still likely to oppose such a plan ―strenuously.

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"Republicans are all about long-term [Medicare] solvency,"Whitlock said. In fact, in recent years, Republicans have pushedto raise the eligibility age to 67, to match the new SocialSecurity threshold being phased in.

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When analysts first started looking at the impact of changingMedicare's eligibility age, they thought that lowering it wouldhelp both the Medicare and private insurance risk pools. That'sbecause the 60- to 64-year-olds would become the youngest, andlikely healthiest, members of the Medicare pool. Conversely, theyare currently the oldest, and presumably sickest, members of thepool for individual market insurance.

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But that view has changed over the past few years. A 2019study bythe Rand Corp. evaluated the consequences of allowing evenyounger Americans to buy into Medicare. The Rand study found thatwhile those 50-64 would themselves likely pay less under a buy-inprogram, that doesn't necessarily translate to savings for the poolof people who buy their own coverage on the individual market.

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"When older adults leave the market, insurers are left with asmaller pool of younger, less healthy, and relatively expensivepeople given their age, leading to higher premiums," the studyfound.

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Still, said Whitlock, Biden's latest proposal could disrupt GOPefforts to oppose Medicare for All. Right now, he said, thecrux of their argument is that expanding Medicare to everyonewould threaten the viability of the popular program for those on itnow. But "only doing it for a targeted group will complicateRepublicans' message," he said.

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KaiserHealth News is a nonprofit news service coveringhealth issues. It is an editorially independent program of theKaiser Family Foundation, which is not affiliated with KaiserPermanente.

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