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Medical Groups Balk at Medicare ‘Buy-In’

WASHINGTON - Hospital and doctor groups that have generally supported the effort to revamp the nation's health care system pushed back Wednesday against a new idea proposed by Democratic leaders to let younger Americans buy into Medicare.

The proposal, which would allow people 55 to 64 to enroll in the seniors health program, has emerged as a central part of an agreement struck between centrist and liberal Democrats sparring over the creation of a government-run insurance program.

Though the idea gained traction on Capitol Hill - and got a boost from President Obama - the outcry from the medical groups underscored the difficulty lawmakers are facing as they look for compromises that can win broad support for the Senate's bill, which would cost $848 billion in the first 10 years.

"Bringing more people into a system that doesn't work very well is not a good answer," said Jeffrey Korsmo, executive director of the Mayo Clinic Health Policy Center. "The current Medicare program is not sustainable."

The Medicare proposal is one of several ideas included in a tentative agreement reached by a group of 10 Democrats - five centrists and five liberals - seeking alternatives to the government-run insurance program, or "public option."

Though he has in the past supported the public option as a way to drive down health insurance costs by increasing competition, Obama said Wednesday that he supports the new Senate framework. The president predicted it "will help pave the way for final passage of legislation."

Still, some Democrats whose support will be needed to pass the bill said they are reserving judgment until they can review a pending cost analysis from the Congressional Budget Office. Sen. Blanche Lincoln, D-Ark., said there was only "consensus that we needed more information in order to move forward."

The Senate is racing to approve the health care legislation by Christmas. Senate Majority Leader Harry Reid of Nevada needs to corral 60 votes, and he has focused mainly on Democrats because no Republicans have expressed support for the bill.

Nebraska Sen. Ben Nelson, who has been among the most vocal Democratic critics of the public option and who met privately with Reid on Wednesday, said he isn't leaning for or against the deal. "I just want to know what the costs are," he said.

Created in 1965, Medicare had 45 million beneficiaries in 2008, according to the Kaiser Family Foundation, but rising health care costs have threatened the program's viability. According to the 2009 annual report by its trustees, the program is on track to run out of money in 2017.

Many details have not been announced, but the American Hospital Association and the American Medical Association, pounced on a proposal to expand the seniors program because doctors receive less from Medicare than from private insurance for the same procedures.

"If more people move into Medicare we'd bear the financial brunt of this," said Rich Umbdenstock, president and CEO of the hospital trade group.

The hospital group has not endorsed the legislation, crafted by Reid, but it has backed the broader effort. In July, it agreed to forgo $155 billion in government reimbursements over 10 years to help pay for other changes to the health care system.

Sen. Mary Landrieu, D-La., who along with Lincoln was among the 10 senators negotiating a compromise, said it would be a "very good idea" to allow people between 55 and 64 to buy into the Medicare program, but she said key provisions of how the program would work for the new enrollees are not yet clear.

For instance, Landrieu would like the buy-in to be available immediately but said the start date would ultimately depend on projected costs. Lawmakers are also negotiating whether the government would initially subsidize the younger Medicare enrollees.

If not subsidized, Medicare can be costly. Americans who are over 65 but don't qualify for the program for other reasons pay a $461 monthly premium to buy into the portion of the program that covers hospitals stays, said Vicki Gottlich, a policy attorney with the non-partisan Center for Medicare Advocacy. The group has supported the buy-in concept but is waiting to see details of the proposal, Gottlich said.

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