Adam Gaffney further notes:
Overall approach is that of "managed competition," which is reason for obvious parallels with ACA exchanges.
Whereas ACA exchanges were meant to expand insurance access (problematically), Medicare exchange will be used to kill Medicare as we know it
Important to note that inroads have been made in this direction by previous administrations: Privatized Medicare plans already exist.
Insurance companies have bilked the public purse through these Medicare Advantage plans (and their predecessors) for years.
Yet this will be something truly new. Benefits will be tiered to income insofar as voucher will only "offset" premium for some plans.
Medicare is imperfect, but it's universal. It's (mostly) public. It has admin overhead of ~2% as opposed to > 10% for most private plans.
Insurance companies will suck money out of the program in the form of profits and admin waste, further compromising its universality.
A "Medicare Exchange" will ultimately mean differential access according to economic means-It will be difficult to undo-It must be resisted.
Framing will be critical -- they will seek to contextualize using the language of choice and fiscal necessity.
By having it not apply to existing enrollees, they are seeking to divide older adults and weaken solidarity.
Grassroots resistance to the barbarous GOP healthcare agenda needs to be fierce, but we mustn't forget our long term goal: single payer.
