Bill Overview
Title: Healthcare Enrollment Reform Modernization and Navigation Act
Description: This bill establishes and otherwise modifies requirements relating to coordinated coverage between employer health insurance and Medicare. Specifically, the bill prohibits employer-sponsored health plans for certain smaller employers from reducing benefits for employees who are eligible for Medicare but have not yet enrolled.
Sponsors: Sen. Casey, Robert P., Jr. [D-PA]
Target Audience
Population: people eligible for Medicare but not yet enrolled and have employer-sponsored plans
Estimated Size: 15000
- The bill affects workers who are eligible for Medicare but have not enrolled yet. This usually includes individuals aged 65 and older.
- It specifically targets those who have employer-sponsored health insurance.
- The focus is on smaller employers whose plans might reduce benefits for Medicare-eligible employees.
- This situation is present in many countries with systems similar to Medicare and employer-sponsored insurance.
Reasoning
- The policy primarily targets older individuals (aged 65 and above) who are still working and have delayed Medicare enrollment due to holding employer-sponsored insurance.
- While this reform would provide protection and continuity for some, not everyone in this demographic may be aware or willing to shift immediately due to habitual coping mechanisms or limited understanding.
- There's a limitation on how many smaller employers would be affected initially, based on budget constraints, but those affected represent a high-importance group due to their potential vulnerability.
- Consideration is given to various occupations and geographical diversity to better capture different facets of the American landscape.
Simulated Interviews
Teacher (Florida)
Age: 67 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I didn't know my benefits could be reduced. This policy sounds like a safety net.
- It’s comforting to know I'm not forced into Medicare immediately, which I find confusing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 4 |
| Year 20 | 7 | 3 |
Construction Manager (California)
Age: 70 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I'm glad they'll stop reducing my benefits just because I qualify for Medicare.
- I wish this had come earlier, would have saved me a lot of stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 7 |
| Year 2 | 9 | 6 |
| Year 3 | 9 | 6 |
| Year 5 | 9 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retail Sales Associate (New York)
Age: 66 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 12/20
Statement of Opinion:
- I had no idea about these changes; it's great to not worry about benefits being cut.
- This encourages me to work longer while sorting out my Medicare options.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Librarian (Texas)
Age: 72 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 14/20
Statement of Opinion:
- I'm happy for my colleagues, even if it doesn't help me directly.
- The policy seems overdue but is a step in the right direction.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 3 |
Mechanic (Ohio)
Age: 65 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- This policy gives me peace of mind to sort my finances before jumping into Medicare.
- Employer plans should treat older employees fairly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Accountant (Illinois)
Age: 68 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 8.0 years
Commonness: 10/20
Statement of Opinion:
- My firm had hinted about cutting my coverage after 65; this policy is a relief.
- I appreciate the flexibility in planning my future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 6 |
| Year 2 | 9 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 8 | 4 |
Factory Worker (Pennsylvania)
Age: 69 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 9/20
Statement of Opinion:
- This might make staying employed a bit easier, but it's late for me who's nearly retired.
- I'm glad it's happening, maybe my friends can benefit more from it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 3 | 3 |
Software Developer (Georgia)
Age: 66 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 6.0 years
Commonness: 11/20
Statement of Opinion:
- Not having my benefits reduced just gives me some breathing room in decision making.
- It's a small but meaningful change for people like me in high-demand fields.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 9 | 5 |
| Year 3 | 9 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retail Business Owner (Michigan)
Age: 71 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- For those still working like me, this policy helps make the ends meet.
- It's one less worry on a very long list of challenges.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Nurse (Washington)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 8.0 years
Commonness: 12/20
Statement of Opinion:
- I didn't even realize this change was coming, but it's great to know I won't lose coverage benefits by staying on my employer's plan.
- Clinics like ours really need stable staffing, this can help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 9 | 6 |
| Year 3 | 9 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Cost Estimates
Year 1: $375000000 (Low: $300000000, High: $450000000)
Year 2: $380625000 (Low: $304500000, High: $456750000)
Year 3: $386343750 (Low: $309067500, High: $463612500)
Year 5: $397911562 (Low: $318329525, High: $477493485)
Year 10: $425292022 (Low: $340233617, High: $510350426)
Year 100: $712363321 (Low: $570242657, High: $854483986)
Key Considerations
- Maintaining benefits for Medicare-eligible employees could increase costs for smaller employers, potentially affecting hiring or wage decisions.
- The bill helps ensure continuity of coverage, offering potentially better insurance options for older employees.
- Smaller employers may face increasing insurance premiums as insurance companies adjust for the new risk mix.
- Impact on Medicare enrollment and cost savings is uncertain and may be negligible.