SAN LUIS VALLEY -- This week, U.S. Senators Michael Bennet (D-CO) and Tim Kaine (D-VA) announced the re-introduction of their Medicare-X Choice Act, health care legislation that creates a public option by building upon the Affordable Care Act (ACA) and Medicare.

Through Medicare-X, individuals, families and small businesses would have access to low-cost health insurance, a pressing need for many located in rural areas and something Bennet acknowledged in his opening remarks.

“Yesterday, I had a chance to stop in Jackson County, Colorado, a rural county that borders Wyoming where about 1300 people live. 90% of the people are registered Republicans. About three years ago, I’d done a meeting where someone said, ‘You know, I moved back into town and bought a little local business. My wife and I are both working 50 hours a week. Neither one of us has health insurance. And I can’t hire anybody because, if I hire somebody, they’ll have to give up their Medicaid.’ In other words,” Bennet said, “they’ll have to give up their health care.”

Bennet described that situation – having to choose between taking a job and keeping comprehensive health care coverage – as one that could be told across the country, but most especially in rural areas where the lack of access to health care combined with the lack of competition in health insurance has left far too many uninsured and vulnerable to medical conditions that could be catastrophic in nature, both physically and financially.

“We have millions of people who are uninsured or underinsured, and health care has been an incredible pain point for people for years. It’s the subject that has driven most people to tears in my town hall meetings. I can’t tell you how many people have told me, ‘Michael, I earn too much to qualify for subsidies but don’t earn enough to afford a decent private plan, so I’m left with a plan with premiums and deductibles too high to be of any use to my family.’ It’s a huge problem for people,” Bennet said, “and it’s become only more prevalent in the last decade.”

Working within the Medicare framework to establish a Medicare Exchange (that’s what the “X” stands for), Medicare-X would start in rural areas – where there is “one or zero” insurers – and increase competition in the health insurance market, which would lower costs. People would have the option to buy in, if that is what they want to do. In four years, Medicare-X would “migrate” across the country and become available to small businesses, as well.

The plan would also “end the subsidy cliff.”

No one earning more than 400% of the federal poverty level would pay more than 8.5% of their income in premiums. (For 2021, 400% of the federal poverty level for an individual is $51,520 and for a family of four equals $106,000 in annual income.)

No one earning less than 150% of the Federal Poverty Level would pay any premiums whatsoever to access health care. (For 2021, 150% of the Federal Poverty Level for an individual is $19,320 and $39,750 for a family of four.)

For those living below 400% but above 150% of the Federal Poverty Level, the bill provides a larger tax premium subsidy, which helps low-income Americans access coverage by making premiums more affordable.   

“In our view, this bill helps finishes the work of Obamacare. It says to America, if you want access to a public plan, you can have access to a public plan. If you want to keep your insurance, you can keep your insurance.”

The bill ensures access to affordable prescription drugs by empowering the Secretary of Health and Human Services to negotiate drug prices, a move that is widely supported among Coloradoans, and includes Medicare level reimbursement for plans, which saves money for individuals and families by expanding premium subsidies to ensure that the cost is low for everyone buying an individual plan.

Also of local importance, Medicare-X includes provisions to better support rural hospitals and providers and increases access to Americans living in rural community by allowing for payment adjustments of up to 150% of Medicare fee-for-service rates, a provision that can reap big benefits in attracting more health care providers to rural communities.

The bill has funding for three years for reinsurance, which helps cover higher-cost patients, and also includes resources to reduce health market consolidation, ultimately controlling health costs and lowering premiums for everyone.

Bennet also addressed those who might be concerned that Medicare-X carries a big price tag for taxpayers. Although this bill has not been specifically scored by the Congressional Budget Office (CBO), it is a bill that creates a public option. And the CBO has previously scored a public option as a “money saver” due to increasing the number of insured Americans, decreasing the number of emergency room visits for uninsured people with chronic diseases – which costs the whole system – and reduces the payout of federal subsidies.

Medicare-X is closely aligned with the plan President Biden endorsed during his campaign. Both Senators Bennet and Kaine are not only confident of the White House’s endorsement for their bill but hopeful that their Republican colleagues will join them in addressing the pressing need for health care reform, a need both revealed and exacerbated by the pandemic that has devastated the lives of so many Americans.