The Path to Medicare-for-All Starts with Medicare-for-Kids

The mechanics of single-payer are daunting. Could government-run health insurance for all American children be an attainable first step?

At last, progressives are beginning to grapple with what it would take to make single-payer healthcare a reality in the United States. And while the mechanics of Medicare-for-All may be daunting, there’s a logical place to start: Medicare-for-Kids.

Support for moving toward a single-payer, Medicare-for-All healthcare system is ascendant in the Democratic Party. More and more prominent Democrats have come out in favor of a Medicare-for-All system—a whopping 117 out of 194 House Democrats have signed on to Rep. John Conyers’s Medicare-for-All bill.

While single-payer sounds good to many progressives in the abstract, an abrupt transition to such a system could prove prohibitively disruptive. The vast majority of Americans get private insurance through their employers. They’d rightly fear the unknown impact of being thrust into a new system overnight. The tumultuous short-term politics of Medicare-for-All could fatally overwhelm the program’s long-term benefits.

This has left progressives searching for easier pathways to make inroads toward an eventual Medicare-for-All system. One place to start is by providing government-run health insurance to all American children. Children could be auto-enrolled in Medicare coverage at birth until some point in early adulthood, perhaps age 26—the current cutoff for children to stay on their parents’ insurance. Families would have the option of opting out of Medicare for their children in favor of employer-sponsored coverage or another suitable private plan.

Though over 4 million American children still lack health insurance today, Medicare-for-Kids would extend universal coverage to all children. And the transition would be much less disruptive than would be moving all Americans to Medicare. Over 40 percent of all American children are already insured by Medicaid, the Children’s Health Insurance Program (“CHIP”), and other public programs. Medicaid alone covers nearly half of all births in the United States. Extending automatic public health insurance to the other half of newborns would be a gradual first step toward Medicare-for-All.

Bringing children into Medicare’s fold also makes good financial sense. Children are typically cheap to insure because they generate few healthcare costs. By adding them to Medicare, children would improve the program’s overall financial profile by lowering average Medicare costs.

Children are also among the most vulnerable to what’s known as health insurance churn, meaning that they are often jerked in and out of different types of coverage. Slight changes in their parents’ income can disqualify families from receiving coverage through Medicaid or CHIP, graduating into private insurance instead. The healthcare disruptions caused by our fragmented system could be avoided at least during formative years by simplifying insurance for children by providing consistent, automatic Medicare coverage.

Medicare-for-Kids is not a new idea. When Lyndon Johnson enacted government-run insurance for all elderly Americans in 1965, his administration expected to follow Medicare with a similar program for all young Americans. Robert Ball, who served as LBJ’s social security commissioner, said that the administration “expected Medicare to be a first step toward universal national health insurance, perhaps with ‘Kiddicare’ as another step.” In his 1968 State of the Union address, President Johnson proposed to expand Medicare to cover prenatal and newborn care for low-income families. Johnson’s “Kiddicare” idea ultimately fell by the wayside when he opted not to run for re-election in 1968.

The Great Society was a missed opportunity to provide guaranteed healthcare to children, and the idea lay mostly dormant for the next three decades. In 1997, Congress created CHIP, extending coverage to nearly 9 million children through block grants to state insurance programs.

In 2001, Democratic Congressman Pete Stark and Senator Jay Rockefeller proposed a program to guarantee health insurance for children. Their plan included a mandate requiring parents to maintain coverage for their children. If parents could not provide coverage, their children would be automatically enrolled in a new government-run MediKids program. “MediKids simplifies the confusing array of health insurance assistance programs for children today and guarantees them coverage until adulthood,” Stark said.

And during his campaign for the 2004 Democratic presidential nomination, Senator Joe Lieberman ran on a plan to create a new federal program to cover all children from birth, which was also called MediKids. Lieberman promised that under his plan, “newborn babies won’t go home with just a name and a birth certificate. All American children, rich or poor, will have health insurance that stays with them from the moment they’re born, all the way to age 25.”

As progressives chart a path toward greater universal healthcare today, the Medicare-for-Kids idea has been quietly kicking around. A number of advocatespolicy expertsand commentators have endorsed it. But for all the Democratic enthusiasm surrounding Medicare-for-All, no current candidates or officeholders have picked up the mantle of Medicare-for-Kids as a place to start. They should do so. It’s a simple pitch to bolster the health security of the youngest and most vulnerable Americans. Reviving the unfinished business of LBJ’s Great Society, Medicare-for-Kids would be a major attainable step toward a single-payer future.

And it could be a step with powerful reverberations. Medicare-for-Kids would create a generation of Americans accustomed to universal healthcare as an automatic right of birth. Starting with children may be the best path progressives have to an eventual system of guaranteed healthcare for everyone.

Joel Dodge

Joel Dodge is a writer and attorney in New York City. His work has appeared in Quartz, The Week, The New Republic, and The American Constitution Society.