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If Medicare stops offering coverage for 65- and 66-year-olds, who picks up the tab?

As Congress and the White House debate the menu for a new fiscal diet, raising the Medicare eligibility age to 67 is a favorite dish for some. And it’s certainly a favorite topic for Washington journalists, interest groups and opinion makers to dish on these days.

The change would save the Medicare program 5 percent over the next 20 years, according to a Congressional Budget Office brief. That would help both the debt-burdened U.S. Treasury and the Medicare program itself, which will soon struggle to handle coverage for boomers.

But while raising the eligibility age could save the program $5.7 billion in 2014, points out health policy reporter Sarah Kliff in her piece “5 Ways Raising Eligibility Could Change Medicare,” she cites a report by Kaiser Family Foundation that finds “other parts of the health care systems would spend $11.7 billion more providing the same health care benefits.”

Here’s who will pay instead:

  • Current Medicare beneficiaries. Excluding the youngest — and relatively healthiest — enrollees raises the average cost per person program-wide. That in turn could lead to higher premiums.
  • People ages 65 and 66. The newest senior citizens who don’t have other options will have to turn to the private market, though President Obama’s health care law could soften the blow. The Kaiser Family Foundation estimates the tab at $3.7 billion in 2014.
  • Employers. More older employees will stay on employer-sponsored insurance if they can’t get Medicare. The Kaiser Family Foundation estimates that tab at $4.5 billion in 2014.
  • States. Lower-income seniors who can’t get Medicare will turn instead to the Medicaid system, which is funded by the states and federal government.

Here are two opposing points of view:

“We want to see improvements that actually lower health care costs, not simply change that makes seniors pay more for health care.” — David Certner, AARP legislative policy director

“When people first began receiving Medicare benefits in 1966, the average 65-year-old old lived another 15 years; today that figure is 20 years. It’s little wonder that Medicare costs have grown 14-fold, in real terms, since 1970.” — Maya MacGuineas, president of the nonpartisan Committee for a Responsible Budget

As negotiations about the “fiscal cliff” continue, we’re bound to have a heaping serving of viewpoints to sort out.