It has been called “Single-Payer Health Care”, “Medicare For All”, “Medicaid For All”, and “Universal Health Care”. Australia, Canada, France, Germany, Singapore, Switzerland, and the United Kingdom all have Universal Health Plans.
America Needs Universal Health Care.
This blog post has a timeline of information about the Universal Health Care in the United States of America. It includes studies that show it can work better than our insurance-based system, ideas for implementing it, and how it would help people.
May 31, 2017: The Sacramento Bee posted an article titled: “Higher taxes on cars and dining to pay for California health care? Nurses have a proposal”. It was written by Angela Hart. From the article:
…A report by economists at the University of Massachusetts Amherst, released Wednesday, found that overall health care spending in California would fall 18 percent under the proposal from state Sent. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego.
Accounting for savings achieved with their Senate Bill 562, it would cost $331 billion per year to run a universal coverage system in which state government, with taxpayer dollars, pays for medical service and procedures – down from more than $404 billion in spending under today’s system, according to the economic analysis. It was paid for by the California Nurses Association, the bill’s lead sponsor, which also endorsed Lara in his 2018 run for state insurance commissioner.
The report proposes a complete overhaul of the state’s current health care system. People would no longer have to purchase insurance through Kaiser or Anthem Blue Cross, for example. Instead, health care payments would be reorganized under a single state-run system funded, in part, by new taxes on consumer purchases like new cars and dining out at restaurants, and business revenue.
There would be no insurance premiums. No out-of-pocket costs for prescription drugs. No more deductibles.
To make the universal health care proposal work, however, existing state and federal funding that subsidizes health care for low-income people, seniors, and people with disabilities would have to remain in place. That could be a challenge under President Donald Trump and the Republican-controlled Congress. Of the $331 billion needed to run the system, $225 billion would come from state and federal sources, a portion of which is currently spent on MediCal and Medicare.
Cost savings would come through reductions in executive salaries and administrative costs for health care billing, as well as unnecessary or inefficient medical services. The state could also negotiate with pharmaceutical companies for lower drug prices and restructure reimbursement rates paid to providers – the current fee structure pays based on the quantity and complexity of medical services provided.
Providing universal access to care would also lower costs by allowing people to see the doctor when they need to instead of delaying doctor visits because they can’t pay, the report found…
…Business groups, including the California Chamber of Commerce, and health insurers like Kaiser oppose the proposal…
September 13, 2017: Senator Bernie Sanders introduced S.1804 – Medicare for All Act of 2017 to the Senate. It was read twice and referred to the Committee on Finance.
Cosponsors of the bill included: Tammy Baldwin (Democrat – Wisconsin), Richard Blumenthal (D-Connecticut), Cory Booker (D-New Jersey), Al Franken (D-Minnesota), Kirsten Gillibrand (D-New York), Kamala Harris (D-California), Martin Heinrich (D-New Mexico), Mazie Hirono (D-Hawaii), Patrick Leahy (D-Vermont), Ed Markey (D-Massachusetts), Jeff Merkley (D-Oregon), Brian Schatz (D-Hawaii), Jeanne Shaheen (D-New Hampshire), Tom Udall (D-New Mexico), Elizabeth Warren (D-Massachusetts), and Sheldon Whitehouse (D-Rhode Island).
The purpose of the bill was to establish a Medicare-for-all national health insurance program.
Here are some key points of the bill:
- Every individual who is a resident of the United States is entitled to benefits for health care services under this Act.
- No person shall, on the basis of race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in, or be denied the benefits of, or be subjected to discrimination by any participating provider… or entity conducting, administering, or funding a health program or activity, including contracts of insurance.
- Covered benefits include: hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs; ambulatory patient services; primary and preventative services, including chronic disease management; prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products; mental health and substance abuse treatment services, including inpatient care; laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn care; pediatrics; oral health, audiology, and vision services; short-term rehabilitative and habilitation services and devices
- No cost-sharing
- By not later than September 1 of each year, beginning with the year prior to the date on which benefits first become available…the Secretary [of Health and Human Services] shall establish a national health budget, which specifies the total expenditures to be made for covered health care services under this Act.
- An Office of Primary Health Care will be established within the Agency for Healthcare Research and Quality. Its main function is to be the hub that coordinates everything.
- Medicare for All will be paid for by a Universal Medicare Trust Fund. The money comes from taxes. It also comes from funding for Medicare, Medicaid, the Federal Employees Health Care Benefits program, TRICARE, and the maternal and child health program. All of those would become part of Medicare for All.
- The bill includes a Transitional Medicare Buy-In Option and Transitional Public Option, and establishes the Medicare Transition Plan. Transitional Medicare Reforms protect against high out-of-pocket expenditures for fee-for-service benefits and elimination of Parts A and B deductibles.
July 19, 2018: Representative Pramila Jayapal (Democrat – Washington) posted a press release on her official website titled: “Rep. Jayapal, Rep. Ellison, Rep. Dingell, and Members of Congress Launch Medicare For All Congressional Caucus”. From the press release:
…The Medicare for All Congressional Caucus will help build the evidence base for Medicare for All. It will sponsor briefings on topics ranging from the basics of Medicare for All to financing universal health care systems around the world. In development is also a clearinghouse of resources for members of Congress and their staff. Additionally, the caucus will provide an opportunity for members and their staff to interact with partners and providers across the country to gain a practical understanding of how a Medicare for All system would work.
Support for Medicare for All is growing, not only among movement-builders, but within Congress. At its launch, an unprecedented 70 members had joined the caucus…
July 30, 2018: The Intercept posted an article titled: “Koch-Backed Think Tank Finds “Medicare For All” Would Cut Health Care Spending And Raise Wages. Whoops.”. It was written by Ryan Grum and Zaid Jilani. From the article:
A new study from the Mercatus Center at George Mason University is making headlines for projecting that Independent Vermont Sen. Bernie Sanders’s “Medicare for All” bill is estimated to cost $32.6 trillion – a number that’s entirely in line with 2016 projections, and is literally old news. But what the Associated Press headline fails to announce is a much more sanguine update: The report, by Senior Research Strategist Charles Blahous, found that under Sanders’s plan, overall health costs would go down and wages would go up.
The study, which came out of the Koch-funded research center, was initially provided to the AP with a cost estimate that exceeded previous ones by an incredible $3 trillion – a massive error that was found and corrected by Sanders’s staff when approached by AP for comment…
…Blahous’s paper, titled “The Costs of a National Single-Payer Healthcare System,” estimates total national health expenditures. Even though his cost-saving estimates are more conservative than others, he acknowledges that Sanders’s “Medicare for All” plan would yield a $482 billion reduction in health care spending, and over $1.5 trillion in administrative savings, for a total of $2 trillion less in overall health care expenditures between 2022 and 2031, compared to current spending.
In order to arrive at his number, Blahous looked at how “Medicare for All” could loser administrative costs and provide savings in areas like drug spending. He concluded that by empowering the secretary of Health and Human Services to negotiate for lower drug prices, Sanders’s plan would add “846 billion in additional savings over the 2022-2031” period. These savings, and others, are offset by certain other costs, like those which come from higher “utilization”, or the increased amount health care services used once everyone is insured.
Blahous’s report also acknowledges some substantial benefits to eliminating employer-sponsored insurance. He writes that these changes, “should increase worker wage net of employer-provided health benefits,” while also “relieving individuals, families, and employers of the substantial health expenditures they would experience under current law.” The report even admits that the Sanders bill would serve as a boon to states, freeing them from most Medicaid obligations…
You can read the Mercatus Report on its website.
July 30, 2018: People’s Policy Project posted an article titled: “Mercatus Study Finds Medicare for All Saves $2 Trillion”. It was written by Matt Bruenig. From the article:
The US could insure 30 million more Americans and virtually eliminate out-of-pocket health care expenses while saving $2 trillion in the process, according to a new report about Medicare for All released by the libertarian Mercatus Center…
…The report’s method are pretty straightforward. Blahous starts with current projections about how much the country will spend on health care between 2022 and 2031. From there, he adds the costs associated with higher utilization of medical services and then subtracts the savings from lower administrative costs, lower reimbursements for medical services, and lower drug prices. After this bit of arithmetic, Blahous finds that health expenditures would be lower for every year during the first decade of implementation. The net change across the whole 10-year period is a savings of $2.054 trillion…
…But even if you take the report’s headline figures at face value, the picture it pavings is the of an enormous bargain. We get to insure every single person in the country, virtually eliminate cost-sharing, and save everyone from the hell of constantly changing health insurance all while saving money. You would have to be a fool to pass that up.
August 5, 2018: The Washington Post posted an article titled: “Tossing aside skepticism, Democratic candidates for governor push for state-based universal health care”. It was written by David Weigel. From the article:
Wherever he takes his campaign for governor, Abdul El-Sayed is followed by activists handing out information about “Medicare for all.” When he grabs the microphone, El-Sayed makes a promise: He’ll bring universal health care to Michigan…
…El-Sayed, who campaigned this weekend with Sen. Bernie Sanders (I-Vt.) before Tuesday’s primary, is one of at least a dozen of Democrats running for governor this year on a pledge to do what no state has ever done: give basic health insurance to everyone, no matter the costs.
The single-payer Democrats are on the ballot in red and blue states and from California, where Lt. Gov. Gavin Newsom is the heavy favorite to win in November, to Massachusetts, where Democrat Jay Gonzalez believes the issue will give him an opening against a popular Republican governor…
…Yet while Democrats running for the House and Senate talk about Medicare for all in aspirational terms, as a post-Trump national goal, liberal candidates for governor suggest that their states could quickly become laboratories for universal coverage. After years of bristling at questions about higher taxes and “government-run health care,” they’re leading with their chins – and the proposals they invite voters to read on their websites…
…Gov. Jay Inslee (D-Wash.) the chair of the Democratic Governors Association, said that Republicans were losing on the health-care issue and that attacks on single-payer amounted to diversions…
…In Colorado, where voters soundly defeated a single-payer ballot measure in 2016, Rep. Jared Polis (D-Colo.) has said that states could band together to provide universal health care…
August 10, 2018: The Hill posted an article titled: “Fearing ‘blue wave,’ drug, insurance companies build single-payer defense”. It was written by Peter Sullivan. From the article:
…The formation of the Partnership for America’s Health Care Future is a sign of the health-care industry’s alarm over growing support for a single payer health-care law within the Democratic Party.
Health insurance and drug companies, who are often at odds on policy issues, banded together to form the group, which lobbyists say could run advertisements against single-payer plans and promote studies to undermine the idea.
Industry groups are worries that support for single-payer is quickly becoming the default position among Democrats, and they want to push back and strengthen ties to more centrists members of the party to promote alternatives…
…When Democrats controlled the White House and Congress at the outset of the Obama presidency, they stopped short of a single-payer system in creating ObamaCare, which the Trump administration and GOP-controlled Congress have worked to dismantle.
But support for a single-payer system has since gained steam, and a wide range of potential 2020 Democratic political candidates have backed Sen. Bernie Sanders’s (I-VT) “Medicare for all” bill, including Sens. Kamala Harris (Calif.), Cory Booker (N.J.) and Elizabeth Warren (Mass).
Sanders himself may make a second run for the White House, and he would be expected to put Medicare for all at the center of his campaign…
August 16, 2018: The Week posted an opinion piece titled: “The medical lobby is already peddling lies about Medicare-for-all”. It was written by Ryan Cooper. From the opinion piece:
…What’s more, Sanders’ Medicare-for-all program would be immensely superior to virtually all private insurance. The average family premium for an employer-sponsored plan has increased 55 percent since 2007, while average workers contributions have increased 77 percent. Some 81 percent of private plans now have a deductible (which must be paid before insurance kicks in for most care), at an average of $1,505. For primary care, 71 percent have co-pays (a flat fee) and 22 percent have co-insurance (a percentage charge), at $25 and 19 percent respectively. All those cost-sharing trends – and many others for speciality and emergency care, surgeries, and hospital admissions – have been getting steadily worse over time. Insurance networks are also narrowing over time, making it harder to find providers that will accept one’s coverage.
By contrast, Sanders’ Medicare-for-all would cover nearly all areas of medical treatment (including vision, dental, and hearing, though not long-term care) with no cost-sharing except for prescription drugs. Even that limited cost-sharing would be limited to $250 per year. And it would certainly be accepted by virtually every provider in the country – with the entire population in the program, they would have little choice (indeed, over 90 percent of primary care physicians already accept existing Medicare due to its large enrollment base of 59 million, and that is only about 18 percent of Americans.) Worries about out-of-network coverage would vanish. Switching onto that plan would be cause for wild celebration for the vast majority of people, not some uncomfortable burden.
September 5, 2018: Andrew Yang, tweeted: “I’m running for President on a platform of Universal Basic Income, Medicare for All, and evolution to a human-centered economy. Here’s my speech to 1,000 Democratic Activists in Iowa.” The tweet included a YouTube video of the speech.
He has information about his Medicare for All plan on his website. It involves shifting to a new healthcare system where costs will be controlled by setting prices provided for medical services. It also involves paying physicians a salary, instead of a fee-for-service payment (like we have now). The Cleveland Clinic is a good example of how Medicare for All would work.
October 10, 2018: The Washington Post posted a Fact-Checker titled: “Fact-checking President Trump’s USA Today op-ed on ‘Medicare-for-All'”. It was written by Glenn Kessler. From the Fact-Check:
President Trump wrote an opinion article for USA Today on Oct. 10 regarding proposals to expand Medicare to all Americans – known as Medicare-for-All – in which almost every sentence contained a misleading statement or a falsehood…
“Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives”…
…Sanders says he would first improve Medicare for seniors and the disabled by eliminating deductibles and covering dental, vision, and hearing aids, which are not covered under current law. Then, over the course of four years, the eligibility age would be lowered in stages until every American was covered.
On paper at least, the Sanders plan would improve benefits for seniors, not take them away…
…”I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerate Medicare.”…
Under Trump, the date for when the Medicare Hospital Insurance (Part A) trust fund will be depleted keeps advancing. The current projection is 2026, three years earlier than the projection a year earlier.
Part A is financed mainly through payroll taxes of 1.45 percent on earnings paid by both workers and employers; self-employed people pay 2.9 percent. The money raised is then credited to a pay-as-you-go trust fund, which uses the revenue raised to pay the benefits of Medicare beneficiaries.
With the baby-boom generation retiring at a rate of 10,000 people per day, that puts pressure on the long-term financing of the program because fewer workers will be supporting more retirees. If the trust fund is depleted, that means the government would not be able to cover 100 percent of estimated expenses. Yet because of Trump’s tax cut, the budget deficit is soaring even as the economy is booming, in contrast to previous periods of under 4-percent unemployment. That leaves the government less prepared to deal with the consequences of baby-boom retirements.
“Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare.”
Trump resurrects a misleading Republican talking point from the 2012 election..
…”Democrats will seek to slash budgets for seniors’ Medicare, Social Security, and defense.”
Trump may have a point about defense spending, never a favorite among the left, but the president’s $1 trillion deficits will put pressure on all aspects of government, no matter who is in power. Democrats generally have pushed to expand Social Security benefits, not cut them…
November 30, 2018: Common Dreams posted an article titled: “‘Easy to Pay for Something That Costs Less’: New Study Shows Medicare For All Would Save US $5.1 Trillion Over Ten Years”. It was written by Jake Johnson. From the article:
Confronting the question most commonly asked of the growing number of Americans who support replacing America’s uniquely inefficient and immoral for-profit healthcare system with Medicare for All.- “How do we pay for it?” – a new paper released Friday by researchers at the Political Economy Research Institute (PERI) shows that financing a single-payer system would actually be quite simple, given that it would cost significantly less than the status quo.
“It’s easy to pay for something that costs less,” Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlington, Vermont, where Pollin unveiled the paper.
According to the 200 page analysis of Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act of 2017, the researchers found that “based on 2017 US healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare For All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses.”
The most significant sources of savings from Medicare for All, the researchers found, would come in the areas of pharmaceutical drug costs and administration..
The new analysis by PERI is called “Economic Analysis of Medicare for All.”
December 11, 2018: The Guardian posted an opinion piece titled: “Universal healthcare could save America trillions: what’s holding us back?” It was written by Adam Gaffney. From the opinion piece:
If you can’t undercut a popular proposal as undesirable, make it sound impossible. That, in any event, has been the tack of opponents of single-payer healthcare, also called improved “Medicare-for-all”…
…Yet casting Medicare-for-all as an economic impossibility is becoming a Sisyphean pursuit: a slew of studies – including one released just the other week – are confirming that yes, we can afford real universal healthcare in America. But if that’s the case, why haven’t we already achieved it? Well, the real stumbling block is not that single payer advocates’ arithmetic is poor, it’s that American politics are dominated by the rich.
Still, the number smatter. On 30 November, a team of economists with the Political Economy Research Institute (Peri) at the University of Amherst published a highly credible, nearly 200-page economic analysis of Senator Bernie Sanders’ single-payer bill. The Peri study received essentially none of the media coverage lathered on the last such analysis – a flawed piece of work published by the conservative Mercatus Center last summer. But here’s the funny thing: though these two analyses came from economists from opposite ends of the political spectrum, they shared a similar finding: single-payer would reduce our nation’s healthcare spending bill by trillions of dollars over a decade (around $2tn and $5tn, respectively)…
…Going back decades, studies have found that, at worst, these costs and savings will balance out under a Canadian-style single-payer reform. “In Canada, each provincial plan provides for universal insurance coverage with no deductibles or copayments, controls on provider reimbursement, and administration by a single, public payer,” the Unites States General Accounting Office noted in an analysis of a single-payer bill way back in 1992. “We found that if these features were applied in the United States, the administrative savings could offset the added costs.”…
…There is another benefit of this system, albeit one that helps explain why we haven’t achieved it yet. A more progressive system of healthcare financing can, over time, reduce inequality not only in health, but in wealth, helping to close our nation’s disastrous economic divide. It’s not surprising, then, that billionaires don’t like it much. Nor is it unexpected that the corporate behemoths the have the most to lose are already sharpening their swords, pouring cash into a new anti-single-payer lobbying group that, as the Intercept recently reported, is maneuvering to “influence Democratic party messaging and stymie the momentum toward achieving universal health care coverage.”…
The 1992 analysis is titled: “Canadian Health Insurance: Estimating Costs and Savings for the United States“. It is on the U.S. Government Accountability Office (GAO) website.
December 16, 2018: USA Today posted an opinion piece titled: “Pig-headed Republicans are pushing America toward government-run national health insurance”. The opinion piece was written by Will Marshall. From the opinion piece:
..Hang on, don’t Republicans stand foursquare against a government takeover of the entire U.S. health care system? So they say. But the GOP’s pig-headed opposition to less drastic ways to make sure everyone has coverage is stimulating Americans’ appetite for a bigger government role in health care – and it will only be fueled by a federal judge’s ruling Friday night that the Affordable Care Act is unconstitutional.
In a recent poll commissioned by the Progressive Policy Institute, for example, voters by a margin of 54 to 46 percent, including nearly half of Republicans, favored changing “the current health system so everyone gets health care through Medicare instead of through people’s place of work or instead of buying it directly.” A more general “new government health care program” drew even more support, including 52 percent of Republicans…
The poll from the Progressive Policy Institute is titled: “America’s Resilient Center and the Road to 202o Results from a New National Survey“.
December 19, 2019: Representative Rosa DeLauro (D-Connecticut) posted a press release titled: “DeLauro, Schakowsky Introduce Medicare for America”. From the press release:
Congresswoman Rosa DeLauro (CT-03) and Congressmanwoman Jan Schakowsky (IL-09) today introduced the Medicare for America Act, a new healthcare bill that would ensure universal, high-quality, affordable health coverage by making Medicare accessible to all Americans and expanding the program’s covered benefits and services. The Medicare for America plan includes coverage for prescription drugs, dental, vision, and hearing services, as well as long-term supports and services for seniors and Americans living with disabilities.
Medicare for America achieves universal coverage while preserving quality employer-sponsored insurance for those who have it and are satisfied. Americans who are uninsured or do not have employer-sponsored insurance – including those on the individual market – would be auto-enrolled into Medicare for America…
…One of the largest drivers of healthcare costs in the United States is the cost of prescription drugs. Currently, the United States government is banned from negotiating prescription drug prices under Medicare, which keeps prices artificially high for millions of Americans. Medicare for America will finally remove that ban, and if negotiations fail, the Department of Health and Human Services (HHS) will use the prices paid by the Department of Veterans Affairs (VA) or the average price of these drugs in Organization for Economic Co-operation and Development (OECD) nations….
Medicare for America offers a simple, transparent cost structure. Individuals will have a $350 deductible and $3,500 maximum out-of-pocket spending. For households, their deductible will be $500 and $5,000 maximum of out-of-pocket spending. Medicare for America also ensures coverage is affordable for all by capping individual and household premiums at 9.69 percent of their monthly income. Individuals or families making less than 200 percent of the Federal Individual Poverty Level will not pay a premium, have to meet a deductible, or have a maximum out-of-pocket spending. Individuals or families between 200 percent and 600 percent of the Federal Poverty Level will receive subsidies to lower their contribution to the premium….
…Currently, there is incredibly limited access to long-term supports in Medicare and private insurance, leaving Medicaid to be the primary payer of these services and supports. With an emphasis on home and community-based settings, Medicare for America establishes and guarantees access to long-term support and services…
There is a summary of the Medicare For America Act of 2018:
The Medicare for America Act would establish the Medicare for America (MFA) health program to provide universal, comprehensive, and affordable health coverage to all Americans.
Who Can Join? Medicare for America achieves universal coverage by enrolling the uninsured, those that purchase their health insurance on the individual market, and those currently on Medicare, Medicaid, and CHIP. Large employers can continue to provide employer-sponsors care, if it is gold-level coverage. Or, they can direct that contribution toward their employee’s MFA premiums. Or, employees will have the option to choose MFA over employer-sponsored coverage.
What Does it Cover? Medicare for America improves on Medicare’s and Medicaid’s benefits: covering prescription drugs, dental, vision, and hearing services. And unlike Medicaid, your zip code does not determine your benefits.
Medicare for America also comprehensively covers long-term supports and services for Americans living with disabilities and seniors, which Medicare and private insurance do not. And unlike Medicaid, MFA compensates family caregivers, who play a crucial role in resolving America’s long-term care crisis.
What Does It Cost Me? Premiums, to be established by the Secretary, will be no more than 9.69% of individuals’ or households’ monthly income. Current Medicare beneficiaries will pay either Medicare’s premium (how it is presently calculated) or MFA’s whichever is cheaper. And, individuals and families between 200 and 600 percent of the Federal Poverty Level will receive subsidies. Those below 200 percent will have no premium (or deductible or out of pocket limit).
Deductibles for an individual (including seniors and current Medicare beneficiaries) will be $350; $500 for a family (based on a sliding scale for individuals and families between 200 and 600 percent of the Federal Poverty Level). Maximum out of pocket costs for an individual (including seniors and Medicare beneficiaries) will be $3,500; $5,000 for families (based on a sliding ccale for individuals and families between 200 and 600 percent of the Federal Poverty Level). Premiums will vary by family composition, but no individual or family can pay more than 9.69% of monthly income towards their monthly premium…
…What Doctors Can I See? Doctors who specialize in current Medicare remain a participating provider under MFA. The Secretary would establish a process for adding more providers not yet participating in Medicare (e.g. pediatric specialties)…
…What About Skyrocketing Prescription Drug Prices? MFA would end the Big Pharma giveaway banning Medicare from negotiating drug prices. Under MFA, the Secretary would negotiate prescription drugs based on value assessments. If negotiations fail, the Secretary shall use prices paid by the Department of Veterans Affairs or the average price of these drugs in OECD nations. If drug manufacturers refuse to negotiate, MFA will not cover any of their products, with an exceptions process for drugs otherwise unavailable for individuals with chronic conditions. Additionally, MFA bans the use of prior authorization and step therapy in any type of health insurance: public or private….
…How is Medicare For America Paid For? Medicare for America will be finances by sunsetting the Republican tax bill, imposing a 5% surtax on adjusted gross income (including on capital gains) above $500,000, and increasing the Medicare payroll tax and the net investment income tax. Medicare for America also increases excise taxes on all tobacco products, beer, wine, liquor, and sugar-sweetened drinks.
States will also need to make maintenance of effort payments equal to the amounts they currently spend on Medicaid and CHIP. For states that did not expand Medicaid, these amounts would be inflated by the growth in domestic product (GDP) per person plus 0.7 percentage points. For states that did expand Medicaid, these amounts would be inflated by the growth of GDP per person 0.4 percentage points.
After 10 years of payments, they would then increase the growth in GDP per person plus 0.7 percentage points for all states. This structure would ensure that no state spends more than they currently spend, while giving a temporary discount to states that expanded their Medicaid programs.
If states refuse to make the maintenance of effort payments, they will no longer be eligible for funding under the Mental Health Services Block Grant program, Social Services Block grant program, the Substance Abuse Prevention and Treatment Block Grant program (Federal Health Centers Program), State Targeted Response to Opioid Crisis Grants, Community Services Block grants, Section 330 grants, and the Ryan White HIV/AIDS grant program.
The full text of the Medicare for America health program is here.
December 29, 2018: The New York Times posted an article titled “Kamala Harris: Everyone Gets Sick. And We Deserve Better. It was written by Senator Kamala Harris (Democrat – California). From the article:
…I’m so grateful my mother hand Medicare and I will fight for it to be guaranteed to all. I was among the first senators to sign on to the Medicare For All bill when it was introduced last year. There should be nothing partisan about wanting a system where health coverage and care are based not on how much money you have or where you live. We need a system with the goal of good outcomes rather than the goal of high profits. It would save countless lives, and according to recent studies, could trim as much as $15 trillion in health care costs over 10 years.
I believe that health care should be a right, but the reality is that it is still a privilege in this country. We need to change that. When someone gets sick, there is already so much else to deal with: the physical pain for the patient, the emotional pain for the family. There is often a sense of desperation – of helplessness -a s we grapple with the fear of the unknown. Medical procedures already have risks. Prescription drugs already have side effects. Financial anxiety should not be one of them…
January 7, 2019: CNBC posted an article titled: “California Gov. Gavin Newsom rips Trump in his inaugural address, pledges ‘an alternative to the corruption and the incompetence in the White House'”. It was written by Jeff Daniels. From the article:
…Newsom campaigned for governor with ambitious plans for everything from single-payer health care and affordable housing to childhood poverty and universal preschool. The promises raised cost concerns from some taxpayer groups even before Newsome took the reins Monday.
After taking office Monday, Newsome signed a “first-in-the-nation order to create the largest single purchaser for prescription drugs,” according to a press release issued by his office. He also proposed for his first budget to move the state “closer to health care for all,” including providing coverage to young undocumented immigrants through MediCal…
The press release is titled: “Governor Newsom’s Inaugural Address: “A California For All'”. It is on the State of California’s Office of Governor website.
January 7, 2019: California Governor Gavin Newsom posted news on his official website titled: “In First Act as Governor, Gavin Newsom Takes on Cost of Prescription Drugs & Fights for Health Care for All” From the news:
…In his first act as California’s 40th Governor, Governor Gavin Newsom announced a series of major, first-in-the-nation executive actions and budget proposals to lower prescription drug and health care costs for all California families and move California closer to the goal of health care for all…
…Today, Governor Newsom signed the first-in-the-nation executive order that creates the nation’s biggest single purchaser system for drugs and will allow all Californians – including private employers – to sit together at the bargaining table across from big drug companies when negotiating drug prices. In his first budget, he will propose expanding financial help that makes it cheaper for families and individuals to buy health coverage and reinforce the Affordable Care Act after recent federal attacks. Governor Newsom’s proposal would also bring the state closer to toward the goal of health care for all by making it the first state in history to expand Medi-Cal coverage to all eligible undocumented adults. He also signed an executive order to establish a California Surgeon General who will be tasked with addressing the root causes of California health challenges and inequalities…
Here are some key points from Governor Newsom’s proposals:
- The negotiation for pricing and purchasing prescription drugs under Medi-Cal will now be conducted by the Department of Health Care Services on behalf of all 13 million Medi-Cal beneficiaries, as opposed to only 2 million currently.
- The prescription drug executive order directs state agencies to purchase prescription drugs together, as opposed to negotiating with drug companies one-by-one; and charts the path to enable all Californians, including private purchasers, to join forces with public purchasers.
- Two years ago, California started covering undocumented youth under the state’s Medi-Cal program. Governor Newsom proposes that California take another step toward universal coverage by extending Medi-Cal eligibility to undocumented young adults who otherwise meet the program’s eligibility requirements. California will be the first in the nation to cover undocumented adults through a state Medicaid program.
- Governor Newsom announced his first budget will reinforce the Affordable Care Act and expand subsides that help individuals and families to afford health care. His budget proposes increasing the size of the subsidies for families who already receive it, and it would make California the first state in the nation to make subsidies available to middle income families.
- California will be the first in the nation to offer subsidies to individuals and families with income between 400 and 600 percent of the federal poverty level. To pay for the increased financial help, the budget proposes reinstating the individual mandate at the state level.
- Governor Newsom sent a letter to President Trump and Congressional leaders calling on the federal government to lift limitations that prevent California to develop and enact a single-payer health system to achieve universal coverage, contain costs, and promote quality and affordability.
January 7, 2019: California Governor Gavin Newsom sent a letter to President Trump, Speaker of the House Nancy Pelosi, Majority Leader of Mitch McConnell, Minority Leader Charles Schumer, and Minority Leader of the House Kevin McCarthy. From the letter:
…Existing law permits only limited, piecemeal innovation – not the comprehensive reform necessary to address the myriad challenges that Californians face when navigating today’s health care system. California families continue to struggle with rising health care costs. For example, this year alone, some families are expected to see an average of 9 percent rise in health care costs, according to Covered California. We have taken action and will do more to make health care more affordable and available for all Californians.
However, to address this ongoing cost crisis in health care in the most effective way, we must have the federal tools to support California’s ability to provide quality healthcare for everyone, financed through a single-payer model like Medicare. We must have the tools to innovate and expand on the Affordable Care Act, even as we build toward a more comprehensive, universal system that works for patients, providers, and taxpayer alike.
I ask that you amend federal law to enable States to apply for and receive Transformational Cost and Universal Coverage Waivers, empowering California to truly innovate and to begin transformative reforms that provide the path to a single-payer health care system. I am eager to take these challenges head-on and – together with my colleagues in the Legislature and with the benefit of federal policies that more fairly promote innovation, quality and cost-effectiveness – to create an affordable, easy-to-navigate health care system for all Californians….
…The federal government has given States the flexibility to make innovative changes in health care through the use of waivers. However, the existing State Innovation Waiver is too limited to effectively design and implement comprehensive solutions. Congressional leaders have recognized this fact, proposing legislation last year to expand States’ waiver authority to promote universal coverage.
In this spirit, the federal government should enact new law enabling States to apply for Transformational Cost and Universal Coverage Waivers to re-invest federal funding – combined with State funds – to increase coverage, contain costs, and drive improvements in health care quality. Employing such waivers, States could design and tailor their own solutions, and lay the groundwork for more comprehensive solutions, such as a single payer system.
Under this approach, States would be able to apply to:
- Reallocate funds to best meet the needs of all the State’s population;
- Use public exchanges as a platform for potable benefits, leveraging funding from both employers and workers;
- Assure competition by making public plan options available in areas with limited health carriers;
- Support clear, continuous, and seamless coverage as residents move between individual coverage, employer-based insurance, Medicaid, and Medicare;
- Use tools such as all-payer pricing to address rising health care costs;
- Promote improvements to how care is delivered, supporting care coordination and payment systems that reward better quality;
- Integrate critical public health initiatives into the health care delivery system to address emerging and ongoing threats to health, such as conditions precipitated by climate change; and
- Finance locally anchored programs that close health disparities and address underlying social determinants of health
January 7, 2019: Los Angeles Times posted an article titled: “Gov. Gavin Newsom proposes healthcare mandate, Medi-Cal expansion to more immigrants without legal status”. It was written by Melody Gutierrez. From the article:
Gov. Gavin Newsom announced sweeping proposals to tackle the state’s healthcare needs shortly after taking office on Monday, outlining a dramatic Medi-Cal expansion that would cover young immigrant adults who are in the U.S. illegally, require that all consumers in the state carry health insurance and increase subsidies for middle-class families to help those who need it.
The Day 1 announcement was as much a rebuke to the Trump administration as it was an attempt by Newsom to make good on his campaign promise to fix a fragmented healthcare system that leaves many priced out or underinsured. The governor also signed executive orders to consolidate the state’s prescription drug purchases into a state-run program and to create a new surgeon general position to look at health disparities before they manifest, as Newsom put it…
…Newsom campaigned on a universal healthcare platform and has said the issue would be among his top priorities. His announcement on Monday stopped short of the single-payer system demanded by activists that would cover all residents’ healthcare costs, but was characterized as the first step down that path.
The new governor sent a letter to Congress and the White House asking for changes to federal laws so that the state can have the regulatory freedom to overhaul California’s healthcare system and move toward single payer…
…California would be the first state to cover immigrants without legal status who are younger than 26 through Medi-Cal, the state’s health program for people with low incomes. California already covers undocumented children until they turn 19, with Newsom’s plan increasing the age cut-off to mirror that of the Affordable Care Act, which allows young adults to stay on a parent’s health insurance plan until turning 26…
…A legislative proposal last year pegged the cost of extending Medi-Cal to undocumented immigrants under 26 at $250 million a year. That cost would fall solely to California, despite the mix of federal and state money that typically comprises Medi-Cal funding because the Affordable Care Act prohibits the use of federal dollars for covering immigrants who are in the U.S. illegally…
January 7, 2019: Reuters posted an article titled: “New California governor tackles drug prices in first act”. It was written by Sharon Bernstein. From the article:
Hours into his new job, California Governor Gavin Newsom signed an executive order on Monday that could dramatically reshape the way prescription drugs are paid for and acquired in the most populous U.S. state…
…In his executive order, Newsom directed state officials to set up what he said would ultimately be the nation’s largest single-purchaser system for prescription drugs.
It directed California’s massive Medicaid system to negotiate prescription drug prices for all of its 13 million recipients, changing their benefits from a managed-care or HMO approach to one that allows the state to handle all purchases.
Medicaid is the joint federal-state program that provides health insurance for the low income.
The state would create a list of drugs to be purchased in bulk or targeted for price negotiations.
The executive order also took the first steps to allow private companies and other governmental agencies to participate in the process of negotiating drug prices with pharmaceutical companies…
January 9, 2019: Vox posted an article titled: “Bill de Blasio’s plan to guarantee health care for every New Yorker, explained”. It was written by Dylan Scott. From the article:
New York Mayor Bill de Blasio has a plan to bring “universal health care” to America’s biggest city – and, though it’s not quite single payer, the initiative shows that Democratic politicians are getting more creative about what they can do to expand health care in the Trump era.
De Blasio rolled out a new plan this week that he says would guarantee that every New Yorker, regardless of their ability to pay, the ability to visit a doctor and get affordable medical treatment in the city’s historic public hospitals system…
…For most New Yorkers, their insurance won’t change at all; they’ll get it through work, as well as Medicaid, Medicare, or the Affordable Care Act, like they always have. Instead, de Blasio’s wants to invest more money in the city’s safety net – an idea based on a successful predecessor in San Francisco – and it should help the people who don’t have insurance or a regular doctor to get medical care. It’s also a necessary, though limited, fix to a long-running crisis for the city’s public hospital network…
…Through a program called NYC Care, any uninsured New Yorker is able to visit one of the hospital system’s 70 clinics and see a primary care physician. They will be charged on a sliding scale designed to help keep health care affordable…
…The program targets the city’s 600,000 uninsured residents; about half of them are undocumented immigrants, the rest are eligible for coverage but they’re not enrolled for one reason or another. The city is providing $100 million every year to help the hospitals cover the cost of treating those people and then launching an outreach campaign to make sure the people know coverage is available to them…
…Another key component of this will be to boost enrollment for MetroPlus, the city health insurance plan that’s available through Medicare, Medicaid, and the Obamacare exchanges and offers the public hospital system – 70 clinics and 11 hospitals – as the plan’s provider network…
January 10, 2019: Jacobin posted an article titled: “Medicare For All Isn’t Too Expensive”. It was written by Jon Walker. From the article:
When opponents say Medicare for All is too pricey, they’re really saying they oppose any substantial effort to deliver universal quality care…
…The “big number problem” is the simple fact that the United States currently spends a lot of money on health care, some of which the CBO [Congressional Budget Office] considered part of the federal budget and the rest of which it treats as private spending. Redirecting or reclassifying that private spending as public spending would technically result in big increase in the federal budget…
…The CBO doesn’t follow the simple logic of only considering something part of the federal budget if the federal government directly pays for it. Nor does the CBO follow the basic logic of considering private activity part of the federal budget if federal law requires it, like an individual/employer mandate. Instead, the CBO considers health reform an “essentially government program” if it crosses some arbitrary line of regulation…
…In effect, the CBO believes the government forcing you to pay premiums to insurance companies doesn’t make those premiums a tax. But if the government also mandates that private health insurers meet a basic quality floor for their plans, then it would be…
…It is important to look at this in an international context. There is simply no industrialized country whose health care system wouldn’t be considered a government program under the CBO’s definition. Even countries that are widely regarded as government-private hybrid systems, or managed private insurance systems – such as Japan, Switzerland, the Netherlands, and Germany – have actuarial value requirements, plan standard rules and/or medical-loss ratio regulations that would cause the CBO to score the entire health insurance market as federal spending…
…What this means is that copying any of the private systems others point to as alternatives to Medicare for All would produce the same “big number problem” as Medicare for All. The ACA is basically as far as you can go while staying within the CBO’s idea of what is private – and it clearly is insufficient. Even just modest improvements to a few existing regulations in the ACA, such as requiring that a larger percentage of insurance payments go to actual medical care, would cross the CBO’s line and end up being scored as de facto nationalization.
Strip away the complexities of budget scoring, and the upshot is clear: anyone who opposes Medicare for All because it will produce a big number from the CBO is effectively saying they are opposed to all significant health insurance reforms.
January 16, 2019: The Hill posted an article titled: “Dem chairwoman plans hearing on Medicare for All proposals”. It was written by Peter Sullivan. From the article:
The incoming chairwoman of a powerful health care subcommittee on Wednesday said that she intends to hold a hearing on several “Medicare for all” proposals, potentially giving the plans a chance to be considered by key lawmakers.
“There are several Medicare for all bills that are out there, but they all have a different interpretation,” Rep. Anna Eshoo (D-Calif.), the new chairwoman of the Energy and Commerce health subcommittee, told reporters. “I think that it would be interesting to have the authors of these bills come to testify and explain what their bill does and have the members ask them questions.”..
…Eshoo said a hearing would allow lawmakers a chance to ask questions like whether the Congressional Budget Office has done an analysis, “do you scrap the Affordable Care Act,” and what happens to people’s current insurance coverage…
…In 2017, Eshoo cosponsored the main Medicare for all bill in the House, which was led by then-Rep. John Conyers (D-Mich.)…
January 18, 2019: Los Angeles Times posted an article titled: “Gov. Newsom’s healthcare initiatives will test what a single state can achieve on its own”. It was written by Michael Hiltzik. From the article:
…Newsom’s proposals for near-term reforms would be funded entirely with state funds, assuming the Legislature assents. The expansion of Medi-Cal coverage for undocumented young adults would be financed from the general state fund, according to his budget message. The expanded subsidies would be paid for from penalties assessed from residents violating a state individual mandate requiring all Californians to carry health coverage, replacing the federal individual mandate penalty that the Republican Congress and Trump administration reduced to zero as of Jan 1. (State individual mandates are in place in Massachusetts, Vermont, New Jersey, and the District of Columbia.)
State funding for these proposals can be a mixed bag. Budget constraints during a recession could prompt the Legislature to reconsider spending priorities. Paying for premium subsidies assessed on health coverage refuseniks makes theoretical sense, since the refusal of younger and healthier individuals to join the insurance poll drives up premiums in the pool. But it places the state in a policy bind, because if the mandate is successful, there will be less money for subsidies.
Newsom says he’s confident that the expenditures he’s calling for will be sustainable even in an economic downturn. The funds for more early childhood services and developmental screening under Medi-Cal, as he proposed, would come from the tobacco tax increase enacted as Proposition 56 in 2016.
More than $60 minion of the cost of expanding Medi-Cal to undocumented young adults would be covered by savings to county health centers that now have to absorb their treatment costs without reimbursement, Newsom says. And although it’s hoped that the individual mandate penalty will be a declining revenue source, he estimates the at least at first ti will bring in $500 million a year…
January 22, 2019: The Seattle Times posted an article titled: “Inslee proposes ‘public option’ health-insurance plan for Washington”. It was written by Joseph O’Sullivan. From the article:
Gov. Jay Inslee and Democratic lawmakers Tuesday announced proposed legislation for a new “public option” health-care plan under Washington’s health-insurance exchange.
The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act…
…Called the Cascade Care legislation, the plan would be offered in every county.
The proposal would have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange, according to a summary of the proposal.
The plan would be designed with transparent and consistent deductibles, copays and coinsurance, according to the summary, and would “compete on premium price, provider networks, customer services, and quality.”…
…Inslee’s proposed 2019-21 state operating budget would provide $500,000 to fund the initial work to set up the public option. After that, lawmakers and officials would have to determine how much ongoing money would be necessary…
…The legislation also proposes subsidies to help low-income families and individuals afford health insurance. It would require the state to develop a plan that would provide subsidies with the goal of having consumers spend 10 percent or less of their income on premiums..
January 25, 2019: WBUR News posted an audio segment titled: “Warren’s Tax Plan Would Aim At the Ultra-Wealthy”
January 29, 2019: HuffPost posted an article titled: “Kamala Harris Backs Medicare For All And She Isn’t Messing Around”. It was written by Jonathan Cohn. From the article:
Sen. Elizabeth Warren is pitching a wealth tax as she considers a run for president. She said Thursday night on MSNBC that under the plan, taxes would go up 2 percent for people who have more than $50 million, and 3 percent for people who have more than $1 billion…
Two big questions for Democrats who support “Medicare for All” are whether they understand how such a system would actually work – and whether they really support what is arguably its most sweeping and controversial feature.
When it comes to Kamala Harris, the answer to both questions appears to be yes.
Harris, the Democratic senator from California who is now running for president, said during a CNN forum Monday evening that she believes health care is a right – and that creating a single, government-run insurance program modeled on Medicare is the best way to achieve that…
…But the Medicare for All Act of 2017, as the legislation is formally called, envisions some dramatic changes to the U.S. health care system – including a prohibition on private insurance, except for coverage of services outside the scope of the new government plan.
The new plan would pay for just about every medically necessary service, so that wouldn’t leave much of a role, if any, for private coverage…
…The new interest in Medicare for All, which has become a top priority for progressive politicians and activists, is a byproduct of several factors – among them, frustration that the Affordable Care Act, which for all of its success at expanding access to care, has left so many Americans still struggling to pay their medical bills.
Medicare for All holds out the promise of addressing this problem, and finally reaching the elusive goal of universal coverage, by automatically enrolling everybody in the government plan and then using regulation to set prices for doctors, hospitals and the rest of the health care industry. Typically, such proposals envision people paying for coverage entirely through taxes or income-related premiums, with little or not co-payments, deductibles, and other forms of cost-sharing.
Such as system would likely be a lot easier for patients to use, as Harris suggested, and a lot more straightforward for the providers of health care, as well, because they wouldn’t have to worry about billing so many different insurers..
February 3, 2019: Politico posted an article titled: “Buttigieg: ‘Medicare for all’ wouldn’t end private insurance”. It was written by David Beavers. From the article:
South Bend Mayor Pete Buttigieg, a declared 2020 presidential candidate, on Sunday said single-payer health care is “the right place for us to head as a country,” while saying a “Medicare for All” program doesn’t necessarily require doing away with private insurance…
…”If the framework we’re using is Medicare, a lot of people who have Medicare also have Medicare supplements, Medicare Advantage, something like that,” Buttigieg added. “So if we want to make Medicare available to everybody, whether as a public option to buy in or simply establishing that as how the payer structure works in this country that’s going to be the center of gravity.”…
February 4, 2019: The Hill posted an article titled: “Medicare for All talk among 2020 Dems is a way to warm Americans to the idea, says pollster”. It was written by Julia Manchester. From the article:
Pollster Robert Griffin said on Monday that talk among Democratic candidates about instituting a single payer “Medicare for all” health policy is a way to get American voters used to the idea of implementing it across the United States.
“Some of this talk about phasing in over time is really just getting people used to the idea of if we wanted to do this as a country, this is how it might actually work,” Griffin, research director at the Democracy Fund Voter Study Group, told Hill.TV’s Jamal Simmons on “What America’s Thinking”…
February 7, 2019: Modern Healthcare posted an article titled: “New Medicare For all draft bill sets a global budget model.” It was written by Susannah Luthi. From the article:
A draft version of House Democrats’ upcoming Medicare for All bill proposes a national system that would pre-pay hospitals with lump sums while keeping a fee-for-service model for individual physicians.
The 127-page draft, obtained by Modern Healthcare and dated Jan. 14, in many ways tracks with the system laid out in the 2017 bill from Sen. Bernie Sanders (I-Vt.) who brought Medicare for All to the forefront of progressive Democratic policy. But where the Sanders bill sidestepped the question of how the system would be funded by leaving it to the executive branch, the proposal from Rep. Pramila Jayapal (D-Wash.) lays out specific details of a nationalized global budget system.
First, the bill would set up regional directors tasked with overseeing all hospitals, healthcare facilities and physicians in specific geographic areas. The HHS secretary would appoint those overseers.
The regional directors would then negotiate each year with the facilities to set a lump sun, or global budget, that the government would pay out in advance to all institutional providers, These include hospitals, nursing homes, federally qualified health centers, home health agencies, and independent dialysis facilities…
…The existing prospective payment system would serve as the baseline rate to jump-start the global budget negotiations.
Once the budget it set, hospitals and other institutions would need to stick to it for all outpatient and inpatient treatment. However, this budget would also be set up for review by the regional director four times a year…
…Some physicians, including those in certain group practices, could opt to receive a salary from a hospital or other provider subject to the global budget.
Individual physicians, including those who belong to group practices, and who don’t opt for a salary, would be paid through fee-for-service according to a fee schedule set by the HHS secretary. Like the institutional providers, physicians wouldn’t be allowed to charge their patients anything for their care.
The HHS secretary would need to update the fee schedule annually…
February 7, 2019: Barron’s posted an article titled: “Understanding Elizabeth Warren’s Wealth Tax”. It was written by Matthew C. Klein. From the article:
…Now, Sen. Elizabeth Warren (D.,-Mass.) – who is planning to run for president in 2020 – wants to add a new levy with its own distinct purpose: a yearly 2% tax on household net worth above $50 million, with a 3% rate on net worth above $1 billion.
The tax would affect about 75,000 households, with fewer than 1,000 exposed to the 3% rate on net worth above $1 billion. The magnitude of the tax would not be large relative to the typical performance fee charged by managers of hedge funds and other alternative assets, many of whom fail to deliver net results superior to that of investments in index funds. Economists Emmanuel Saez and Gabriel Zucman of the University of California, Berkley, who helped design the Warren proposal, estimate it would confiscate about 1% of the gross domestic product each year. While there is some debate about the constitutionality of a federal wealth tax, there are many scholars who believe it would be legal.
The basic argument for the tax is that it addresses an inequality in the existing system: the ultrarich pay lower effective tax rates than many other Americans because their income takes the form of rising asset values. The tax rate on capital gains is much lower than what the typical worker pays on his or her labor income, but those gains are taxed only when assets are sold, so many of the richest people minimize their tax burden even further by borrowing against their wealth.
According to Zucman, the proposed tax would raise the total effective burden at the very top of the distribution from 3.2% to 4.3%. This tax obligation would still be lower than the average burden of 7.2% of net worth paid by most other Americans…
February 11, 2019: Vox posted an article titled: “John Delaney has a plan for universal health care – but don’t call it “Medicare-for-all”. It was written by Dylan Scott. From the article:
John Delaney has been running for president for nearly two years. Most people haven’t heard of him, and so far, he isn’t getting much traction in the polls.
But the former Maryland Congress member has cooked up one of the more unique universal health care plans of anybody in the 2020 field. Delaney’s plan sticks out for two reasons: He is a former health care financier, so he brings an unusual amount of expertise to the issue, and while his plan is a path to universal coverage, he is going out of his way not to call it Medicare-for-all.
Granted, there are a lot of details Delaney still needs to fill in, but the bones are pretty simple:
* Every American under 65 would be enrolled in a new public plan that covers a certain set of medical services, comparable to the essential health services covered by Obamacare.
* Employers and individuals could purchase supplemental insurance.
* Medicare for people over 65 would be untouched.
* The plan would be paid for mostly by maintaining the shared state-federal payments for Medicaid and by ending the unlimited tax break for employer health benefits…
John Delaney posted information about his Universal Health Care Plan on his official website. From the information:
Delaney’s health care proposal:
* Create a new public health care plan for all Americans under the age of 65 while preserving traditional Medicare. The new plan would protect the reforms delivered by the Affordable Care Act, including guaranteed coverage of preexisting conditions and essential health benefits, and would make access truly universal. At 65, people would transition into Medicare. Medicaid would be absorbed by the new plan. The highly trusted Medicare provider network could be used for a new plan.
* Guarantee universal coverage. Individuals would be automatically enrolled in the new public plan, with no complicated procedures to follow. People would be allowed to opt-out and receive a tax credit to buy their own insurance policy if they choose.
* Keep private insurance options. Individuals and employers will be ablate purchase and negotiate supplemental coverage from private insurers to cover additional health needs. These supplementals could merge into the basic plan to make it easier for the user.
* Employers would be encouraged to negotiate group rate supplemental plans that would merge with the basic governmental plan so that employees would be able to keep similar health care plans, many of which are popular and important to American families…
Pay-fors (numbers are based on a 10-year projection):
* The tax subsidy for employer-sponsored insurance costs the government more than $3.7 trillion and depresses wages for working Americans.
* Allowing the government to negotiate drug prices would stop the transfer of wealth from working families to corporate executives and shareholders of pharmaceutical companies. This would save the government nearly $850 billion.
* This plan would replace the ACA, and savings from ending the ACA’s tax subsidies would total $760 billion.
* Current federal Medicaid spending is projected to be more than $4.8 trillion, which this plan would absorb.
* States are projected to contribute more than $2.9 trillion to Medicaid. States would continue to pay their share for the current Medicaid population and the federal government would cover the cost of expanded coverage.
* Implement cost sharing for higher-income individuals to fund an increase in reimbursement rates for primary care providers.
February 19, 2019: Kaiser Health News posted an article titled: “For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It”. It was written by Shefali Luthra. From the article:
…Isn’t Medicare-for-all what it sounds like? Medicare for everybody?
Not quite. But also, kind of.
Politicians talking about Medicare-for-All typically mean one of two things. It’s either a specific proposal in which every American is covered by the same, single health plan, or the general idea that anyone has the option together health care through Medicare.
The first understanding is outlined in a bill from Sen. Bernie Sanders, (I-Vt.)…
…Sanders’ bill would outlaw private insurance where it competes with the public plan and change Medicare substantially by eliminating copays and other costs sharing, while expanding the program to cover long-term care, prescription drugs, dental care and vision. (As the bill is written, it’s hard to see what would be left for private plans to cover.)
The program would phase in over four years and cover every American. And it’s worth noting that, though many countries run a single-payer system, none offers those “expanded” benefits because the expense could be enormous. Also, many single-payer programs do require a degree of cost sharing, involving small payments or deductibles.
In other cases, the “Medicare-for-all” phrase has been repurposed.
The midterms saw a wave of Democrats campaigning on it. But beyond the buzzards, what they were actually talking about was lowering Medicare’s eligibility age by giving people the option to buy in or join the program. This would leave the private insurance industry intact. It would also preserve Medicare Advantage, in which the government pays private companies to run Medicare plans…
…So what other options are Democrats talking about?
Voters should get familiar with two other ideas: lowering Medicare’s eligibility age, and the “public option,” either through a Medicare or Medicaid buy-in.
These concepts are decidedly not Medicare-for-all – think “Medicare for more” or “Medicaid for more.”
Lowering the eligibility age loops more people into the current system and is seen by advocates as a potential step toward single-payer, says Alex Lawson, head of the left-leaning Social Security Works, who has been involved in drafting Medicare-for-all legislation.
The public option lets people purchase coverage through Medicare or Medicaid. It has attracted criticism from Democrats aligned with the Sanders wing, who argue it’s settling for less…
February 19, 2019: Politifact posted an fact-check titled: “Medicare for All: What it is, what it isn’t”. It was written by Jon Greenberg. From the fact-check:
…What is Medicare for All?
Sanders’ idea of Medicare for All would be a single, national health insurance program that would cover everyone who lives in the United States. In the bill, he introduced in 2017, it would pay for every medically necessary service, from routine doctor visits to surgery to mental health to prescription drugs. Dental and vision care are part of the package, too. The details on long-term health care might vary between the Senate and House versions, but broadly speaking, nursing home and related care would grow under both proposals.
The government would set payment rates for services, drugs and medical equipment. Each year, the secretary of Health and Human Services would determine a national budget for all covered services and spending would be limited by that cap. For individuals, there would be no costs – no deductibles, no copays or coinsurance. The two exceptions would be for some prescription drugs – though that would be limited to $200 a year – and possibly for long-term care.
It would replace all other insurance, with limited exceptions, such as cosmetic surgery. Employer-provided insurance, Medicaid and ultimately Medicare would all disappear.
Would this proposal simply extend Medicare to everyone? Is it literally Medicare for All?
No. Medicare for All is much more generous than the current Medicare program. Right now, the Medicare program is for Americans 65 and older; they receive care, but they’re also responsible for part of the costs. Unlike traditional Medicare, Sanders’ Medicare for All would cover medical bills completely, with no burden on the patient. There would be no Medigap insurance or Medicare Advantage.
If Medicare for All sounds a lot like a single-payer health care system – where the government foots the bill for people’s health care – that’s because the two are largely the same. The new name seems intended to make the concept more popular…
February 23, 2019: The New York Times posted an article titled: “Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All'” It was written by Robert Pear. From the article:
…Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. They have hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts to the left on health care…
…The hospital federation and two powerful lobbies, America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America, created a coalition last June to pre-empt what they saw as an alarming groundswell of interest in proposals to expand the federal role in health care.
In a daily fusillade of digital advertising, videos, and Twitter posts, the coalition, the Partnership for America’s Health Care Future, says that Medicare for all will require tax increases and give politicians and bureaucrats control of medical decisions now made by doctors and patients – arguments that echo those made to stop Medicare in the 1960’s, Mrs. Clinton’s health plan in 1993 and the Affordable Care Act a decade ago.
The coalition will step up the tempo in the coming week as Democrats in the House and Senate plan to introduce bills to establish a single-payer system…
…The coalition has already picked up more than 25 members, including the American Medical Association, the American Hospital Association and the nation’s Blue Cross and Blue Shield plans…
…But the coalition does not speak for all health care providers.
The American College of Physicians, the largest medical speciality organization in the country, has supported a Medicare buy-in for people 55-64…
February 26, 2019: The Guardian posted an article titled: “Medicare for All: House Democrats unveil bill to expand healthcare nationwide”. It was written by Lauren Gambino. From the article:
House Democrats have unveiled details of their ambitious plan to expand a popular, government-run healthcare program to all Americans. The measure marks a fresh sign of the party’s growing support for a once fringe idea the will play a defining role in the 2020 presidential campaign.
The Medicare for All Act of 2019, to be formally introduced on Wednesday with 107 co-sponsors, would transform the American healthcare system from one in which millions of Americans are uninsured to one that provides universal coverage…
…The bill would establish a national health insurance program by gradually expanding Medicare – the federal health insurance program for people who are 65 or older – until it covered all Americans…
…The bill does not include details on how the government would pay for the new healthcare system, which some studies have estimated could cost tens of trillions of dollars over the next decade.
[Congresswoman Pramila] Jayapal envisions major savings as a result of reducing administrative costs and inefficiencies in the current healthcare system. To pay for the plan, she suggested proposals such as taxing the rich at higher rates and mandated employer contributions…
…The plan has no chance of passing the Republican-controlled Senate. But the House speaker, Nancy Pelosi, has promised to allow hearings on the bill for the first time, giving progressives a prominent platform to make the case for a single-payer system…
…But as momentum grows, so, too, does the opposition. Private health insurers, doctors and hospitals are partnering to oppose single-payer proposals, which could significantly affect their bottom line.
The Partnership for America’s Health Care Future has been mobilizing members to ramp up support for improving the Affordable Care Act, also known as Obamacare, as opposed to repealing it, as Republicans attempted to do, or replacing it with a new system…
…According to a summary of the legislation provided by Jayapal’s staff, the program would cover “primary care, hospital and outpatient services, prescription drugs, dental, vision, audiology, women’s reproductive health services, maternity and newborn care, long-term services and supports, prescription drugs, mental health and substance abuse treatment, laboratory and diagnostic services, ambulatory services, and more.”
The transition to a Medicare for All system would happen over the course of two years…
February 28, 2019: Congresswoman Pramila Jayapal posted on her official website a news article titled: “Jayapal, Dingell and more than 100 Co-Sponsors Introduce Medicare For All Act of 2019.” From the news article:
Today, Representatives Debbie Dingell, Pramila Jayapal, other members of Congress and advocates introduced the Medicare For All Act of 2019.
Today’s healthcare system fails to provide quality, affordable healthcare as a right to all people living in the United States, Nearly 30 million Americans are uninsured and at least 40 million more cannot afford the costs of their co-pays and deductibles.
The quality of our healthcare is much worse than other industrialized countries – the life expectancy in the U.S. is lower than other nations, while our infant mortality rate is much higher. Yet the U.S. spends more money per capita on healthcare than any other industrialized nation. We waste hundred of billions of dollars every year on unnecessary administrative costs, while healthcare industry executives measure success in profits, instead of patient care.
The current healthcare system in the United States is ineffective, inefficient and outrageously expensive. It is time to remove the profit motive in healthcare, to resolve the inefficiencies and to guarantee quality healthcare to every person living in the United States.
The Medicare for All Act of 2019 improves and expands the overwhelmingly successful and popular Medicare program, so that every person living in the United States has guaranteed access to healthcare with comprehensive benefits…
February 27, 2019: The Medicare for All Act of 2019, also called H.R. 1384, was posted on Congress.Gov. It was posted with very little information. This is typical of newly introduced bills. More information will be added later.
The purpose of the H.R. 1384 is: “To establish an improved Medicare for All National health insurance program.”
It was sponsored by Representative Pramila Jayapal (Democrat – Washington).
The 106 co-sponsors are:
- Debbie Dingell (D-Michigan)
- Alma Adams (D-North Carolina)
- Nanette Barragan (D-California)
- Karen Bass (D-California)
- Joyce Beatty (D-Ohio)
- Donald Beyer (D-Ohio)
- Earl Blumenaur (D-Oregon)
- Brendan Boyle (D-Pennsylvania)
- Anthony Brown (D-Maryland)
- Andre Carson (D-Indiana)
- Matt Cartwright (D-Pennsylvania)
- Judy Chu (D-California)
- David Cicilline (D-Rhode Island)
- Katherine Clark (D-Massachusetts)
- Yvette Clark (D -New York)
- Wn. Lacy Clay (D- Missouri)
- Emanuel Cleaver (D-Missouri)
- Steve Cohen (D-Tennessee)
- Danny Davis (D-Illinois)
- Peter DeFazio (D-Oregon)
- Diana DeGette (D-Colorado)
- Mark DeSaulnier (D-California)
- Michael Doyle (D-Pennsylvania)
- Eliot Engel (D-New York)
- Veronica Escobar (D-Texas)
- Adriano Espaillat (D-New York)
- Lois Frankel (D-Florida)
- Marcia Fudge (D-Ohio)
- Tulsi Gabbard (D-Hawaii)
- Ruben Gallego (D-Arizona)
- Jesus Garcia (D-Illinois)
- Jared Golden (D-Maine)
- Jimmy Gomez (D-California)
- Vincente Gonzalez (D-Texas)
- Al Green (D-Texas)
- Raul Grijalva (D-Arizona)
- Debra Haaland (D-New Mexico)
- Josh Harder (D-California)
- Alcee Hastings (D-Florida)
- Jahana Hayes (D-Connecticut)
- Brian Higgins (D-New York)
- Katie Hill (D-California)
- Eleanor Holmes Norton (D-DC at Large)
- Jared Huffman (D-California)
- Shelia Jackson Lee (D-Texas)
- Henry C. “Hank” Johnson (D-Georgia)
- William R. Keating (D-Massachusetts)
- Robin Kelly (D-Illinois)
- Joseph P. Kennedy, III (D-Massachusetts)
- Ro Khanna (D-California)
- Ann Kirkpatrick (D-Arizona)
- James R. Langevin (D-Rhode Island)
- Brenda L. Lawrence (D-Michigan)
- Barbara Lee (D-California)
- Mike Levin (D-California)
- Andy Levin (D-Michigan)
- John Lewis (D-Georgia)
- Ted Lieu (D-California)
- Alan Lowenthal (D-California)
- Nita Lowey (D-New York)
- Carolyn B. Maloney (D-New York)
- James McGovern (D-Massachusetts)
- Jerry McNerney (D-California)
- Gregory W. Meeks (D-New York)
- Grace Meng (D-New York)
- Jerrold Nadler (D-New York)
- Grace F. Napolitino (D-California)
- Joe Neguse (D-Colorado)
- Alexandria Ocasio-Cortez (D-New York)
- Ilhan Omar (D-Minnesota)
- Jimmy Panetta (D-California)
- Donald M. Payne (D-New Jersey)
- Ed Perlmutter (D-Colorado)
- Chellie Pingree (D-Maine)
- Mark Pocan (D-Wisconsin)
- Katie Porter (D-California)
- Ayanna Pressley (D-Massachusetts)
- Jamie Raskin (D-Maryland)
- Lucille Roybal-Allard (D-California)
- Bobby L. Rush (D-Illinois)
- Tim Ryan (D-Ohio)
- Gregorio Killi Camacho Sablan (D-Northern Mariana Islands At Large)
- Linda T. Sanchez (D-California)
- John Sarbanes (D-Maryland)
- Janice Schakowsky (D-Illinois)
- Adam B. Schiff (D-California)
- Robert C. “Bobby” Scott (D-Virginia)
- Jose E. Serrano (D-New York)
- Adam Smith (D-Washington)
- Jackie Speier (D-California)
- Eric Swalwell (D-California)
- Mark Takano (D-California)
- Mike Thompson (D-California)
- Dina Titus (D-Nevada)
- Rashida Tlaib (D-Michigan)
- Paul Tonko (D-New York)
- Marc A. Veasey (D-Texas)
- Nydia M. Velazquez (D-New York)
- Peter J. Visclosky (D-Indiana)
- Maxine Waters (D-California)
- Bonnie Watson Coleman (D-New Jersey)
- Peter Welch (D-Vermont)
- Susan Wild (D-Pennsylvania)
- Frederica S. Wilson (D-Florida)
The text of H.R. 1384, “To establish an improved Medicare for All national health insurance program” has been released. Here are some key points:
- Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining eligibility purposes under this Act.
- Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
- No person shall, on the basis of race, color, national origin, age, disability, marital status, citizenship status, primary language use, genetic conditions, previous or existing medical conditions, religion, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy related medical conditions (including termination of pregnancy), be excluded from participation in or be denied the benefits of the program established under this Act… or be subject to any reduction of benefits or other discrimination by any participating provider… or any entity conducting, administering, or funding a health program or activity, including contracts of insurance, pursuant to this Act.
- The Secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under this Act. The mechanism shall include a process for the automatic enrollment of individuals at the time fo birth in the United States (or upon establishment of residency in the United States).
- The mechanism shall provide for the enrollment of all individuals who are eligible to be enrolled as of such dates…
- The mechanism shall include a process for the enrollment of individuals for health care services (under section 102(b)).
- Benefits shall first be available under this Act for items and services furnished 2 years after the date of the enactment of this Act.
- For any individual who – has not yet attained the age of 19 as of the date that is 1 year after the date of the enactment of this Act, or who has attained the age of 55 as of the date that is 1 year after the date of the enactment of this Act, benefits shall first be available under this Act for items and services furnished as of such date.
- Beginning on the effective date described… it shall be unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; for an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
- Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, including additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents.
There is a section that describes the Comprehensive Benefits:
- Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs
- Ambulatory patient services
- Primary and preventative services, including chronic disease management
- Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products
- Mental health and substance abuse treatment services, including inpatient care
- Laboratory and diagnostic services
- Comprehensive reproductive, maternity, and newborn care
- Oral health, audiology, and vision services
- Emergency services and transportation
- Early periodic screening, diagnostic, and treatment services…
- Necessary transportation to receive health care services for persons with disabilities or low-income individuals (as determined by the Secretary)
- Long-term care services and support
Here are more key points from the Act:
- The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, is imposed on an individual for any benefits provided under this Act
- The Act excludes “treatment of experimental items and services and drugs”.
There is a section about coverage of long-term care services.
Individuals enrolled for benefits under this Act are entitled to the following long-term services and supports and to have payment made by the Secretary to an eligible provider for such services and supports if medically necessary and appropriate and in accordance with the standards established in this Act, for maintenance of health or for care, services diagnosis, treatment, or rehabilitation that is related to a medically determinable condition, whether physical or mental, of health, injury, or age that –
- Causes a functional limitation in performing one or more activities of daily living or
- Requires a similar need of assistance in reforming instrumental activities of daily living due to cognitive or other impairment.
Long-term supports under this section shall be tailored to an individual’s needs, as determined through assessment and shall be defined by the Secretary to –
- Include any long-term nursing services for the enrollee, whether provided by an institution or in a home and community-based setting
- Provide coverage for a broad spectrum of long-term services and supports, including for home and community-based services and other care provided through non-institutional settings
- Provide coverage that meets the physical, mental, and social needs of recipients while allowing recipients their maximum possible autonomy and their maximum possible civic, social, and economic participation
- Prioritize delivery of long-term services and supports through home and community-based services over institutionalization
- Unless an individual elects otherwise, ensure that recipients will receive home and community based long-term services and supports … regardless of the individual’s type or level of disability, service need, or age
- Be provided with the goal of enabling persons with disabilities to receive services in the least restrictive and most integrated setting appropriate to the individual’s needs
- Be provides in such a manner that allows persons with disabilities to maintain their independence, self-determination, and dignity
- Provide long-term services and supports that are of equal quality and equally accessible across geographic regions
- Ensure that long-term services and supports provide recipient’s the option of self-direction fo services from either the recipient or care coordinators of the recipient’s choosing
This Act sets up the Universal Medicare Trust Fund. If I am understanding this correctly, the money comes from taxes. It also appears to consolidate the funding for the Medicare, Medicaid, Federal Employees Health Benefits program, the TRICARE program and the Maternal and Child Health Program.
There is a whole lot more in the Act that I have not described here. I recommend you read it over if you want the full information.
March 4, 2019: Seattle Patch posted an article titled: “Jayapal’s Medicare For All Bill Was Born On Seattle’s Streets”. It was written by Neal McNamara. From the article:
On a warm, sunny day last August, organizers with the local Democratic Socialists of American (DSA) were leading a panel discussion about Medicare For All in the basement of the Columbia City Library.
It was a serious event. One member of the panel, a physician, reminded that “people are going to die” if the U.S. healthcare system continues as it is.
But it was also an event that’s part of a long term strategy by Seattle DSA organizers (along with 120 other DSA chapters across the U.S.) to pressure lawmakers into supporting M4A.
The movement scored a victory last week when U.S. Rep. Pramila Jayapal, D-Seattle, introduced a comprehensive Medicare-for-all bill in the House. It’s not the first M4A bill, but it is the result of a more recent movement tapping into frustration over private health insurance.
On the streets of Seattle, DSA organizers have been door-knocking on M4A since spring 2018…
…DSA and a host of other progressive groups and labor unions have endorsed Jayapal’s bill. It hits all the points DSA has lobbied for: abolishing private insurance for a single healthcare provider; comprehensive coverage for any condition, including dental and vision; no payment at the point of service; coverage for everyone, including immigrants; and a jobs program for workers transitioning out of the healthcare industry….
March 4, 2019: Bloomberg posted an article titled: “Health-Insurance Stocks Have Been Selling Off on fears of ‘Medicare for All'”. It was written by John Tozzi. From the article:
Health insurance stocks were battered last week after progressive Democrats in the House introduced plans to replace private medical benefits with a government-run single payer system.
The rollout of the legislation signals what could be a new period of uncertainty for a sector that has known nothing but steady, substantial gains for several years.
The S&P 500 managed-care index has fallen 5.3 percent through Friday from Feb. 26, when Representative Pramila Jayapal, a Democrat from Seattle, outlined her Medicare-for-all proposal after the market closed. The decline was the most in a three-day period since September 2015. On Monday, the index extended its losses by 4.4 percent, one of the biggest one-day losses since 2015.
Wall Street analysis’s called the selloff an overreaction to a policy proposal with near-zero chances of becoming law in this Congress. Veda Partners analyst Spencer Perlman dubbed it “an impossible dream.”
Even so, the decline may reveal investor’s fears that shifting political ground could increase scrutiny of managed-care businesses including UnitedHealth Group Inc., Anthem Inc., and CVS Health Corp.’s Aetna insurance business. That could lead to unfamiliar tumult for a group of sticks that’s enjoyed a long ascent even as other corners of the health care industry were roiled by political wrangling…
…More than half of adults expressed support Medicare for All in a Kaiser Family Foundation poll in January. That support diminished substantially if they were told it would eliminate private coverage or require higher taxes. Respondents found the idea more attractive if it were framed as a guarantee of health insurance for all that would cut premiums and out-of-pocket costs…
March 14, 2019: KOMO News posted an article titled: “Mayor signs universal health care resolution, making Seattle first in nation to support”. It was written by Karina Mazhukhina. From the article:
…This past Tuesday, Mayor Jenny Dirkan signed the ‘Medicare for All’ Council Resolution, making Seattle the first city in the nation to support U.S. Representative Pramila Jayapal’s bill to establish a national health insurance program.
The bill will most likely revive hearings in the Democratic-controlled House, but prospects for passage in the Republican-controlled Senate are virtually zero. Even then, the president would likely veto the bill.
The bill calls for a two-year transition to universal health care.
Those over age 55 and under the age of 19 would become eligible after one year and every person in the U.S. would be eligible after two years…
…The plan would cover essentially everything, ranging from hospital visits, primary care, medical devices, lab services, maternity care, and prescription drugs to vision and dental benefits. It would also cover abortion services.
There would be no out-of-pocket costs when you visit the doctor, let alone an emergency room.
Jayapal’s plan also covers long-term care options for nursing-services – which is not covered by the current Medicare program nor Bernie Sanders’s single, government-run system in the Senate…
March 26, 2019: Senator Bernie Sanders tweeted: “Over 30,000 Americans could die every single year if Trump gets his way and destroys the Affordable Care Act. Our job is to fight back against his efforts tot take health care away from millions of people. We must make health care a right through Medicare for All.”
The tweet included a link to tweet from Vox, which had a link to a Vox article titled: “The Trump Administration wants all of Obamacare overturned by the courts”.
March 26, 2019: Pete Buttigieg (Mayor Pete) – who is running for President of the United States tweeted: “If you benefit from the #ACA, it is now the official position of the White House to take away your health coverage, with no sign of a plan to help you if they win and you lose.
Pete Buttigieg also tweeted: “If the whole ACA really is unconstitutional then let’s just get everyone health care like other developed countries do. Come to think of it, let’s do that regardless.
He was likely responding to the news reported by The Guardian (and many other news sites). The Guardian posted an article titled: “Trump administration pushes to completely gut Obamacare in dramatic escalation”. It was written by Erin Durkin. The article was posted on March 26, 2019. From the article:
The Trump administration now believes that the entire Affordable Care Act should be struck down, a major shift in the federal government’s position and one that could endanger health coverage for millions of Americans with pre-existing conditions.
In a letter on Monday night, the justice department said it is now backing a Texas judge’s controversial December ruling that the healthcare law known as Obamacare is unconstitutional…
April 2, 2019: U.S. Representative Anthony Delgado (D-New York) introduced the Medicare-X Choice Act in the U.S. House of Representatives. His speech was posted on his official website. From the speech:
Today I rise to highlight the need for our country to finally achieve universal health care coverage. As the wealthiest country in the world, there is simply no excuse for us to be the only developed country left without universal health care. There are a lot of different ways to achieve universal health care – and I believe that a public option is the best way for us to get there.
That’s why I was pleased yesterday to introduce the Medicare-X Choice Act, which will finally bring our country to universal health care coverage. My bill would combine Medicare physician networks and reimbursement rates with ACA coverage standards to create a new, public option available to all Americans. My bill would allow those who are happy with their employer-provided insurance to keep it, while offering another, more affordable coverage option to those in ned.
With this bill, we’re introducing more choice and more competition to the marketplace, starting in the places that need it most – like rural areas with provider shortages. This much-needed competition will drive down costs for everyone.
Our constituents expect us to take on the big issues impacting their lives. This should not be a partisan issue. We must roll up our sleeves and get to work so we can lower the cost of coverage for all Americans.
April 2, 2019: U.S. Representative John Larson (D-Connecticut) posted quotes from the people who introduced the Medicare-X Choice Act on his official website. From the posting:
…”By building on the successful framework of the Medicare system, Medicare X creates an additional affordable healthcare option for the American people. This is a solution that is bold and achievable and will ensure that every American has access to high-quality, affordable health care,” said Congressman Larson.
“It’s unacceptable that despite being the wealthiest country in the world, the United States is the only developed country without universal healthcare,” Congressman Delgado said. “This has been a top priority for me in Congress, and I’m proud to lead my colleagues in introducing a bill to finally get us to universal coverage. Whether it be at town halls or meetings with constituents, the folks I talk to back home want access to more coverage options at lower costs. The Medicare-X Choice Act would deliver by allowing those who are happy with their employer-provided insurance to keep it, while offering another, more affordable coverage option to those who need it. Adding a public option creates competition and will drive down costs and deductibles.”
Congressman Higgins said, “This bill provides people under 65 a public option already proven to be successful – Medicare. By doing so, it provides greater choice and competition, building on the protections provided in the Affordable Care Act, with an efficient healthcare delivery alternative that lowers the cost curve for consumers.”
The Medicare-X Choice Act uses the existing health care system, and gradually reinforces it, by providing more options for the public of all ages. Medicare-X would be offered through individual and family coverage plans and the Medicare provider network would be expanded to include pediatricians, children’s hospitals and others. The Act will ensure Essential Health Benefits like maternity, newborn care, and pediatric services are covered. The bill also calls for prescription drug negotiation through Medicare Part D.
Under the bill, premiums are put into a new, separate trust fund, holding the Medicare trust fund for individuals ages 65 and over harmless. In addition, the bill would expand access to premium tax credits and those beyond the 400% of the federal poverty line, the current threshold for premium assistance under the ACA.
Beginning in 2021, the Medicare-X plan will be available in rural areas of the country where there is only one or no health insurance providers on the exchange. The plan will also be available in counties where there is a shortage of health plan options, which have driven up costs and rendered prices simply unaffordable for the American below the age of 65. By 2024, the public option would be available on the individual market and in 2025, the plan would be an option on the Small Business Health Options Program (SHOP) exchange.
April 2, 2019: The Hill posted an article titled: “Democratic senators unveil ‘Medicare X’ bill to expand coverage.” It waswrittenv by Jessie Hellmann. From the article:
Two Democratic senators rolled out a proposal Tuesday that would allow anyone to buy Medicare plans, a proposal they say is more realistic than proposals like Medicare for all that would eliminate private insurance companies and reshape the American health care system.
The introduction of “Medicare X” comes as the Democratic Party debates its next steps on health care, with the left wing of the caucus pushing for a single-payer “Medicare for all” system and more moderate members supporting efforts to strengthen the Affordable Care Act (ACA).
“I just think this is a much more practical way of trying to achieve the objective of universal coverage, and over time, a reduction in our expenditures on health care, then practically any other proposal that’s been made since the ACA was passed,” said Sen. Michael Bennet (D-Colo.), who is weighing a run for president and sponsored the bill with Sen. Tim Kaine (D-Va.), who was Democratic presidential nominee Hillary Clinton’s running mate in 2016.
The bill would leave the existing health care system intact, but would create a public option for Medicare, allowing individuals of any age to purchase plans that would include access to the program’s network of health care providers and ObamaCare’s range of benefits, like maternity care and mental health services. Currently, only adults 65 and older can participate in Medicare.
It would also expand access to tax credits that help people buy ObamaCare coverage and would allow those credits to be used for Medicare X plans. Under those changes, individuals would pay no more than 13 percent of their income toward their insurance premiums for a standard health plan. The bill also increases the size of tax credits for those with lower incomes. A House version was introduced Monday by Reps. Anthony Delgado (D-N.Y.), John Larson (D-Conn) and Brian Higgins (D-N.Y.)…
…Medicare X is also supported by Sens. Cory Booker (D-N.J.) and Kamala Harris (D-Calif.), two other presidential candidates who are also co-sponsors of Sanders’s bill.
April 2, 2019: Senator Michael Bennet (D-Colorado) posted information about the Medicare-X plan on his official website. From the press release:
U.S Senators Michael Bennet (D-CO) and Tim Kaine (D-VA) today reintroduced legislation to create Medicare-X, a public plan that would offer families, individuals, and small businesses additional, low-cost health insurance choices and create more competition in the marketplace. The updated Medicare-X Choice Act of 2019 further lowers premiums and increases coverage for Medicare-X consumers and those in the individual market.
“It is a disgrace that people’s lives are upended daily in our country because they have no health insurance,” Bennet said. “We need to cover everyone, reduce costs, and improve quality – and Medicare-X is the best way to accomplish those objectives. Medicare-X starts in rural areas because the market there is failing too many Americans. And by using the existing Medicare framework, it provides a new, affordable option without adding bureaucracy. There is no excuse for us not to finish with the ACA started and close the coverage gap in America through Medicare-X”.
“Our goal is more health care options and lower costs,” Kaine said. “With those priorities in mind, we introduced Medicare-X to give Americans more quality, affordable health care choices, especially in rural communities that face a shortage of insurance options. This bill takes additional steps to reduce premiums, increase coverage, and make health insurance more affordable. I want to make sure that Virginians – and all Americans – can get the care they need.”…
…The plan would build on the Medicare framework to establish a public option. Medicare-X initially would be available on the individual exchange in areas where there is a shortage of insurers or higher health care costs due to less competition – including rural communities in Colorado and Virginia. By 2024, Medicare-X would expand to every ZIP code in the country. By 2025, the public plan would be added as another option on the Small Business Health Options Program (SHOP) Marketplace.
Medicare-X would use Medicare’s network of doctors and providers and guarantee the essential health benefits established in the ACA, such as maternity care and mental health services. Additionally, it would ensure access to affordable prescription drugs by offering prices negotiated in conjunction with the Medicare Part D program…
…In addition to Bennet and Kaine, the legislation is cosponsored by U.S. Senators Ben Cardin (D-MD), Amy Klobuchar (D-MN), Patrick Leahy (D-VT), Tina Smith (D-MN), Debbie Stabenow (D-MI), Kamala Harris (D-CA), Cory Booker (D-NJ), Gary Peters (D-MI), and Dick Durbin (D-IL).
The text of the “Medicare-X Choice Act of 2019” is available. It had not been assigned a number when it was posted.
April 2, 2019: The information posted about Medicare-X on Senator Bennet’s website included a link to a summary titled: “The Medicare-X Choice Act of 2019”. From the summary:
…Establishment and Plan Availability. In 2021, the Bennet-Kaine Medicare-X plan would be available in areas with one of fewer options on the Exchange. The plan would also be available in rating areas with a shortage of providers or a lack of plan competition, including HPSAs and rural areas. By 2024, the plan would be available in all rating areas. In 2025, it would be available on the Small Business Health Options Program Exchange.
The bill allows the HHS Secretary to contract with outside entities to process claims or administer additional components of the plan. This includes contractors that currently administer certain functions for Medicare. The bill also directs the Secretary to gather data from State Insurance Commissions in order to set adequate premiums.
Benefits. The plan would cover essential health benefits to align with other plans on the Exchange. Benefits like maternity and newborn care, as well as pediatric services, are optimally suited for Americans under 65, main it practical for families. The bill directs the Secretary to create options in the silver and gold tiers with flexibility to add bronze and platinum options. Advance Premium Tax Credits and Cost-Sharing Reduction payments would be available to enrollees.
Elimination of the Subsidy Cliff by Expanding Eligibility for Premium Tax Credits. The bill would eliminate the subsidy cliff by extending eligibility for the premium tax credit to those at and above 400% FPL. Individuals at 400% FPL would pay 9% of their income toward the “benchmark plan,” increasing to 13% of their income at 600% FPL and above.
Enhancing Premium Affordability for Those Earning Less Than 400% FPL. For Americans below 400% FPL, the bill would reduce the percentage of income one is expected to contribute to the benchmark plan by 0.5 percentage points. These enhancements would prompt affordability and encourage more families to get covered.
Reinsurance. The bill authorizes 3 years of funding for a national reinsurance program at $10 billion per year, which would reduce premiums.
Provider Network Reimbursement Rates. Providers who participate in Medicare and/or Medicaid would also accept Medicare-X patients. The bill directs the Secretary to enroll additional providers, such as pediatricians and OB/GYNs. The bill reimburses providers at Medicare rates, with flexibility for the Secretary to reimburse up to 125% of Medicare rates for hospitals and physicians located in rural areas.
Prescription Drugs. The bill gives the Secretary authority to negotiate drug prices under Part D and permits the public plan to participate in those arrangements. The Secretary is encouraged to utilize value-based payment arrangements for prescription drugs.
Delivery System Reform for an Enhanced Health Plan. The bill directs the Secretary to use outcomes-based alternative payment models that are aimed at care coordination for patients with chronic conditions. Providers would use innovative technology, such as telehealth and remote patient monitoring, and integrate social services like food, housing, and transportation. The bill additionally authorizes the Secretary to establish a grant program that would allow for broader experimentation with accountable communities for health, in order to integrate social needs in the delivery of health services.
Funding. The bill would set premiums to cover the full actuarial cost of the plan, including administrative costs.
Traditional Medicare: The bill would have no effect on benefits offered through Medicare Fee-For-Service (FFS), Medicare Advantage, or the Medicare trust fund.
April 10, 2019: Senator Bernie Sanders posted a press release on his official website titled: “Sanders, 14 Senators Introduce Medicare for All”. From the press release:
Sen. Bernie Sanders and 14 of his Democratic colleagues introduced the Medicare for All Act of 2019 Wednesday to guarantee health care to every American as a right, not a privilege.
The United States spends far more per capita on health care than any other nation; however, 34 million Americans do not have health insurance, thousands of people die each year because they cannot afford medical care, almost one in three adults with insurance has been unable to afford the care they need and nearly half fear bankruptcy in the even of a health emergency.
Sanders’ legislation fundamentally transforms the country’s dysfunctional health care system by eliminating profit-driven health insurance corporations and instead covering eery resident through an improved Medicare plan at far lower cost to working families and the nation as a whole…
…Seventy percent of Americans support Medicare for All, according to recent HarrisX and Reuters.
The Medicare for All Act of 2019 would ensure that Americans could go to the doctor of their choice and get the care they need, when they need it, without going into debt. It would significantly lower the price of prescription drugs by empowering the federal government to negotiate with pharmaceutical corporations. And it would expand coverage to include home and community based long-term care services, ensuring people with disabilities can receive the care they need to stay in their homes and remain part of their communities.
Under this bill, Americans will benefit from the freedom and security that comes with finally separating health insurance from employment. As is the case in every other major country, employers would be free to focus on running their businesses rather than spending time, energy and money trying to provide health insurance to their employees…
…Sanders introduced the bill along with Sens. Tammy Baldwin (D-Wis.) Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Kristen Gillibrand (D-N.Y.), Kamala Harris (D-Calif.), Mazie Hirono (D-Hawaii), Martin Heinrich (D-N.M.), Patrick Leahy (D.Vt.), Edward Markey (D-Mass.), Jeff Merkley (D-Ore.), Brian Schatz (D-Hawaii), Tom Udall (D-N.M.), Elizabeth Warren (D-Mass.) and Sheldon Whitehouse (D-R.I.)…
The text of the Medicare for All Act of 2019 has been released. Here are some key points from it.
- In General – Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act.
- Treatment of Other Individuals – The Secretary (1) may make eligible for benefits for health care services under this Act other individuals not described in subsection (a) and regulate their eligibility to ensure that every person in the United States has access to health care; and (2) small promulgate a rule, consistent with Federal immigration laws, to prevent an individual from traveling to the United States for the sole purpose of obtaining health care services provided under this Act.
- Freedom of Choice – Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
- Non-Discrimination: No person shall, on the basis of race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy related and medical conditions (including termination of pregnancy), be excluded from participation in, be denied the benefits of, or be subjected to discrimination by any participating provider as defined in section 301, or any entity conducting, administering, or funding a health program or activity, include contracts of insurance, pursuant to this Act.
- Enrollment: The Secretary shall provide a mechanism for the enrollment of individuals eligible for benefits under this Act. The mechanism shall – (1) include a process for the automatic enrollment of individuals at the time of birth in the United States or upon the establishment of residency in the United States; (2) provide for the enrollment… of all individuals who are eligible to be enrolled as of such date; and (3) include a process for the enrollment of individuals made eligible for health care services under section 102(b).
- Issuance of Universal Medicare Cars: In conjunction with an individuals enrollment for benefits under this Act, the Secretary shall provide for the issuance of a Universal Medicare card that shall be used for purposes of identification and processing of claims for benefits under this program. The card shall not include an individual’s Social Security number.
The Medicare for All 2019 Act has information about effective dates of benefits:
- The benefits will become available for items and services furnished on January 1 of the fourth calendar year that begins after the date of enactment of this Act.
- For any eligible individual who has not yet attained the age of 19, benefits shall first be available under this Act for items and services furnished on January 1, of the first calendar year that begins after the date of enactment of this Act.
- Anyone who is eligible to receive benefits (described in the earlier part of this Act) may opt to maintain coverage in private health insurance coverage until the effective date (when the Medicare for All benefits begin).
- After the Medicare for All Act benefits begin, it will be unlawful for (1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or (2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
- Nothing in this Act should be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by the Act.
Here is a list of what the Medicare for All 2019 Act covers:
- Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs
- Ambulatory patient services
- Primary and preventative services, including chronic disease management
- Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products
- Mental health and substance abuse treatment services, including inpatient care
- Laboratory and diagnostic services
- Comprehensive reproductive, maternity, and newborn care
- Pediatrics, including early and periodic screening, diagnostic, and treatment services
- Oral health, audiology, and vision services
- Short-term rehabilitative and habilitative services and devices
- Emergency services and transportation
- Necessary transportation to receive health care services for individuals with disabilities and low-income individuals
- Home and community-based long-term services and supports
In addition, the Secretary of Health and Human Services shall regularly evaluate whether the benefits package should be improved or adjusted to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make any recommendations to Congress regarding such improvements or adjustments.
States are allowed to provide additional benefits for their residents (at the expense of the State).
- The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits provided under this Act, except forL
- The Secretary can set a cost-sharing schedule for prescription drugs and biological products provided that; (A) such schedule is evidence-based and encourages the use of generic drugs; (B) such cost sharing does not apply to preventative drugs; (C) such cost sharing does not exceed $200 annually per individual, adjusted annually for inflation; (D) such cost sharing is not imposed on individuals with a household income equal to or below 200 percent of the poverty line for a family of the size involved
- The Secretary can exempt brand-name drugs from consideration in determining whether an individual has reached any out-of-pocket limit if a generic version of such drug is available.
- No provider may impose a charge to an enrolled individual for covered services for which benefits are provided under this Act.
The Medicare for All 2019 Act has details about “regular Medicare”. It also has specific details about qualified provider participation and standards. The rest of the Act is aimed at Congress, giving Congress guidelines about how to pay for the Medicare for All, preventing fraud, and other things.
April 10, 2019: The Hill posted an article titled: “Sanders sets bar for 2020 Dems with ‘Medicare for all’ rollout”. It was written by Jessie Hellmann. From the article:
…Sanders has made his plan to move the U.S. to a single-payer, government-run health care system center point of his second presidential campaign, with no room for compromise or other proposals that would take incremental steps toward universal coverage.
And while four out of five Senate Democrats running for president backed the new version of the plan that Sanders introduced Wednesday, most of them are also open to other “pathways” to making sure everyone is insured – a concept called “universal coverage.”…
…[Cory] Booker (D-N.J.), said a Medicare For all system is ideal but that he also supports “pragmatic” proposals that would build off the current system by keeping ObamaCare and private, employer-sponsored insurance while expanding Medicare on a much smaller scale.
Sens. Kamala Harris (D-Calif.), Kirsten Gillibrand (D-N.Y), and Elizabeth Warren (D-Mass.), all vying for the Democratic nomination as well, also support Sanders’s plan which has 14 co-sponsors in all. But they have likewise come out in support of what they say are other pathways to universal coverage. Of Sanders’s 2020 opponents, Gillibrand was the only one to attend the rollout Wednesday.
All but Warren have signed on to a a bill introduced earlier this year that would let anyone between the ages of 50 and 64 buy Medicare plans.
And Harris and Booker both support a proposal by potential 2020 contender Sen. Michael Bennet (D-Colo.), called Medicare-X, which would expand access to ObamaCare and let anyone buy a Medicare plan…
…Sanders himself only supports his plan, which would overhaul the entire U.S. health care system and transform Medicare into a single-payer program run by the government, replacing private health insurance and eliminating other government plans like Medicaid…
April 11, 2019: NPR posted an article titled: “As Sanders Calls for ‘Medicare-For-All,’ A Twist On That Plan Gains Traction”. It was written by Shefali Luthra. From the article:
…On Wednesday, Sen. Bernie Sanders, I-VT., who is running in Democratic primaries, reaffirmed his stance on health care by reintroducing a “Medicare-For-All” bill. The idea that fueled his 2016 presidential run…
…Already, it has an impressive list of Senate co-sponsors – including some of Sanders’ rivals for the Democratic presidential nomination: Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.
But many of the candidates – even official “Medicare-for-all” co-sponsors – are at the same time edging toward a more incremental approach, called “Medicare for America.” Proponents argue it could deliver better health care to all Americans while avoiding political, budgetary and legal objections…
…From the consumer perspective, a sweeping overhaul poses a risk. Despite Medicare’s popularity with its beneficiaries, the majority of Americans express satisfaction with their health care, and many are nervous about giving up private options. Also, many analysts are worried that a generous “Medicare-for-all” plan that promises everything would break the bank if it didn’t include copayments from patients.
That tension is pushing a number of candidates toward an option that has come to be called Medicare for America. The bill was introduced last December with little fanfare by two Democrats – Rep. Rosa DeLauro of Connecticut and Rep. Jan Schakowsky of Illinois. It hasn’t been reintroduced in the new Congress…
…”Medicare for America” got its first high-profile endorsement from former Texas Rep. Beto O’Rourke, who launched his own 2020 bid for president in mid-March. Other candidates – including Warren, Gillibrand and Pete Buttigieg, the Mayor of South Bend, Ind. – have tiptoed toward that policy without making any endorsements, suggesting that they back “Medicare-for-all” in theory but also support a system that retains private insurance, at least temporarily…
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