House Democrats Initiate Policy Conversation about ‘Medicare for All’; Funding for Plan is Not Defined
February 27, 2019
The concept of a single-payer health care system, in which government operates a tax-funded health insurance plan for all residents, has been a mainstay of political health care reform discussions for years. As Democrat Presidential hopefuls define their position relative to single-payer, progressive leaders of the Congressional Caucus advocating for “Medicare for All” introduced a sweeping overhaul of the our existing health care system. The plan would transition all Americans into a government-run, single-payer, universal Medicare program over two years, eliminating private insurance. This legislative proposal also calls for providing global budgets to all health care providers in order to contain costs. Global budgets prospectively set the amount of money that can be spent.
While the proposal boasts generous coverage benefits, it does not establish a financing plan. Independent analyses have forecasted government-run, single-payer proposals could cost as much as $32 trillion over 10 years.
The House Rules and Budget Committees will hold hearings in March to explore “Medicare for All” concepts. Many other proposals to leverage and expand coverage through existing government programs also are being discussed. Those policies include concepts that:
- Allow near-retirees to enroll in Medicare
- Permit individuals to buy into Medicare
- Allow residents not already eligible for Medicaid who are not concurrently enrolled in other health insurance coverage to buy into a state Medicaid plan
Pennsylvania hospitals support efforts to ensure coverage for all individuals. The framework established under the Affordable Care Act (ACA) is the most viable mechanism to expand coverage and reduce costs. The framework offers subsidized coverage through health care insurance exchanges reflecting the market in each state, combined with expanded access to Medicaid. The ACA builds upon, rather than disrupts the employer-sponsored health insurance system that covers 156 million (49%) of Americans and 6 million (52%) of Pennsylvanians.1
Major issues that will require extensive conversation and attention in this debate, include:
- Disruption to employer-sponsored coverage
- Access concerns that would stem from expanding reliance on public programs—Medicare and Medicaid—that have historically reimbursed providers less than the cost of delivering services
- The threat of politicization and micro-management of Medicare and Medicaid whereby politicians may be under pressure to address costs by ratcheting down payment rates for providers
- Stifling of delivery system reforms that have improved care, enhanced quality, and reduced costs
HAP looks forward to engaging with the Pennsylvania Congressional Delegation to inform policy conversations about expanding access to coverage and care.
H.R. 1384, the Medicare for All Act of 2019, was introduced by Congresswoman Pramila Jayapal (D, WA-07). Congressmen Brendan Boyle (D, PA-02), Matt Cartwright (D, PA-08), Mike Doyle (D, PA-18), and Susan Wild (D, PA-07) have signed on to the legislation.
If you have questions, contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, or Jeff Bechtel, HAP’s senior vice president, health economics and policy.
1 Kaiser Family Foundation’s Health Insurance Coverage of the Total Population, based upon the Census Bureau’s American Community Survey, 2017.