Medicare for All or Medicare for Everyone Who Wants It
August 15, 2019
By Jill Zorn |
There is actually a lot of consensus around the values and goals of Medicare for All.
Looking at the health reform bills introduced in Congress and the policy approaches being debated by Democratic candidates vying for the presidency, there is clear support for universal access to quality, affordable health care. There is agreement that the current system is broken and that government should play a stronger role in expanding and improving coverage.
But there is plenty of disagreement, too.
The range of bills Democrats have introduced in Congress can generally be categorized as follows:
- Improved Medicare for All
- Improved Medicare for Everyone Who Wants It
- Medicare for More
- Medicare for Some
Today’s blog covers the policy similarities and differences of the first two, Improved Medicare for All and Improved Medicare for Everyone Who Wants It.
Overview and History
There are two very similar Medicare for All bills, one in the House and one in the Senate. And there is one Medicare for Everyone Who Wants It bill: the Medicare for America Act introduced in the House by Connecticut Rep. Rosa DeLauro.
|Title and Bill Number||Chief Sponsor||Cosponsors|
|Medicare for All Act of 2019||Sen. Bernie Sanders||14 cosponsors, including
Sen. Richard Blumenthal
|Medicare for All Act of 2019||Rep. Pramila Jayapal||117 cosponsors, 1 from CT: Rep. Jahana Hayes|
|Medicare for America Act of 2019||Rep. Rosa DeLauro||23 Cosponsors|
Both Medicare for All proposals are single-payer bills (see our previous blog, What Do We Mean When We Say “Single Payer” to read more about this term) where the health care for all Americans would be administered and paid for through one federal government program.
The original Medicare for All bill, HR 676, was sponsored in the House in 2003 by Rep. John Conyers. The bill underwent a major rewrite and was re-introduced in 2019 with a new bill number and a new sponsor – Rep. Jayapal. A Senate bill did not emerge until 2017, when it was introduced by Bernie Sanders. The 2019 version of the Senate bill also underwent some revision.
Medicare for America was first introduced in December 2018, and then re-introduced in 2019. This proposal makes Medicare available to everyone, while allowing employers to still offer private coverage if they wish. Essentially the bill assumes that over time the employer market will disappear or certainly shrink in size, but it does not force it to disappear within the shorter time frames (two-to-four-years) in the Medicare for All bills. Medicare for America draws many of its ideas from policy proposals written by:
- Yale professor Jacob Hacker: The Road to Medicare for Everyone
- Progressive journalist and blogger Jon Walker: Medical Insurance and Care for All
- Center for American Progress: Medicare Extra
All three bills guarantee coverage for all US residents and disrupt the current system in major ways. Similarities include:
- Enrolls all newborns at birth in Medicare
- Everyone currently on Medicaid (with one exception – see below), the Children’s Health Insurance Program, and in the current individual insurance market, including the ACA exchanges, enrolls in Medicare
- Transforms the Medicare program, providing enhanced benefits including dental, vision, hearing and both home-based and institutional-based long-term care, except the Senate Medicare for All plan retains Medicaid to cover nursing home care
- Women’s reproductive health services are completely covered – Hyde Amendment limitations on abortion coverage are repealed
- Prescription drug prices are negotiated at the federal level
- Provider payment rates are set and charging more (balance billing) and private contracting with patients for higher payments (i.e. “concierge” medicine) is prohibited or severely limited
The chart below highlights several of the key differences. One major area of difference is about whether employer-sponsored and Medicare Advantage insurance survives. How the plans are financed, and how big of an impact they have on the federal budget also differs. The Medicare for All plans have provided less detail about financing. But they are very clear that premiums and out-of-pocket payments will generally not be part of financing – that all financing will be via taxes. Medicare for America relies on a combination of premiums, copayments and employer and individual taxation, while protecting lower income people from these payments and taxes.
|Medicare for All||Medicare for America|
|Employers’ role in coverage||Eliminates all employer-sponsored insurance||Employers choose whether to offer or retain private insurance coverage or pay 8% of payroll into the Medicare Trust Fund. Employees can opt into Medicare or keep their employer coverage, if it is offered|
|Transition period||Senate plan: four years
House plan: two years
|Two years for individuals. Up to six years for large employers to decide whether to offer coverage or pay toward their employees’ Medicare coverage|
|Role of private insurance||Basically none||Medicare Advantage plans are allowed, with strict regulation and payment limits and enhanced consumer protections|
|Premiums||None, but individuals pay into the program via taxes||No premiums below 200% FPL. Sliding scale tied to income and limited for those above 600% of FPL to full premium or 8% of income, whichever is lower|
|Out-of-pocket cost sharing||None, except Senate plan proposes cost-sharing for prescription drugs capped at $200/year||No deductibles. 20% cost sharing based on income on a sliding scale; max of $3,500 per individual and $5,000 for family|
|Financing||Unspecified taxes. The senate plan has a separate white paper that lays out possible options. Both plans set a global budget for federal health care expenditures.||A combination of premiums, cost-sharing, employer payroll taxes, repealing the 2017 tax cut and specific taxes generally paid by wealthier individuals.|
To Learn More:
What is in the bills – Medicare for All
- Vox Explainer: Senate Medicare for All Bill
- White paper: Options to Finance Medicare for All
- Vox Explainer: House Medicare for All Bill
- Podcast: Interview of Pramila Jayapal about the House Medicare for All bill
What is in the bills – Medicare for America (Medicare for Everyone Who Wants It)
- Press release and two-page summary of Medicare for America
- HuffPost article: 2 Liberal Democrats Are Promoting A Twist On ‘Medicare For All’
- A REALLY DEEP DIVE into the updated “Medicare for America” bill, from Charles Gaba’s ACA Signups blog
Articles and charts comparing bills
- Kaiser Family Foundation: Compare Medicare-for-all and Public Plan Proposals and Side-by-Side Comparison of Medicare-for-all and Public Plan Proposals
- Vox: We read 9 Democratic plans for expanding health care. Here’s how they work