- - By admin

Medicare for All or Medicare for Everyone Who Wants It

By Jill Zorn |

Note: This is Part 2 of our Medicare For All Series. Check out Part 1 here.

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

S 1129 Sen. Bernie Sanders 14 cosponsors, including

Sen. Richard Blumenthal Medicare for All Act of 2019

HR 1384 Rep. Pramila Jayapal 117 cosponsors, 1 from CT:  Rep. Jahana Hayes Medicare for America Act of 2019

HR 2452 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:

Similarities

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

Differences

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

What is in the bills – Medicare for America (Medicare for Everyone Who Wants It)

Articles and charts comparing bills