June 04, 2019
The House Committee on Rules held the first hearing on Rep. Pramila Jayapal’s (D-WA) bill (H.R. 1384) that would eliminate existing public and private coverage and implement a universal health program called “Medicare for All” (M4A) in 2 years. The 7-hour long hearing featured witnesses from think tanks, academics, disease advocates and providers discussing the pros and cons of a single payer system, with most raising concerns about the costs, the impact on providers, the impact on access to care, and higher taxes.
Earlier last month, Senator Bernie Sanders (D-VT) and 14 Democrat cosponsors, including 4 rival presidential candidates, introduced a revised M4A bill (S.1129) that adds a 4- year transition and enhanced long-term care benefits. Neither bill has official CBO cost estimates yet, but experts estimated the 2017 M4A bill would cost $32 trillion over 10 years without enhanced long-term care benefits. Senator Sanders’ bill does not include funding, but his office separately released financing options that included an additional 4% income tax; an additional 7.5% payroll tax for employers; adopting a more progressive income tax and wealth tax; and increasing corporate taxes.
A variant on M4A, was introduced by Representatives Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL). The Medicare for America Act, would cover people currently in the individual market, Medicare, Medicaid and the Child Health Insurance Program (CHIP), and would permit employees to choose between their existing group coverage (which would need to have an actuarial value of at least 80%) or the new government plan.
Looking at Medicare expansion proposals, those which would permit people to buy into Medicare voluntarily, last Wednesday Senator Jeff Merkley (D-OR), along with 14 other Democrats, introduced the Choose Medicare Act.
Impact on Employers and Employees
At this point, given that there are few details and the likelihood of anything passing is not anytime soon, impacts for employers are minimal and mostly about future health care strategy and planning.
The key questions and concerns for employers and employees are about the impact on access to care as providers and facilities adjust to Medicare-like payments comprising a larger part of their revenues; accountability for overall cost control and stakeholder costs (whatever the mix between premiums, cost-sharing, and taxes); who will lead the drive for delivery transformation, innovation, and quality of care; and how will current beneficiaries and retirees be affected. Moreover, how realistic the proposals are when it comes to these and other factors will be important. Aside from that, most employees covered by their employers like their plans and would be unhappy if forced to give it up.
As with previous large-scale attempts at health reform, success should focus as much if not more on transforming care as it does on coverage expansion. Otherwise, coverage gains may be unaffordable in the long term.
Outlook
It’s unclear whether M4A legislation will advance in the House during the 116th Congress and it’s very unlikely to pass the Senate. The issue will remain in the debate, however, as a prominent part of the 2020 election.
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Policy & Advocacy
Medicare For All
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