Medicare For All Who Want It
One of the hottest topics right now is the Medicare buy-in programs that are flying around Washington. We can all agree that it benefits our country to get health care access to all.
To make that a reality, some lawmakers have plans detailing their ideas.
Medicare buy-in gives protection to people who can afford the premium. Also, it helps to ease some of the costs Medicaid pays.
Three Medicare for All Buy-In Proposals
“Medicare for All” plans include similar benefits with various funding options.
Most importantly the plans provide coverage for medically important services; including dental and vision while banning balance billing.
Next, they introduce a national fee schedule and a global budget.
The global budget would decide the amount of money available to refund hospitals, doctors, and clinics nationwide.
Medicare for all offsets the removal of current spending, employer programs, and ACA subsidiaries.
Although, either one could replace all sources of private and public health coverage with cost-sharing by the beneficiary.
Bernie Sanders Medicare for All Bill
Senator Sanders says his bill allows doctors and patients to negotiate private contracts. Also, Long term care would have coverage through Medicaid.
Use payment rates to create a fee schedule and a process for updating those rates. However, the public plan would provide coverage for reproductive health including abortion.
Effectively repealing the Hyde Amendment; which forbids taxpayer funds from paying for abortions except in cases of rape, incest, or to save the woman’s life.
Establish an Ombudsman to help the Secretary of Health and Human Services with complaints, and to identify issues with payments or coverages.
4-year phase-in period with subsidies that would add dental, vision, and an out of pocket maximum to beneficiary cost-sharing.
Keith Ellison’s bill includes long term services. Also, it prevents for-profit hospitals, facilities, and doctors from joining in the Medicare program.
Negotiate a fee schedule between State/Regional directors and providers. The schedule must have the approval of the Medicare director.
Those 18 and under would first receive a Universal Medicare Card. Then, those with employer coverage would transition to Medicare; the company would pay higher taxes instead of paying for the cost of private plans.
Elizabeth Warren Medicare For All Plan
We all know Medicare for All is going to cost trillions of dollars. Elizabeth Warren released her Medicare For All plan explaining the funding for this mass coverage.
Previously she was talking about creating a tax on the wealth of the richest in American to finance student debt cancellation and universal childcare.
Ms. Warren has said she is with Bernie on Medicare for all; however, Sanders openly admits that taxes will increase for the middle class.
Elizabeth says she won’t sign a bill that doesn’t lower costs for middle-class families.
Three Federal Public Plan Proposals
The three Federal Public plans focus on providing a marketplace premium with cost-sharing subsidies. Also, filling the holes left by the ACA plans currently on the marketplace.
These plans would be through the ACA; plans would be available to people and businesses. ACA’s essential health benefits would have coverage.
Medicare doctors must join in the public plan. Other doctors can join to meet the needs of children and those with special needs.
Due to rising prescription drug costs, each of these bills proposes allowing the Secretary to negotiate lower drug prices for the Federal Public plan.
Not all of the options are Medicare Buy-In options; some prefer Medicare for All or Medicare for Most.
Jeff Merkley’s bill directs the Secretary to negotiate payment rates for Medicare for Everyone; or, Part E.
Allows large employers to offer the Federal Public plan to employees. Also, the Federal Plan could operate as a Third-Party Administrator for self-insured plans.
It reduces the cost-share for most participants by tying them to Gold level plans based on income and subsidies. Additionally, it includes coverage for Part A, B, and D as well as reproductive services including abortion.
Also, adds an out of pocket limit to cost-sharing on the Federal Public plan and the current program. The ACA rating rules would extend to the large group market.
To address limitations, federal funding would be spent on navigator programs. Then, employers not offering coverage must direct employees to the navigators.
The Secretary negotiates lower drug prices for the Federal Public plan and Part D enrollees.
This option contains a failsafe; if lower drug costs aren’t available by the Secretary then prices go on the lesser of the Veterans Administration or the federal supply schedule.
The Michael Bennet bill uses Medicare rates for the new Medicare-X plan. This would ensure people don’t pay over 13% of income on healthcare premiums; although, for millions, it would be much less.
For example, a 4 person family making $101,000 would have a max 9% income on premiums. Then, there would be an increase in the tax credit for those earning less than 400% of federal poverty.
Also, the bill eliminates the arbitrary subsidy cliff, while providing premium tax credits for those that don’t qualify for assistance due to being above the 400% poverty line.
Phase in the Federal Public program in areas with minimal competition. Federal Public plans will be available at all ACA metal levels and an out of pocket limit would begin.
$30 billion over a 3-year period will go to the national reinsurance program to ensure marketplace stability. Finally, direct reforms will coordinate healthcare with employment, education, transportation, food, and housing; all of these affect health and can cause delays in accessing medical care.
Medicaid doctors must join. The Secretary would negotiate lower drug prices for the Federal Public plan and Part D enrollees.
Congresswoman Jan Schakowsky made a reintroduction of the Medicare for America Act in May 2019; this bill ensures affordable, universal, healthcare.
Medicare for America sounds like a true dream; coverage on drugs, dental, vision, and long term support for seniors. Health coverage is a human right, not a privilege.
Medicare for America cost structure includes no deductibles. Also, Individuals have a $3,500 maximum out of pocket and households have a $5,000 Maximum out of pocket (MOOP).
There would be a cap on premiums, at 8% of monthly income. However, those making less than 200% of the Federal Poverty Level won’t pay a premium.
Those with an income between 200% and 600% of the Federal Poverty Level would qualify for a subsidy to lower the premium and establish a MOOP sliding scale.
Two Medicare Buy-in for Older Adults Proposals
If you’re one of the millions that are 50 or older without health coverage, we hear your voice.
The Medicare buy-in for older adults would give eligible people the option to buy. Although, there is no out of pocket limit.
Beneficiaries would want additional coverage to fill the gaps. This could be in the form of a subsidy through the marketplace, a supplement, or an advantage plan.
Medigap plans must be available on a Guaranteed Issue basis for those electing the buy-in option. Also, the enrollee would pay the full cost of the benefit plan plus administrative expenses.
The marketplace is where beneficiaries can apply for financial assistance. However, the buy-in option wouldn’t compete with marketplace plans.
The Secretary would determine subsidy calculations. Medicare would continue to prohibit balance billing.
Also, the current Medicare trust fund would remain separate from the new buy-in Medicare trust fund.
The Brian Higgins Medicare buy-in plan would be available to adults 50-64. The location determines the cost of the plan.
Also, part of this plan is to commission a reinsurance program to cover the cost of high dollar claims. As well as Empower the Secretary to negotiate lower drug prices for the buy-in and the current program.
As buy-in enrollees turn 65 and are eligible for Medicare, all features revert to the current program.
Those eligible for insurance through their employer would be able to enroll in the buy-in. As well as employers being able to pay those Medicare premiums on behalf of the employee.
Commits to appropriate $500 million to raise awareness about new subsidies, consumer assistance programs and help people enroll.
Senator Stabenow Introduces Medicare at 50 Act
Debbie Stabenow’s Medicare at 50 act allows enrollment through Medicare to be available for adults 50-64. Then, buy-in costs would be based on a national premium.
This would give anyone over the age of 50 the option to buy into Medicare; lowering costs, strengthening Medicare, and improving the quality of care for millions. By covering this age group, the ACA marketplace could grow.
Tom Malinowski Expanding Health Care Options for Early First Responder Retirees
The Tom Malinowski legislation would give first responders age 50 and older to buy into Medicare. First responders usually retire early than the average worker.
Police officers, EMTs, and firefighters all would have access to Medicare buy-in at 50 years old.
Coverage under this bill would be identical to the current Medicare program.
State Public Plan Options
The State Public plan options suggest using the Medicaid program as the starting point. Although, states would have the option of creating plans that go alongside the private plans through the marketplace.
People of all income levels could buy into Medicaid, provided they have no other coverage.
Each state will determine the premium amounts based on age, geography, family size and tobacco use. Further, the state will decide deductibles and cost-sharing.
States would get federal matching payments. As a result, the bill doesn’t require premiums and cost-share to cover the full cost of the buy-in.
Instead, the states have the flexibility to market the plans with premium rates lower than those set by commercial plans. Consequently, there is an expectation the federal government pays the difference.
As with the current Medicaid program, the state would have to finance the state share of the cost.
Senator Schatz proposes a State Public Option Act which would give states the option to offer Medicaid buy-in. Essentially, this gives people a high-quality, low-cost option.
There are already at least 14 states exploring these public options with legislators.
Medicaid Buy-in Proposal
The Medicaid buy-in would be available as the Silver level plan and enrollees would get an alternative benefits package or the ACA essential health benefits.
Also, this program relies on Medicaid doctors and managed care organizations to provide services.
Key Policy Considerations
There is a way to have affordable care for everyone; however, the path to affordable care for all isn’t easy.
Each of the bills provides health care to the public, at a cost. Some plans extend coverage to everyone, while others are more selective.
Will Medicare for all increase my current Medicare cost?
Medicare for all proposes enhancing the current program to include dental and vision coverage. Although, we can expect the premium trust funds to remain separate for those over 65 and those under 65.
Also, we expect the expenses will decrease and federal spending for health care will increase. The Medicare controlled fee schedule will help maintain a fair allowance to doctors while keeping the costs in check.
Overall, the cost of an individual will lower. Premiums will stabilize because more people are in the risk pool. Benefits become premium quality thanks to the buying power of a larger group.
Who will pay for this coverage?
The switch to Medicare for all transfers costs to the federal government. Many believe the top 5% of earners will pay most of the cost. There has been no further information on financing options.
The resulting impact of any one proposal will bring its own challenges. However, there is no definitive answer on which is the best solution for our national healthcare crisis.
Medicare for All Poll
We would love to hear your feedback on the above proposals.
Would you pay a higher tax for Medicare for All if you knew your insurance cost was going down? Or, do you want Medicare for America that caps the premiums?
Is Medicare buy-in your preference?
Leave a comment below letting us know what proposals you do and don’t agree with!