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Wednesday, 20 March 2019 06:40

House Democrats Propose New National Health Insurance Program

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Medicare for All is a universal health care model (also known as single-payer plan) which has been developed and promoted in the past few years by Senator Bernie Sanders. This latest version is even broader, with the intent being to help more Americans access health care, especially those that are not in a traditional employment environment.

What are the Details?

This single-payer system proposal has been revamped and now reintroduced in the House of Representatives as the Medicare for All Act of 2019 (H.R 1384), with the messaging “Everybody In. Nobody Out.” Here are some key details about this latest proposal:

  • The current proposal leaves two government health care systems intact – The Veterans Health Administration and the Indian Health Service – while automatically incorporating all existing recipients of Medicare coverage

  • This system would eliminate private major medical insurance options (though it allows for supplement plans to be sold) – which means employer-based plans could be a thing of the past

  • Premiums, deductibles, and copays would be eliminated

  • Doctors would be allowed to refuse to participate and instead charge patients cash; reimbursement rates for participating doctors have not been established

  • The government would negotiate directly with drug manufacturers to withhold or reissue drug patents to target high prescription costs

  • The bill allows for a 2-year transition period to adopt the new plan (the ACA had a 4-6 year implementation)

  • The initial estimates indicate that up to one to two million jobs could be eliminated due to the elimination of private insurance and the reduction in reimbursement rates to providers (https://www.modernhealthcare.com/government/house-democrats-introduce-medicare-all-bill)

  • The bill would likely require new taxes but is silent on how much those would be

What would the Medicare for All Act of 2019 cover?

The current proposal would continue or expand existing Medicare coverages, most with no or little cost sharing to patients:

  • Inpatient and outpatient health care services

  • Preventive, emergency, and nonemergency health care services and treatments

  • Primary and specialty health care, including palliative care

  • Care for vision, hearing, and oral health problems

  • Mental health and addiction services

  • Prescription medications

  • Medical equipment and supplies

  • Diagnostic tests

In addition, the following services would also be covered:

  • Long-Term Care

  • Comprehensive Reproductive Healthcare and Abortion Services

Though the plan would offer comprehensive benefits, the government would determine what procedures are “medically necessary and appropriate” and should be covered by the new plan. No final decisions have been made regarding plan offerings or costs.

Compared to employer plans, Medicare today doesn’t offer certain services only used among younger beneficiaries, such as maternity coverage or well-child visits. Many more details are needed to ensure vital services like these are still available.

Alternatives being discussed

Though a recent poll suggests that most Americans support a Medicare for All program, with 56% of respondents in favor, that support drops substantially to 37% if the program eliminates private health insurance plans.

Multiple alternatives to Medicare for All are being debated across the country, with many states, including Colorado, exploring options like a Medicaid Buy-In plan offered by the state to compete with private insurers rather than eliminate them. Though details would vary by state, low-income and unemployed individuals would typically receive assistance to participate in the program.

With a very divided Congress, these models may not have much chance of becoming law anytime soon. Count on Fall River to keep you informed of further developments in this area, and don’t hesitate to reach out to us if you have questions or would like more information!

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Read 1336 times Last modified on Friday, 29 March 2019 09:40
Juliet Fitzgibbons

Juliet joins Fall River as an Account Executive and brings over 15 years of prior broker and account management experience. Her experience brings extensive knowledge on employee benefit programs, account management and creative cost-saving strategies and compliance solutions for employers of various sizes.

She is responsible for new business proposals, client renewals including plan benchmarking, rate analysis and mid-year reviews. She helps clients navigate healthcare systems and educates employers and employees through open enrollment meetings and day-to-day service requests. Juliet joined Fall River in 2015.