“Medicare for All” Plans
There are two different Medicare for All Plans in Congress: Senator Sanders S 1129 and Representative Jayapal’s HR 1384. They are comparable, but with a few salient differences. Both cover all Americans for a comprehensive set of benefits with no cost sharing or premiums, using a Medicare-like payment program. Both eliminate all employer and individual private insurance and the existing Medicare program and most of the Medicaid program as well (Senator Sanders retains it for institutional long term care – i.e. nursing homes. Neither eliminates the VA programs for veterans or the IHS (Indian Health Services) program for Native Americans.
Eligibility is for all US residents as defined by the Secretary of HHS. This covers the undocumented residing in this country I assume. Individuals are auto-enrolled at birth or at enrollment sites. The House bill starts two years after enactment while the Senate bill starts four years after enactment.
Benefits include the ten essential benefits covered by the ACA, plus vision, plus dental, plus long term care. Senator Sanders leaves institutional long-term care (i.e. nursing homes) with the state Medicaid programs.
There are no cost sharing (copays and deductibles) and no premiums. It would be financed by moving all current government health spending into the program plus new taxes, which are not specified nor yet identified.
Any state licensed provider who signs a participation agreement is eligible to participate. No balance billing of patients is permitted for any participating provider. Under the Sanders plan, the Secretary of HHS sets a fee schedule for all services. Under the House version, hospitals and other facilities are paid a quarterly global budget negotiated with their regional director while doctors and other practitioners are reimbursed fee for service based on the Medicare fee schedules. Prescription drugs are reimbursed based on negotiations with the HHS Secretary, comparative clinical effectiveness and the availability of generic alternatives.
Weaknesses in my humble opinion: lack of specific financing and weak cost controls (apart from rate regulation). Fails to distinguish between effective care and good health outcomes vs. ineffective care and poor health outcomes.
Prepared by: Lucien Wulsin