Members of the home on Wednesday offered their form of a “Medicare-for-all” bill that's broader than what's been help with by Sen. Bernie Sanders (I-Vt.), whose 2021 presidential run pushed the problem into the political mainstream.
Rep. Pramila Jayapal (D-Wash.) and Rep. Debbie Dingell (D-Mich.) unveiled the “Medicare for All Act of 2021,” which redefines what the alternation in healthcare coverage might mean. The specifics contained in the bill could lead to the upcoming Democratic presidential primary campaign because candidates seeking support in the party's progressive wing leverage the phrase. But often, they will use it to mean something more important.
Is this bill so not the same as Medicare-for-all proposals which have come before? And why would those differences matter? Listed here are the essential takeaways:
In terms of the policy 411, the Jayapal-Dingell bill includes provisions not in other proposals.
In many different ways, the proposal sounds familiar: The federal government would set up a health plan that pays for basically all types of health care for all citizens. That's the way it has got the moniker “Medicare-for-all.”
Under this plan of action, patients wouldn't be accountable for any cost sharing of medical expenses, and the government coverage would include hospitals, doctors, preventive care, prescription meds and dental and vision care. Private insurers wouldn't be permitted to sell plans that compete with the government program.
Senior citizens could be folded into the new Medicare plan, which would become more generous than their current coverage, and the government would make sure any health care they are getting is not disrupted. The bill leaves two other government health care payers intact: the Veterans Health Administration and also the Indian Health Service. Beneficiaries enrolled in these programs would have a range of signing up for the new Medicare-for-all plan or staying with their current coverage.
Just like the Sanders bill, the home legislation covers what it calls “comprehensive reproductive health.” Backers say it is supposed to cover abortion – a controversial provision. At this time, government-funded health plans are legally prohibited from providing funds for abortions.
There are differences, too. For one, the transition to the new Medicare-for-all system would take place over two years, which would be considered a fast turnaround for a substantial task. Sanders' bill suggested a four-year transition.
The biggest difference: This House vision of Medicare-for-all would also cover long-term care. That isn't area of the Sanders bill, which is not included in Medicare. But for people with disabilities and the elderly, it is a significant benefit – and one that can end up with expensive to purchase out-of-pocket. (The Affordable Care Act included a long-term care provision which was eventually scrapped due to its high cost.)
The House bill also would take a swipe at high costs for prescription drugs by empowering the federal government to negotiate prices directly with manufacturers and to remove and reissue drug patents if such efforts faltered. This concept, referred to as “compulsory licensing,” has appeared in drug-pricing bills, but not in other Medicare-for-all legislation.
And the balance wades into among the hottest Medicare-for-all controversies: the function of non-public healthcare. Notably, it permits it. Private plans can cover services not included in the single government health plan. Doctors may also won't have fun playing the program and charge patients cash for medical treatment instead.
“Whether there's someone in Beverly Hills who sees the stars and doesn't partake – that would be possible,” said Dr. Adam Gaffney, a physician and president of Physicians for a National Health Program, a single-payer advocacy group that props up legislation. “The way the entire program is structured is to really allow it to be such that that's a very insignificant overall phenomenon.”
And the legislation assumes wonkier questions, like healthcare costs – proposing so-called global budgets that set a strong amount the us government would purchase hospitals, for instance, as a strategy to bring down spending.
Still, the legislation leaves lots of meaningful details available to interpretation.
Three big ones: precisely what would be covered, what doctors would be paid and how the program would be financed.
Generally, Medicare-for-all provides “comprehensive benefits,” accounting for healthcare needs as “medically necessary or appropriate.” That means covering hospital and doctor visits, but additionally, for instance, mental health, maternity services, addiction treatment, pediatrics and medications.
Where it gets tricky is determining which specific services become qualified as “necessary.” Sometimes that's obvious – insulin for diabetics or a cast for any broken leg.
In other cases, it is not as clear. Examples include politically controversial treatments, like gender confirmation surgery. Most professionals do the procedure is an important option for individuals with gender dysphoria. But specific aspects of it are occasionally deemed cosmetic or unneeded – often by those skeptical from the treatment to start with.
There will also be reconstructive surgeries that provide medical value, but may be deemed cosmetic.
The Department of Health and Human Services might have significant discretion in interpreting what specific services are “medically necessary.” That means political leanings or scientific debates could sway what's covered, even from administration to administration.
“Reasonable people could disagree on some things,” Gaffney acknowledged.
The legislation also spells steps for determining how you can pay doctors – a difficult issue, since doctors often complain that traditional Medicare pays them less than does private insurance. But the bill doesn't set up a reimbursement system.
Of course, there is the question of how the U.S. pays for the brand new program. Studies suggest Medicare-for-all would bring down national healthcare costs. Currently, though, a lot of that health expenses are borne by the private sector. Underneath the Jayapal-Dingell bill, the money would need to come out of taxpayer dollars.
That would mean new taxes, and that's a topic that does not appear any place in the Jayapal-Dingell bill. (Jayapal has stated she will released a separate list of potential taxes that may finance her single-payer proposal. Sanders also used this tactic – a separate listing of “pay-fors” – to make a case for his bill.)
The bill could resonate throughout the 2021 campaign.
The House bill keeps a spotlight around the Medicare-for-all issue – requiring Democratic presidential primary candidates to reply to more questions and spell out stances on this particular policy.
That could create some land mines. Medicare-for-all is controversial, and already major health industry groups have ramped up opposition towards the broad idea. This bill's specific provisions, for example its coverage of abortion, would add more adversaries. Its long-term care coverage would further increase its multitrillion-dollar price tag
But Robert Blendon, any adverse health care pollster in the Harvard T.H. Chan School of Public Health, pointed out that addressing concerns such as the long-term care benefit could increase the measure's political muscle. It might make the idea more appealing to older voters, who otherwise may be hesitant to change their coverage but that do come out disproportionately to vote in primaries.
That dynamic, he said, could skew primary results to favor candidates who endorse Medicare-for-all, as opposed to more moderate Democrats who've distanced themselves in the issue. (Inside a general election, he noted, costs could certainly diminish that support.)
“The long-term care piece is unbelievably significant,” he said. “It surely can help [progressives] with older voters.”