How Obamacare, Medicare And 'Medicare For All' Muddy The Campaign Trail


The healthcare debate has Democrats on Capitol Hill and also the presidential campaign trail facing renewed pressure to make clear where they stand: Are they for “Medicare for All”? Or can they occupy the push to safeguard the Affordable Care Act?

Obamacare advocates have found a powerful ally in House Speaker Nancy Pelosi, who in a recent “60 Minutes” appearance asserted concentrating on the law is preferable to Medicare for All. She argued that because the ACA's “benefits are better” than those from the existing Medicare program, implementing Medicare for those means changing major provisions of current Medicare, which provides coverage for people 65 and up as well as individuals with disabilities.

This talking point – one Pelosi has utilized before – seems tailor-made for the party's establishment. It's politically palatable among moderates who believe that defending the ACA's popular provisions, for example protecting coverage for all those with preexisting conditions, fueled the Democrats' House takeover in 2021.

Progressive Democrats reason that it is now time to succeed an even more disruptive policy, one which guarantees healthcare to any or all Americans. Those dynamics were on full display on Capitol Hill, as recently being an April 30 Medicare for All hearing.

But this binary view – Medicare (and, for argument's sake, Medicare for All) versus Obamacare – oversimplifies the issues and distracts in the policy proposals.

“It's sort of a unique argument,” said Robert Berenson, any adverse health policy analyst in the Urban Institute, of Pelosi's talking point. “She's trying to argue the Affordable Care Act must be defended, and Medicare for those is really a diversion.”

As the debate continues, some point ought to be clear: Medicare for All would not seem like the ACA or like Medicare today. Instead, it – or any other single-payer system – would drastically change how Americans get health care.


Analyzing Medicare Isn't That Helpful In Understanding 'Medicare For All' Proposals.

Medicare for those is complicated, analysts noted, and the phrase is usually deployed to mean various things, depending on who is speaking.

What's clear would be that the “Medicare” described in Sen. Bernie Sanders' (I-Vt.) legislation – the flagship Medicare for All proposal – would produce a health program much more generous than traditional Medicare's current benefit, or perhaps the vast majority of health plans made available through the ACA.

Sanders relied heavily on this concept throughout his 2021 Democratic presidential primary run and recently introduced an updated version in the Senate.

To be fair, though, Sanders also sometimes blurs the lines between the programs. In a May 5 appearance on ABC’s “This Week with George Stephanopoulos,” he used existing Medicare as part of his sales hype: “Medicare at this time is the most popular medical health insurance program in the nation,” he said. “But it just applies to people 65 years old or older. All that I wish to do is expand Medicare on the four-year period to cover every man, woman and child within this country.”

As counterintuitive because it sounds, understanding Medicare as it works today isn't helpful in envisioning a Medicare for those plan. In contrast to existing Medicare, the proposed health plan would cover things like elderly care care, vision care and services. It would get rid of cost sharing – meaning no premiums, deductibles or copays. (Sanders has acknowledged that financing the program means raising taxes.)

“It's not Medicare. It's something different,” said Ellen Meara, a health economist at the Dartmouth Institute for Health Policy and Clinical Practice.

But voters may not hold the differences between your existing Medicare program for seniors and also the hypothetical one being discussed. Pelosi's comments may add to that confusion. Pelosi's office did not react to a request for comment.

Prioritizing efforts to bolster the ACA according to Medicare's current benefit package “is convenient and never necessarily compelling,” Berenson said, adding: “No the first is proposing the Medicare benefit package would be taken and applied nationally.”

That said, most of the presidential candidates have advanced much less sweeping healthcare options that would lower the Medicare age to 55 or allow people to buy to the current Medicare program – an approach also known as a “public option.” Those would keep the program essentially structured because it is today.

The Democratic Health Care Debate Is More Complicated Than the others Familiar Words Suggest.

Every analyst interviewed for this story floated some kind of concern regarding a Medicare for those system. There is the issue of how people would react to losing the option of private insurance – a probable results of Sanders' proposal – and the question of the items degree of tax hikes could be necessary to finance this type of system, especially if it covers a big-ticket item for example long-term care. There's also concerns concerning the financial impact for hospitals, often large employers in a community, or the private insurance industry jobs that will likely disappear.

Focusing on current Medicare benefits misses the purpose, suggested Sherry Glied, any adverse health economist and dean at New York University. When debating the merits from the ACA versus Medicare for those, Medicare's current generosity is kind of a red herring, she said.

Plus, making Obamacare or Medicare for those an either-or debate ignores a sizable political bloc: Democrats who say they offer the ACA and see single-payer as a next thing. That tension is at have fun with presidential candidates like Kamala Harris, who frame Medicare for All being an ultimate goal, while also backing incremental reforms.

Comparing Medicare To Obamacare Is Difficult Since Each Offers Different Advantages to Different People.

The problem is that both Medicare and Obamacare are vast programs. Based on your income, health needs and the version you sign up for, each one can be the better choice.

“It's impossible to say the ACA as a concept has pretty much generous benefits,” Berenson said.

Broadly, the ACA has protections in position that traditional Medicare doesn't. It caps just how much patients pay out-of-pocket, and contains more generous coverage of mental healthcare and drug abuse treatment. But, used, those benefits have proved elusive for many since Medicare generally has a more robust network of participating physicians than most of the ACA's cheaper plans, which restrict patients to some narrower coverage network.

Also, most beneficiaries don't solely have traditional Medicare.

About a third use Medicare Advantage, by which private insurance companies construct Medicare plans with benefits and protections according to factors such as company, tier and geography. They, too, are often restricted to narrower networks.

More than One in five traditional Medicare beneficiaries also receive Medicaid coverage, based on figures kept by the Kaiser Family Foundation, and about a third of them buy so-called Medigap plans, which are sold by private insurance and therefore are designed to supplement gaps in coverage.

The ACA also encompasses an array of coverage options. Which plans are available in an area and whether earnings qualify a consumer for a government subsidy- a tax break meant to make an ACA plan less expensive – make a factor in evaluating whether Medicare or an ACA plan offers better benefits for the person or family.

Suggesting that certain is clearly better than another, Meara said, is really a “gross oversimplification.”

But that kind of oversimplification may be hard to prevent, especially in a primary season where health care is really a top issue.

“The Affordable Care Act is also not just one thing, the way in which Medicare is not something,” said Katherine Baicker, dean of the Harris School of Public Policy in the University of Chicago. “So a lot of health care is more complicated than we are able to explain inside a sound bite.”