Tagged Insurance

Podcast: KHN’s ‘What The Health’: Still More ‘Medicare-For-All’

Vermont Sen. Bernie Sanders, a presidential candidate, unveiled the 2019 version of his “Medicare-for-all” bill this week. But even more than two decades after first proposing a single-payer plan for the U.S., Sanders still has not proposed a way to finance such a major undertaking.

Congress continued to pursue its examination of high prescription drug prices this week by calling to testify both insulin makers and the drug “middlemen” known as pharmacy benefit managers.

And Idaho is following Utah in trying to scale back an expansion of Medicaid under the Affordable Care Act approved by voters last November.

This week’s panelists are Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

Also, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans.

Among the takeaways from this week’s podcast:

  • “Medicare-for-all” was in the spotlight again this week with the release of Sanders’ bill, which is co-sponsored by four of the five other Senate Democrats running for president. Still, neither Sanders nor any other candidates — or their proposals — focus on how to pay for it. Experts differ on how much expanding Medicare would cost. But, whether it’s moving around money already being spent or raising new taxes, expanding Medicare to more people would result in winners and losers, a key political factor going forward.
  • Both parties face internal divisions over health care, revolving around whether to create something new or stick with the status quo. Within the GOP, the split is between Republicans who point to years of unsuccessful efforts to repeal and maybe replace the ACA and want to move on to other things, and others — including some in the White House — who are continuing the push. Democrats’ division is between those who back House Speaker Nancy Pelosi’s call to strengthen and improve the ACA and those who back various efforts to create a Medicare-for-all system.
  • The GOP is playing both offense and defense on the ACA. Leaders say they want to be the party of health care and protect people with preexisting medical conditions, even as the Justice Department is officially backing a court ruling in Texas that would invalidate the entire law, including those protections.
  • There was lots of talk but little action on drug prices at hearings before Congress. Lawmakers heard from drug companies and pharmacy benefit managers, but are no closer to answering the question about what to do about high drug prices. While there may be incremental changes that can be adopted, few expect legislation that would fundamentally change business practices, intellectual property rights or the ability for Medicare to negotiate drug prices.
  • Action in the Utah and Idaho legislatures around Medicaid expansion show that even successful ballot initiatives to expand the program can be changed by lawmakers in ways voters may not have expected. In both state capitols, elected officials reduced the number of people eligible for expansion below what voters approved.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The New York Times’ “Would ‘Medicare for All’ Save Billions or Cost Billions?” By Josh Katz, Kevin Quealy and Margot Sanger-Katz

Sarah Kliff: Politico’s “Public Option Hits a Wall in Blue States,” by Rachana Pradhan and Dan Goldberg

Margot Sanger-Katz: Politico’s “Obamacare Fight Obscures America’s Real Health Care Crisis: Money,” by Joanne Kenen

Paige Winfield Cunningham: STAT News’ “Amazon Alexa Is Now HIPAA-Compliant. Tech Giant Says Health Data Can Now Be Accessed Securely,” by Casey Ross

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

State Highlights: On Brink Of Nurses Strike, New York Hospitals Agree To Increase Staffing Levels; Use Of Urgent Care Clinics Expands In New Orleans, Nationwide, Report Finds

Media outlets report on news from New York, Louisiana, Georgia, California, Ohio, New York, North Carolina, Iowa, Florida, Wisconsin, Michigan, Arizona and Massachusetts.

As Sanders Officially Revives Medicare-For-All, Plan B For Democrats Gains Traction

As Democratic presidential primary candidates try to walk a political tightrope between the party’s progressive and center-left wings, they face increasing pressure to outline the details of their health reform proposals.

On Wednesday, Sen. Bernie Sanders (I-Vt.) reaffirmed his stance by reintroducing a “Medicare-for-all” bill, the idea that fueled his 2016 presidential run.

As with its previous iterations, Sanders’ latest bill would establish a national single-payer “Medicare” system with vastly expanded benefits, prohibit private plans from competing with Medicare and eliminate cost sharing. New in this version is a universal provision for long-term care in home and community settings (but Medicaid would continue to cover institutional care).

Already, it has an impressive list of Senate cosponsors — including Sanders’ rivals for the Democratic presidential nomination, Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Kamala Harris (D-Calif.) and Elizabeth Warren (D-Mass.).

But many of the candidates — even official Medicare-for-all co-sponsors — are at the same time edging toward a more incremental approach, called “Medicare for America.” Proponents argue it could deliver better health care to Americans while avoiding political, budgetary and legal objections.

It comes as politicians tread carefully over the political land mines a Medicare-for-all endorsement could unleash, while seeking to capitalize on a growing appetite for health reform.

During the 2018 midterm election campaigns, some congressional candidates talked about allowing people older than 55 to join Medicare, or allowing people younger than 65 to buy into it if they choose (the “public option”). Many aren’t eager to face the industry opposition that a full-on Medicare expansion would surely trigger.

From the consumer perspective, sweeping reform poses a risk. Despite Medicare’s popularity with its beneficiaries, the majority of Americans express satisfaction with their health care, and many are nervous about giving up private options. Also, many analysts are worried that a generous Medicare-for-all plan that promises everything would break the bank without any patient payments.

That tension is pushing a number of candidates toward an emerging option called “Medicare for America.” The bill was introduced last December to little fanfare by two Democrats, Rep. Rosa DeLauro (Conn.) and Rep. Jan Schakowsky (Ill.). It hasn’t been reintroduced in the new Congress.

This proposed system would guarantee universal coverage, but leaves job-based insurance available for those who want it. Unlike Medicare-for-all, though, it preserves premiums and deductibles, so beneficiaries would still have to pay some costs out-of-pocket. It allows private insurers to operate Medicare plans as well, a system called Medicare Advantage that covers about a third of the program’s beneficiaries currently, and which would be outlawed under Medicare-for-all.

“Before policies get defined, what you see is people endorsing a plan that is a little, perhaps, less subject to early attack,” said Celinda Lake, a Democratic pollster. “A lot of candidates feel if they endorse a plan that leaves some private insurance, they get more time to say what their ideas are about.”

Medicare for America got its first high-profile endorsement from former Texas Rep. Beto O’Rourke, who launched his own 2020 bid in mid-March. Other candidates — including Warren, Gillibrand and Pete Buttigieg, the mayor of South Bend, Ind. — have tiptoed toward it without making any endorsements, suggesting they back Medicare-for-all in theory but also support a system that retains private insurance, at least temporarily.

Such an approach is perhaps unsurprising. Polling indicates voters want strong health reform. Candidates, election experts say, need something powerful to deliver.

Improving the Affordable Care Act, an idea backed by Sen. Amy Klobuchar, a Minnesota Democrat running in the primary’s moderate lane, may not suffice.

“The ACA is popular at the 50 percent level, but it’s not energetic. It doesn’t get people who really like it,” Blendon said. “What they’re looking for is something that is exciting but isn’t threatening.”

Both Medicare-for-all and Medicare for America, experts noted, offer something that presidential candidates can campaign on and a health alternative that at first blush sounds appealing to many. But the latter could skirt some potential obstacles.

Approval for Medicare-for-all drops when people learn that, under such a program, they would likely lose their current health plan (even if the government-offered plan could theoretically provide more generous coverage).

The cost-sharing element of Medicare for America, meanwhile, would ostensibly quiet some of the concerns about paying for Medicare’s expansion, though critics on the left worry it would mean some people would still be unable to afford care.

This also tracks with recent polling which suggests that, while Medicare-for-all support can be swayed, voters of all political stripes favor some sort of way to extend optional Medicare coverage, without necessarily eliminating the private industry altogether.

Employers would have to offer plans that were at least as generous as the government program, or direct employees to Medicare. Employers who stop offering health benefits would have to pay a Medicare payroll tax.

For now, most candidates are still avoiding a concrete stance on Medicare for America. Despite signs of interest, the Buttigieg, Gillibrand and Warren campaigns all declined to directly answer questions about whether they endorse Medicare for America. The campaigns of other candidates in the race — Harris, Klobuchar, Booker, former Housing and Urban Development Secretary Julian Castro and Washington Gov. Jay Inslee — similarly declined to comment.

Reading between the lines, though, their promises to achieve universal health care by expanding Medicare — while retaining private insurance — leaves them few options besides something like Medicare for America, argued one of its main architects.

“There are variations besides this particular plan, but once you start to actually dig into this, if you want universal coverage you’re going to have to do the kinds of things” spelled out in Medicare for America, argued Jacob Hacker, a political scientist at Yale University, who played a lead role in devising this proposal.

Still, though, it has prompted objections from both the left and the right.

On the far left, the cost sharing is a dominant concern. (Under Medicare for America, an individual would have a $3,500 out-of-pocket limit; a family would have a $5,000 limit. Premiums would be capped at almost 10% of a household’s income.) Those critics also say the plan’s accommodations to private insurance limit the government’s ability to negotiate lower prices.

Conservatives repeat many of the arguments levied against Medicare-for-all — too expensive, too disruptive.

Hospitals, insurance, drugmakers and doctors, who have already mobilized against Medicare-for-all, also can be expected to make just as strong a showing against Medicare for America, political analysts said. More Medicare means less revenue for the medical industry.

Said David Blumenthal of the Commonwealth Fund: “The fact of expanded Medicare will be the focus of attacks.”

N.C. Lawmakers Working Toward Covering More Low-Income People, But Shy Away From Politically Charged ‘Medicaid Expansion’ Term

The NC Health Care for Working Families Act would help low-income people get coverage through the state’s Medicaid program, but it wouldn’t technically be “expanding” Medicaid. It’s estimated that about 543,000 people would end up gaining coverage through the proposal. Medicaid news comes out of North Dakota, Illinois and Ohio, as well.

Economists Weigh In On True Cost Of ‘Medicare For All.’ Bottom Line: It Would Be Expensive.

Sen. Bernie Sanders (I-Vt.), a 2020 hopeful at the front of a crowded pack, is set to unveil an updated version of his “Medicare for All” legislation, a plan that has gained momentum with progressive Democrats. It’s difficult to put an actual price tag on one of the largest proposed domestic policy changes in a generation, but economists try provide an estimate. In the end, patients would probably pay less, and the government would pay a whole lot more.

House Committee Chairmen Demand Answers About Administration’s ‘Sudden And Significant’ Reversal In Health Law Case

“The [Justice] Department owes Congress and the public an explanation as to why it refuses to enforce the law,” chairmen of five House committees wrote. Meanwhile, Attorney General William Barr defended the decision at a hearing on Tuesday. “Do you think it’s likely that we are going to prevail?” he asked, in response to questions about the reversal. “If you think it’s such an outrageous position, then you have nothing to worry about. Let the courts do their job.”

Florida Health Care Businessman Charged In $1B Medicare Fraud Scheme, One Of Biggest In History

Federal prosecutors say Philip Esformes, a Miami Beach resident, was the mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016, as well as paying regulators to inform him when patients complained and when there would be inspections. News on Medicare fraud comes from Illinois, as well.

Florida Health Care Businessman Charged In $1B Medicare Fraud Scheme, One Of Biggest In History

Federal prosecutors say Philip Esformes, a Miami Beach resident, was the mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016, as well as paying regulators to inform him when patients complained and when there would be inspections. News on Medicare fraud comes from Illinois, as well.