The debate over healthcare is expected to return to Congress after the Labor Day holiday.
This time, it’s the Democrats’ turn.
Sen. Bernie Sanders (I-Vt.) says he plans to introduce legislation for a single payer health system when Congress is back in session.
That bill picked up support last week from Sen. Kamala Harris (D-Calif.), who said she will co-sponsor the proposal.
The Golden State has been batting around the idea of installing a single payer system.
A single payer program is a healthcare system overseen by the government.
Along the same lines, Sen. Brian Schatz (D-Hawaii) has said he will soon introduce a bill to establish a so-called “Medicaid for All” healthcare system.
Basically, that plan would allow anyone to enroll in the Medicaid program, which until now has been primarily for low-income households.
Opinions vary greatly on the proposal.
The insurance industry, for one, doesn’t like the idea at all.
“It’s just another name for government-run healthcare,” David Merritt, executive vice president for public affairs for America’s Health Insurance Plans (AHIP), told Healthline. “Government would simply be paying the entire bill.”
However, the proposal seems plausible to the consumer groups and doctors’ organizations that spoke to Healthline.
“The idea of Medicaid buy-in has potential,” said Leni Preston, president of Consumer Health First. “Of course, everything is in the details.”
How ‘Medicaid for All’ would work
Under Schatz’s plan, Medicaid would still be preserved for low-income consumers.
However, the proposal would allow states to open up their Medicaid plans to anyone who wants to purchase the insurance coverage, regardless of their income.
Households with higher incomes would pay premiums, while those from low-income households would continue to receive the program benefits at no cost.
It’s similar to how states currently have the option under the Affordable Care Act (ACA) to expand their Medicaid program to people making less than 133 percent of the federal poverty line.
Currently, 31 states and the District of Columbia have expanded their Medicaid programs.
Now, about 74 million people participate in the Medicaid program.
Schatz’s plan would make Medicaid for All one of the options in the ACA’s state marketplaces.
Nevada almost became a test case for the Medicare buy-in plan.
Earlier this year, the state legislature approved a Medicare for All option, but in June, Nevada Gov. Brian Sandoval vetoed the measure.
He said there were still too many unanswered questions about how the program would work.
Advocates of the Medicaid for All plan say one of the biggest advantages would be that more people would have insurance.
Preston said the new enrollees could include people who might drop out of the ACA system this coming year because of higher premiums.
She agreed with the idea of making the system part of the ACA’s marketplaces.
“You need a basic structure in place to do this,” she said.
Dr. Scott Poppen, chairman of the board of directors for Doctors for America, said physicians support the idea of increased enrollment.
“We feel that the more people who have health insurance, the better,” Poppen told Healthline.
He added a Medicaid for All plan could “help people who fall between the cracks” in the current system.
Poppen said doctors also favor the provision in Schatz’s plan to raise the Medicaid reimbursement rate to the same level as Medicare.
Right now, he said that rate is about 77 percent.
“This is an essential element,” he noted.
Kurt Mosley, vice president of strategic alliances for Merritt Hawkins health consultants, said the Medicaid buy-in plan has the potential to provide people with low-cost options in ACA marketplaces.
He said it could also give consumers an extra choice in those markets.
“This could be advantageous to people who need help now,” Mosley told Healthline.
Merritt said the insurance industry doesn’t see any advantages to a Medicaid for All plan.
For starters, he predicts such a system would raise costs for providers and raise premiums for consumers.
Some estimates say a Medicaid buy-in plan could save billions each year.
Merritt, however, isn’t buying it.
He sees prices rising, as well as an increase in waste, fraud, and abuse.
Merritt also said the Medicaid buy-in plan could limit the options for consumers by forcing private insurers out of the marketplaces.
Then, states would only be offering similar programs throughout the country.
“One size for all doesn’t work,” he said. “You need different options for different people.”
Mosley said the insurance industry’s opposition to the proposal really is all about competition.
“The Medicaid proposal is going to take business away from them,” he said.
However, Merritt said the insurance industry has the same goals as consumers and doctors’ groups.
They just favor a different approach.
“There’s no question the healthcare system needs to be fixed,” he said. “We want every American to have good quality coverage.”
The big issues
For a Medicaid for All plan to work, there are a number of things that have to happen.
For starters, Mosley said, it has to be affordable. Otherwise, there is no reason for consumers to buy in.
Second, he said the program has to offer the same benefits to its higher income members that it does to its lower income members.
Otherwise, the folks who are paying premiums are going to feel ripped off.
“It has to be the same coverage,” Mosley said.
Mosley’s firm also released a survey this summer that indicated physicians across the United States are warming up to ideas like a Medicaid buy-in.
In the survey, 56 percent of doctors said they could support a single-payer system. In 2008, 58 percent were opposed.
Mosley said the key to doctors’ support is the reimbursement rate.
Without it matching the Medicare rate, doctors won’t participate in a Medicaid for All program.
“You can have insurance,” said Mosley, “but if your doctor doesn’t take it, then you’re not covered.”
The other hurdle for doctors’ support is the image of Medicaid.
It’s still viewed by many as healthcare for poor people.
“They have to market this better than they did the state marketplaces,” Mosley said. “It’s all about marketing because confused buyers don’t buy.”