It looks like lawmakers have done all they’re going to do in the way of health care reform until after the 2018 midterm elections. President Donald Trump and GOP leaders came out of their Camp David retreat last weekend with a scaled down agenda for safety net programs and health law. For what it’s worth, polls show that the vast majority of both Republicans and Democrats oppose funding reductions for Social Security and Medicare. Of course, lawmakers did enough in December, when they passed the Tax Cuts and Jobs Act which, among other things, struck down the individual mandate requiring every American to have health insurance.
Meanwhile, Democrats are thinking outside the box. The mandate repeal, snuck into the tax bill at the last minute and essentially beyond their control, has mobilized them to look for “big ideas.” Here’s a sample of ideas under debate by Democrats and others on the political left:
Medicare for All: Vermont Sen. Bernie Sanders made single-payer, government-run health care the cornerstone of his campaign for the 2016 Democratic presidential nomination. It remains the most talked-about health care idea on the left. Financing would be funneled through the tax system. Individuals wouldn’t have to worry about deductibles, copays or narrow provider networks.
Medicare-X: The legislation from Sens. Kaine, and Michael Bennet, D-Col., would allow individuals in communities lacking insurer competition to buy into a new public plan built on Medicare’s provider network and reimbursement rates. Medicare would be empowered to negotiate prescription drug prices. Medicare-X would be available as an option through HealthCare.gov and state health insurance markets.
Medicare Part E: Yale University political scientist Jacob Hacker has proposed a new public health insurance plan based on Medicare, for people who don’t have access to job-based coverage meeting certain standards. It would be financed partly with taxes on companies that don’t provide insurance. Consumers would pay income-based premiums. Hospitals and doctors would be reimbursed based on Medicare rates, generally lower than what private insurance pays.
Medicare at 55: Sen. Debbie Stabenow, D-Mich., has introduced a bill that would let older adults buy into Medicare starting at age 55. Enrollees would be eligible for subsidies under Obama’s law. They’d also have the option of picking a plan through Medicare Advantage, which offers private insurance options.
Medicaid Buy-In: Sen. Brian Schatz, D-Hawaii, and Rep. Ben Ray Lujan, D-N.M., have introduced legislation that would allow states to open their Medicaid programs up to people willing to pay premiums. Although Medicaid started out as insurance for the poor, it has grown to cover about 75 million people, making it the largest government health program.
None of these ideas are likely to be introduced in Congress in 2018, as long as Republicans remain in control. But if Democrats are smart, they will pick one idea that appeals to the public and run on it in 2018.
This post was originally part of a longer article in Savvy Medicare Planning’s biweekly newsletter. To learn more about Savvy Medicare Planning, click here.