Healthcare Reform Proposals

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A number of proposals to expand access to affordable healthcare have been introduced and are being debated in Congress.  This includes “universal healthcare” proposals to expand public healthcare options.  Disability advocates must continue to educate Congress about the services that people with disabilities need – long-term services and supports (LTSS), particularly Home and Community Based Services (HCBS) – to ensure they are included in any healthcare proposals being considered.

Background

For the last several years, the disability community has fought attempts by Congress to cut Medicaid and repeal the Affordable Care Act (ACA).  In the 116th Congress (that began in Jan. 2019), we expect to see both the Senate and House introduce universal healthcare proposals expanding the public healthcare options for all Americans.  So far, these bills have ranged from “Medicare for All” to Medicaid Buy-in programs.  A discussion about improving access to healthcare is underway.  At the same time, the ACA continues to be at-risk, and even with the ACA, millions remain uninsured, and costs and deductibles can remain unaffordable for those with coverage.

Specific Proposals

In the 116th Congress

  • Medicare for All
    • The House version of Medicare for All (H.R. 1384) was introduced by Rep. Jayapal on Feb. 27, 2019.  Here’s a 2 page summary and section by section summary explaining some of the key provisions. 
      • This bill would create a “single payor” public healthcare system that would subsume existing public programs like Medicare and Medicaid and would eliminate private health insurance.  The program would be administered by the federal government (like the current Medicare program) and not together with states (like the current Medicaid program).  That means that coverage would not vary state-by-state as it does with Medicaid.
      • The House Medicare for All bill covers long-term services and supports, including HCBS, with broad eligibility.  It also provides a “community-first” presumption. That would mean no more waiting lists for HCBS. Disability advocates have raised concerns about the short phase-in period (2 years) and that the provisions around global budgets (a cost-saving mechanism) could lead to limiting expensive care.      
    • The Senate version of Medicare for All (S. 1129) was introduced by Senator Sanders on April 10, 2019.  Here’s the text, and a summary by title.
      • Like the House version, this bill would create a “single payor” system and eliminates private health insurance.
      • The House and Senate versions differ in how they address LTSS.  The Senate Medicare for All bill covers HCBS, with broad eligibility.  Institutional LTSS would be covered by state Medicaid programs, not the Medicare for All program.  Disability advocates have raised concerns about the short phase-in and the use of a formulary for prescription drugs.  The Senate bill does not include global budgets.
  • Medicare for America
    • Medicare for America (H.R. 2452) was introduced by Rep. DeLauro on May 1, 2019.  Here’s a summary of the bill in question and answer format.
    • This healthcare bill would expand coverage by creating a public healthcare program that would subsume Medicaid and Medicare but would continue to allow the option of large employer-sponsored health insurance that meets certain minimum standards.
    • Medicare for America includes LTSS as a covered service, with broad eligibility.  It has a detailed list of covered services, including a range of HCBS and mental healthcare services.  Like the House Medicare for All bill, it has a community-first presumption and would eliminate waitlists for HCBS.  Medicare for America has a longer phase-in period to ensure continuity of care. Unlike the Medicare for All bills, it does include some copays and cost sharing.  
  • Keeping Health Insurance Affordable Act of 2019 (S 3)  introduced by Sen. Ben Cardin.
  •  Medicare at 50 Act (S 470) introduced by Sen. Debbie Stabenow.
  • Medicare Buy-In and Health Care Stabilization Act of 2019 (H.R. 1346)  introduced by Rep. Brian Higgins.
  • State Public Option Act (S 489/HR 1277)

Kaiser Family Foundation tool to Compare Medicare-for-all and Public Plan Proposals

Key proposals and bills in the last Congress

  • Medicare for All (House and Senate):  single payer system proposed, (S.1804H.R. 676 in the 115th Congress)
  • Medicare for America (House):  expanded federal program with private employer insurance  (H.R. 7339 in the 115th Congress)
  • Medicaid Buy-in (House and Senate):  option for additional people to buy into Medicaid through the ACA marketplace proposed in the 115th  (S. 2001H.R. 4129 in the 115th Congress).
  • Medicare expansion (House and Senate):  lowering age to qualify for Medicare with buy-in (S. 1742H.R. 3748  in the 115th Congress)
State -Based Healthcare Expansion Proposals

Examples include:

  • CA – Gov. Gavin Newsom proposed an overhaul of health care, funded by a California version of the individual mandate. [San Francisco Chronicle, 1/7/19]
  • CO – A Colorado Senate bill would create a public option health insurance plan that Coloradans who live in the highest-cost areas could buy instead of their current insurance starting in the fall of 2019. A House bill would expand that program to the entire state by the fall of 2020. The Denver Post, 1/4/19]
  • ME – Gov. Janet Mills signed an Executive Order directing the state to implement Medicaid Expansion. [CNN, 1/3/19]
  • NM – New Mexico Democrats plan to introduce the nation’s first Medicaid buy-in program [Politico, 1/9/19]
  • WA – Gov. Jay Inslee announced proposed legislation for a new “public option” health-care plan under Washington’s health-insurance exchange. The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases  [The Seattle Times, 1/8/19]
  • WI – Gov. Tony Evers signs Executive Orders directing the State to develop a plan for expanding Medicaid, and providing insurance protections for people with pre-existing conditions. One order directs the state Department of Health Services to develop a plan to expand the state’s BadgerCare Plus health care program for low-income people under the Affordable Care Act. The issue is expected to come to a head this year as Evers and lawmakers work on a state budget that will determine whether the state taps into additional federal aid through the ACA. The second order tells state agencies to prepare plans to find ways to protect coverage for people with pre-existing conditions, bolster consumer protections, improve the public’s understanding of insurance, and require insurers to make their costs and terms easily understandable. [Milwaukee Journal-Sentinel, 1/8/19]
  • NYC – New York City Mayor Bill de Blasio proposed a $100 million plan that he said would provide affordable ‘healthcare for all,’ reaching about 600,000 people, including undocumented immigrants, low-income residents not enrolled in Medicaid and young workers whose current plans are too expensive. The plan, which de Blasio dubbed ‘NYC Care,’ will offer public health insurance on a sliding price scale based on income, the mayor said during an interview Tuesday morning on MSNBC. It will begin later this year in the Bronx and will be available to all New Yorkers in 2021, and would cost at least $100 million once it reaches full enrollment, according to the mayor’s office.” [Bloomberg, 1/8/19]

Resources

CCD Disability Principles for Inclusion of Long Term Service and Supports (LTSS) in Universal Health Care, Consortium for Citizens with Disabilities

Medicare-for-All and Public Plan Buy-In Proposals: Overview and Key Issues, Kaiser Family Foundation (10/9/18)

Primer on the Medicare-for-all Debate, Kaiser Family Foundation (2/19/19)

The Only Guide to ‘Medicare for All’ That You Will Ever Need, Splinter (2/14/19)

Bernie Sanders’ New Medicare for All Bill Goes Even Further than Before, ThinkProgress (4/10/19)

The Landscape of Federal and State Healthcare Buy-In Models, Manatt (Feb. 19)

Single Payer Getting More Attention at State Level, Not Going Away, HealthLeaders (7/18/18)

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