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Medicare for all: Don't rip health system apart and start from scratch, insurers and providers say

Government has history of slashing payments, providers say; Reimbursement for Medicare, Medicaid less than what private insurers pay.

Susan Morse, Senior Editor

Both insurers and healthcare organizations are against the Medical For All Act introduced by House Democrats this week.

Payers are against a plan that would eliminate private insurance. Providers say a government-run health plan would ultimately result in lower reimbursement, since that's traditionally been the case.

The American Hospital Association said Congress has a history of slashing provider payments for government health programs and that Medicare and Medicaid reimburse providers less than the cost of delivering care.

"America's hospitals and health systems are working with policymakers to help expand coverage and improve affordability for all Americans," said AHA Executive Vice President Tom Nickels. "However, we are opposed to 'Medicare for All,' as it would impede our shared goals. The AHA believes there is a better alternative to help all Americans access health coverage – one built on fixing our existing system rather than ripping it apart and starting from scratch."

The Federation of American Hospitals said it opposes legislation that would needlessly upend coverage for hundreds of millions of Americans, eliminate private health insurance and lead to a massive disruption in care for patients.

America's Health Insurance Plans is against what it calls the one-size fits-all  government system. Under current coverage, Americans have choice and control over their options and treatment, AHIP said.

"This bill will hurt patients, consumers, and taxpayers: Americans will pay more, to wait longer, for worse care," AHIP said.

Reps. Pramila Jayapal, D-Wash. Debbie Dingell of Michigan and 107 cosigners introduced the Medicare for All Act of 2019, legislation that would establish a national health insurance program for universal coverage.

The federal government would pay for health coverage, including premiums, copays and deductibles. Employers and private insurers would be barred from providing and selling the same benefits, but they could provide supplemental coverage.

Payments to hospitals would be on a global budget.

WHY THIS MATTERS

The consensus is that the current bill has little chance of passing.

However, Medicare for all is gaining traction in the Democratic party and will  likely be a 2020 election issue. Support from leaders such as Senator Kamala Harris has given credence to what was viewed in 2016 as the too-far-the-left idea of Independent Senator Bernie Sanders.

The enticement is seeing other countries such as the United Kingdom and Canada offering a single payer system that offers affordable care to all.

The cost of implementing such as a system is reportedly in the trillions.

THE TREND

Essentially, Medicare for all would expand the existing Medicare program to younger Americans, replacing current coverage, including for Medicaid.

But the government through the Centers for Medicare and Medicaid Services has been heading in the opposite direction, promoting the benefits of private Medicare through Medicare Advantage plans. At least a third of all Medicare beneficiaries have a MA plan, and that percentage is expected to grow.

There can be a Medicare for all system that does not do away with private insurers, according to Stephanie Kennan, senior vice president, Federal Public Affairs at McGuireWoods Consulting.

One could establish a federal public option built upon the Affordable Care Act to allow for a blend of private insurance and public coverage, Kennan said. The public plan option could be offered alongside private insurance through the ACA marketplace and small employers.

"With Medicare for all, there's a lot of different ways to do it," Kennan said. "It reduces the role of private insurance. I think Americans like choice."

The proposal released by Democrats this week would exclude the private insurance option.

This bill gives physicians the option not to participate, but there would not be a lot of avenues for them to choose whether to be in or out, she said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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