Medicare for All vs. The Affordable Care Act –
important choices facing our nation
Senator Bernie Sanders epitomizes the “Medicare for All” proposal. Vice President Joe Biden is the chief proponent of building on the Affordable Care Act. These are two very different ways to get to universal coverage with very important policy differences that merit serious thought and rational debate.
Senator Sanders builds on the Medicare program, which covers seniors and the disabled. He eliminates the copays, deductibles and premium contributions of Medicare. He adds benefits such as long-term care, dental care and vision care, which are not part of Medicare. He then eliminates private insurance through employers, Medicaid for the poor, private insurance for individuals and the important advances of the Affordable Care Act and replaces them with Medicare for all. He finances the health coverage with an 8% payroll tax for employers and 4% income tax surcharge for individuals. These revenue sources are dedicated to Medicare for All and cannot be used for other purposes.
Vice President Joe Biden builds on the Affordable Care Act. He increases premium assistance and reduces cost sharing for those purchasing individual insurance through the Exchanges. He uses Medicare to cover the uninsured poor in the states like Texas and Florida who have declined to adopt the ACA’s Medicaid Expansion. He allows for a Medicare buy in (the public option) through the Exchanges. He also allows individual employees to opt for a Medicare buy in. He proposes a series of other reforms on drug pricing, anti-trust enforcement and surprise medical bills. The cost of his proposal is far less because he does not end private insurance, does not end patient cost sharing and premium contributions and does not expand covered benefits.
Eligibility
Medicare for All covers everyone. The Biden plan covers 98% of American residents, but leaves out the undocumented who are eligible only for emergency services through Medicaid. It covers the poor in the Southern states and others who have refused to expand Medicaid through Medicare with no copays or deductibles for primary care.
Benefits
The Sanders plan covers all services except for institutional long term care (e.g. nursing homes) which he leaves to state Medicaid programs. The Biden plan covers all ten essential health benefits (e.g. hospitals, doctors, drugs, mental health and drug treatments, etc.) as determined under the Affordable Care Act; this does not include vision, dental, hearing or most long-term care.
Out of pocket
The Sanders plan eliminates copays, deductibles and premiums. The Biden plan upgrades the premium assistance offered by Obamacare from linkage to a silver plan (70/30 cost sharing) to linkage with the gold plan (80/20 cost sharing). The Sanders plan eliminates all balance billing from providers. The Biden plan eliminates surprise medical billing when a patient goes out of network for care.
Private insurance
The Sanders plan eliminates private insurance entirely (through employers, individually purchased or Medicare Advantage). The Biden plan offers a Medicare buy in (the public option) through the Exchanges to anyone who wants it, including employees who can drop their employment-based coverage and use their employer’s premium contribution to buy into Medicare in the Exchanges.
Cost containment
The Sanders plan sets rates for hospitals, doctors, prescription drugs and all other services consistent with the approaches under Medicare. It relies on federal regulation of rates. The Biden plan negotiates drug prices, beefs up antitrust enforcement against local provider monopolies and oligopolies, allows importation of drugs from countries with lower prices and encourages more price competition from generics. It’s a hybrid approach combining competition and regulation.
Financing
The Sanders plan ends all private financing and instead relies on federal taxes on employers (8%) and individuals (4%). The Biden plan retains private financing and pays for its increased premium assistance by repealing the Trump tax cuts for the very wealthy and taxing capital gains as regular income.
Administration
The Sanders plan is administered by the federal government like Medicare is today. The Biden plan is administered by the federal government, the 50 states, and private employers and insurers as the existing systems are today.
Prepared by: Lucien Wulsin
Dated: 7/31/19