Medicare For All Who Want It – Mayor Pete’s Plan
Pete Buttigieg’s Health Plan has a catchy title. It is essentially the same plan as Vice President Biden outlined several months ago, but it has some interesting new wrinkles and improvements worth considering for all candidates. https://peteforamerica.com/issues/#HealthCare
“Medicare For All Who Want It” applies to several groups of people. First low-income parents, couples and singles in states, which have not adopted the Medicaid expansion, would be automatically enrolled in Medicare. Second employees who found their employer’s offer of coverage too expensive could use Medicare; it’s unclear whether they can take their employer’s contribution with them. Third, individuals applying through the Exchanges could choose a Medicare plan. As I read it, it does not allow employers to opt into Medicare for their employees’ coverage.
The plan envisages automatic enrollment of all who are Medicaid eligible and simpler enrollment for those who are Exchange eligible. There would be a bad debt pool to pay for the costs of those who do not enroll and retroactive coverage through Medicaid for those who did not enroll even though eligible to do so. This will assure that all low-income uninsured in the nation have coverage and all providers get paid.
For those who are Exchange eligible, premium assistance would be increased and linked to gold (80% coverage) as opposed to silver (70% coverage) plans. Premium assistance would be expanded to more middle-income families and individuals by capping their contributions to premiums at 8.5% of income. Cost sharing reductions would be reinstated and expanded. Maximum out of pocket caps would be expanded so that individuals have to pay much less out of pocket. This will make coverage more affordable and care less costly for low, moderate and middle-income consumers using the Exchanges.
There is nothing in Mayor Pete’s plan that helps the undocumented who account for over 60% of California’s remaining uninsured.
Surprise medical bills occur when a patient uses a hospital, but some of its affiliated doctors or labs are out of network and send the consumer a huge bill for their “charges”. Mayor Pete’s plan would require that all of the affiliated providers bill at the in network rate for services provided at a participating hospital. It would also cap the charges for out of network care at 200% of Medicare; some out of network hospitals bill for charges at 500% of their costs. These are important improvements around the edges of overpriced American health care.
Seniors enrolled in Medicare are protected by an out of pocket expenditure cap if they are enrolled in a Medicare Advantage plan (Part C of Medicare) but not if they enroll in Medicare fee for service (Medicare Parts A, B and D). Mayor Pete would introduce an out of pocket expenditure cap for all Medicare enrollees. This is an important improvement in the Medicare program and will be vital for those seniors and disabled with the most serious illnesses.
Treatments for mental illnesses and substance abuse are already required to be at parity. Mayor Pete will extend the parity requirements to Medicare and Medicaid and sanction those plans that violate parity. The bigger problem is behavioral health providers who choose not to be in plan networks and instead bill their patients for charges.
Mayor Pete proposes to increase transparency of provider prices and quality of care, to establish an All Payer Claims database, to improve provider directories, drug formulary comparisons and plan quality ratings. These could be important advances that would depend on motivated and informed consumers to make them effective in reducing costs and improving quality. There is as yet no evidence that the existing transparency requirements have been particularly effective.
Mayor Pete is proposing to simplify billing, claims, eligibility, and prior authorization by requiring consistency and uniformity and ease of interoperability across all plans. If achievable with few or no plan and payer exceptions, this would be a big improvement for providers and consumers alike.
Stronger anti trust enforcement against provider and plan mergers that increase costs to the patients and the health system is the final plank in Mayor Pete’s new framework for the American health system. There is an urgent need to distinguish between those plan and providerr mergers and consolidations that increase prices and those that offer lowered prices and better, more integrated services leading to a lower costs and better patient outcomes.
Prepared by: Lucien Wulsin
Dated: 9/23/19