Universal health coverage remains a Democratic priority, but the party is still debating how it achieves that and what role Obamacare should play in the transition.
At a Dec. 9 hearing of a House Energy and Commerce subcommittee, Democrats weighed several alternatives for covering more Americans, which could serve as roadmaps for the party if it takes control of the White House and Senate in 2020.
More than half of House Democrats have co-sponsored one or more bills to either expand Medicare to everyone or allow people to buy plans run by Medicare.
A major difference among Democrats remains how much support the Affordable Care Act continues to enjoy as the primary method for improving health coverage.
“I do believe that the ACA could have and still can achieve almost universal coverage,” said Energy and Commerce Chairman Frank Pallone Jr. (D-N.J.), who helped draft the 2010 law. He said it is necessary to include undocumented immigrants in government health coverage or else they will increase costs by relying on emergency rooms for care.
Pallone favored Rep. Marc Veasey’s (D-Texas) bill to provide incentives for expanding Medicaid (H.R. 584). If every state expanded Medicaid under the ACA, that would cover an additional 2 million people, Sara Rosenbaum, a health law and policy professor at George Washington University, said.
From Buy-Ins to Medicare for All
Proposals discussed at the hearing ranged from Rep. Pramila Jayapal’s (D-Wash.) full Medicare for All proposal (H.R. 1384), which would expand benefits to include vision, hearing, dental, mental health, and long-term care coverage, to more limited measures. Rep. Brian Higgins’s (D-N.Y.) proposal (H.R. 1346) would allow people ages 50-64 years to buy Medicare coverage for a premium based on the cost of their benefits.
Jayapal said families would save 14% of what they currently pay in premiums and out-of-pocket costs under her bill by reining in the $3.9 trillion spent annually on health care.
Medicare for All “is a truly sweeping reform unlike any single payer elsewhere on the globe,” Douglas Holtz-Eakin, president of the right-of-center think tank American Action Forum, said. Other countries often rely on private insurance to supplement government systems, and they don’t eliminate copayments, he said.
Opponents warned Democrats that expanding Medicare coverage could have unintended consequences.
“There are some serious trade-offs,” Holtz-Eakin said. “Among them will be a trade-off between covering folks in this manner and access to care and the quality of that care.”
Hospitals’ success in improving quality has depended on higher reimbursement rates from commercial insurers, and the proposals would reduce the rate of reimbursement, Holtz-Eakin said. Reimbursements may be so low that hospitals couldn’t remain open in many cases, he said.
Proposals to introduce government-run public options for health insurance in the ACA exchanges would likely crowd out private insurance, Scott Atlas, a fellow with the conservative Hoover Institution at Stanford University, said.
Republicans emphasized the loss of employer-sponsored health coverage for 180 million Americans for a “one-size-fits-all” government-run system that would cost an estimated $32 trillion over 10 years.
“Medicare for All is not the right approach” to achieving universal coverage, Energy and Commerce ranking Republican Greg Walden (R-Ore.) said.