By Jan and Greg Phillips
U.S. Representatives Jayapal (D-WA) and Dingell (D-MI) recently reintroduced H.R. 1976, their improved Medicare For All Act of 2021 (M4A) in the House of Representatives. The bill proposes a single-payer, national health insurance system providing comprehensive and guaranteed health care to all Americans.
H.R. 1976 calls for expanding and modifying our existing Medicare system to cover every citizen, of any age, from birth to death. It would include all necessary care: hospital, primary and preventive services, dental, vision, hearing, long-term care, mental health, substance abuse, prescription drugs and transportation.
As with our existing Medicare and Medicaid systems, patients would receive health care from their choice of physicians, clinics, hospitals and allied health care professionals. There would be no exclusion based on pre-existing conditions. Patients would retain access to health care regardless of changing jobs or moving from state to state.
The system would be based on need, not ability to pay. There would be a process for the automatic enrollment of individuals at the time of birth in the U.S. (or upon establishment of residency in the U.S.) Providers would be required to adhere to established and reviewed best practices, and the patient and their provider would determine decisions about diagnosis and treatment. The government would pay for, not deliver, the health care. Patients would never be billed for care and there would be no co-pays, private insurance premiums, deductibles, or other cost sharing.
The national health system would reimburse providers directly for their services at rates established by the Department of Health & Human Services (HHS). Institutions, such as hospitals and nursing homes, would be funded quarterly in advance to cover all services, similar to the way we fund fire departments. Hospitals would have stable funding during a crisis, like the COVID-19 pandemic, allowing them flexibility to redeploy resources to meet public health needs. The lump sum payment amount would be negotiated between institutions and regional directors appointed by the Secretary of HHS. Budgets would be reviewed quarterly and adjusted as needed.
H.R. 1976 would phase in M4A over a two-year period. During the first year, existing Medicare enrollees would receive the expanded benefits such as dental, hearing and vision care. After year one, everyone 18 and under and 55 and over would automatically be enrolled and all other citizens would be eligible to purchase Medicare coverage on the ACA Exchanges. This “Medicare Transition buy-in plan” would phase out after year two at which time everyone would be automatically enrolled in M4A. During the transition period private insurers would be prevented from denying coverage.
As a result of the single-payer approach of M4A, commercial insurance would no longer be necessary. Insurance companies would be prohibited from selling health insurance coverage that duplicates the benefits provided by M4A but would be allowed to offer plans that cover some elective or “luxury” procedures.
M4A proposes to reduce health care costs by eliminating commercial insurance; simplifying administrative and billing burdens on providers; reducing drug costs by negotiating prices for medications and equipment (overriding drug patents when necessary), and establishing a national drug formulary that promotes the use of generics.
H.R. 1976 does not specify the cost of or funding mechanism for M4A. Based on other single-payer bills in the House and Senate, it is likely that a combination of increased income and/or payroll taxes would be required. Numerous studies have concluded that any increase in taxes would be less than what 95% of Americans are paying now for health care and what small businesses currently spend on insurance for their employees. This reduction will be the result of administrative savings and negotiating lower prices from drug and medical device companies. Some studies have suggested that high-income families would pay slightly more than they do now.
H.R. 1976 addresses the potential loss of revenue and jobs in the health insurance industry by allocating 1% of the budget for the first five years to assist displaced insurance workers.
It remains to be seen whether the political will and trust in government exists in the U.S. to transition to a single-payer system. H.R. 1976 certainly advances the debate, addressing specific problems with our current, for-profit system and providing a template for a plan based on lessons learned from Medicare, Medicaid and single-payer systems in Canada, Taiwan and other wealthy nations.
Jan and Greg Phillips live in Durango, CO. Their business, SOF, Inc., began as a health education publishing company in 1988. They moved the company and our family to Durango in 1990. The business ultimately morphed into a marketing consulting firm with over a 100 clients nationwide as well as locally.