The Biden-Sanders Unity Task Force recently released its recommendations for health care reform. Unfortunately, the three Sanders’ appointees on the health care task force were not able to move the Biden appointees to support reforms that will guarantee health care to all Americans, much less get us meaningfully closer to Medicare for all. Rather, the Task Force’s proposed reforms are small and not likely to help most Americans.
Vice-President Joe Biden wants to “build upon our bedrock health care programs, including the Affordable Care Act, Medicare, Medicaid, and the Veterans Affairs system.” In his view, building means adding a “public option” and lowering the age of Medicare eligibility to 60. It’s unclear what exactly a public option would mean or how it would help guarantee Americans access to good affordable health care.
Here’s what we know: Joe Biden believes that if Americans had the choice of enrolling in a “public health plan”–health insurance provided directly by the federal government–in the state health insurance exchanges, private health insurers would engage in “real competition” and have a financial incentive to deliver quality affordable care. But, the evidence suggests otherwise.
We know that private Medicare Advantage plans do not engage in real competition with the public Medicare plan. Rather, they game the system, market to healthy people, create barriers to care for their members who need it and drive up costs. There is no reason to believe that private health plans would behave any differently for people under 65 if a public option were available.
What’s more, the Unity Task Force has in mind the possibility of more than one public plan choice, but it does not explain why there would need to be more than one choice. It says that at least one choice would not have a deductible and would be administered by traditional Medicare, not a private health insurance company. For reasons that are not explained, the government administrator of the new public plan would engage in its own negotiations with doctors and hospitals over prices rather than piggyback off of Medicare rates.
Anyone with employer coverage or coverage through the ACA would be free to enroll in the public plan. One special feature of this public plan is that people who are not eligible for Medicaid but whose incomes are low would automatically be enrolled in the public plan. People living in states that have not expanded Medicaid could also enroll in this public plan. They would not pay a premium for it and could opt out of it if they chose.
In addition to creating a public plan option, the Unity Task Force recommends that, at age 60, anyone could choose to enroll in Medicare. But, it does not recommend an out-of-pocket cap on traditional Medicare or other reforms that would improve Medicare benefits and make it easy to enroll in traditional Medicare.
Of course, with many options available, it will be easy for marketers to confuse people about what health plan is best for them. Inevitably, plenty of health plans will not meet people’s needs. For example, they might inappropriately delay and deny care, have narrow networks without high-value health care providers, or high copays. To help people distinguish among plans, the Unity Task Force supports appropriating money to let people know about their options and enroll them. But, assistance is of little help if there are no good options available. And, information that would shed helpful insight into which are better than others–such as which don’t have high denial rates–is not available.
The Unity Task Force recommends giving states the right to come up with their own health plans. Many advocates and states want that right. Still, the likelihood of success on the part of states to guarantee residents affordable health care is slim given financial constraints and their lack of resources to take on the private health insurance industry. States have never been able to serve Americans well on the health insurance coverage front and there is no evidence that they will do so in the future.
The Unity Task Force sees its recommendations as meeting the needs of people who are recently unemployed as a result of the pandemic along with people who have been uninsured for a long while. But, it’s unclear why. With health care costs continuing to rise and little focus on reining them in, it’s hard to imagine the public option–the Task Force’s chief way of improving health insurance–will be affordable to most people without substantial federal subsidies.
If you can’t afford health insurance as a result of these health care reforms, you might want to get care at community health centers, sometimes known as Federally Qualified Health Centers, and rural health centers. The Task Force recommends greater and more predictable funding for these health centers.
To address shortages of health care providers, particularly primary care nurses and dentists and mental health counselors, the Unity Task Force recommends a larger National Health Service Corps.
Here’s more from Just Care:
- Congress must protect our community health centers
- Programs that lower your costs if you have Medicare
- What are the major differences between Medicare for all and a public option?
- How would lowering the Medicare eligibility age to 60 help?
- If you want easy health care access and good quality care, you probably want traditional Medicare