The Republican leadership in Congress is still planning to kill the Affordable Care Act, with no viable alternative to replace it. If the ACA is repealed, the Democrats in Congress have many compelling reasons to align around Medicare for all. Yale political scientist Jacob Hacker made the case more than a decade ago in his initial plan to expand on Medicare’s model as a way to ensure everyone in America has access to care; he built on this plan in 2007 in his Health Care for America proposal.
Here are some of the key elements of Hacker’s plan. It would create a new broad public insurance pool for people without employer coverage and not eligible for Medicare.
What benefits would this expanded Medicare proposal offer individuals?
- Like Medicare, choice of a traditional fee-for-service plan or a commercial insurance plan with the same guaranteed benefits.
- Coverage of a defined package of essential benefits with a maximum individual and family out-of-pocket cap, but with a sliding scale on these caps based on income.
- A single deductible and coinsurance rate for medical and inpatient services.
- An income-related premium, with federal premium and copay subsidies for people with low incomes, and with people earning 200 percent of the federal poverty level or less paying no premiums.
- Broad spreading of risk so that health care is affordable to everyone including people who need costly health care.
What benefits would this expanded Medicare proposal offer the health care system?
- A streamlined national system, with far less fragmentation and complexity than our current system.
- Transparency that allows for accountability and the ability to drive quality and cost improvements to the health care system.
- Substantial leverage from bargaining jointly with Medicare to secure lower prices and improved quality, reining in health care costs and delivering better care.
- Low administrative costs.
- Significant savings to employers, individuals, states and the federal government.
How would this expanded Medicare proposal work?
- Automatic coverage for all legal U.S. residents without insurance to ensure that people do not fall through the cracks, and people with insurance are not subsidizing health care for people without it.
- People with Medicaid and SCHIP are included in the program with special low-income protections and additional benefits.
- Continuous guaranteed coverage except for people who gain qualified private workplace coverage.
How would this expanded Medicare proposal be administered?
- Like Medicare, the federal government would administer the program through the Centers for Medicare and Medicaid Services at the Department of Health and Human Services, and people would have access to doctors and hospitals across the nation.
- Employers could choose to cover their workers, so long as the benefits were at least as comprehensive as Medicare, or make a small payroll contribution of a percentage of a workers’ income to cover the cost of the public insurance.
- Individuals not working could buy into the program.
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