We Can Have Medicare For All -- If Both Parties Compromise

Dan Mendelson Contributor

Jan 3, 2019, 05:43pm

As Democrats take control of the House of Representatives, they face the stark reality of having to make good on a big campaign promise: extending affordable health insurance to all Americans.  Likewise, Republicans who survived the “blue wave” did so partly by saying that they would preserve a guarantee of coverage for those with pre-existing conditions that can only realistically be fulfilled by further expanding access to health insurance.

Among the ideas floated by Democrats, “Medicare for All” gained immediate traction with liberal activists, while being quickly branded as socialized medicine by the Right.

Given the current era of a divided government, and the poor track record for healthcare programs that are not embraced by both sides, the only way forward is through bipartisanship.  Republicans and Democrats need to find a mutually amenable way to guarantee Americans the right to purchase insurance irrespective of their health status, to subsidize this insurance for very low-income individuals, and to ensure that the broader crisis of healthcare affordability is addressed.

Fortunately, there are options.  One viable way to proceed is what I call “Medicare Advantage for All” – to guarantee a right for anyone lacking insurance to purchase insurance under the Medicare Advantage program – a popular, relatively affordable program that is administered by private health plans.

Medicare Advantage – the private health plan option available to most Medicare beneficiaries in the United states – is thriving.  Once disliked by Democrats, the program enjoyed stability and growth during both the Bush and Obama Administrations.  In fact, it has grown steadily from 7% of total Medicare enrollment in 2000 at the close of the Clinton Administration, to 33% of Medicare enrollment in 2016, prior to President Trump’s election.  And that rapid growth has continued.

The program is optional for seniors – and is growing rapidly because seniors are opting in, choosing to accept restrictive networks of providers in return for simplified and lower cost sharing and attractive supplemental benefits.  As the program has grown over the years, more plans offering more options have emerged.  From 2018 to 2019, the total number of Medicare Advantage plans available will increase by 17%, from 2,208 to 2,594.

These plans are popular in part because of very low-cost sharing.   In 2019, 90% of Medicare beneficiaries will have access to a $0 premium plan – up from 84% in 2018.  Most plans also cap maximum out of pocket costs below $6,000, and reduce typical cost sharing for drugs that seniors face in their Part D drug benefits, including free generics.

The Administration is wisely allowing intensive experimentation and new program options.  This year, they started giving plans an option to offer nutritional services and enhanced home care options to seniors when they get out of the hospital.  And the plans are increasingly allowing this because they believe it will save money.  These health plans are also paid more if they increase the quality of beneficiary care – as measured by a rating system agreed on by the government and private health plans.

These plans aren’t perfect.  Some seniors have bad experiences with the restrictiveness of provider networks, the lack of availability of drugs, or the fact that it sometimes takes a long time for appeals of medical benefit decisions to work their way through the system.  Policy makers have sometimes, in the past, questioned whether the plans are overpaid.  All of these issues point to the fact that policy makers will need to actively regulate the plans, which they do currently.

A compromise in which the private market is deployed to ensure availability of coverage has been the formula through which every major coverage expansion over the past two decades has been achieved.  The Children’s Health Insurance Program – enacted in 1997 – was passed as a capped entitlement and implemented through private Medicaid managed care programs.  The Medicare drug benefit – enacted in 2003 – was delivered by private plans competing for the affection of seniors.

Structuring a program to enable Medicare Advantage to be accessible to all American consumers that do not have an employment-based or public health insurance option would certainly meet the promise that both sides have made to ensure Americans the right to coverage irrespective of pre-existing conditions.   Perhaps it could also put us back on a bipartisan path to coverage for all Americans.

https://www.forbes.com/sites/danielmendelson/2019/01/03/we-can-have-medicare-for-all-if-both-parties-compromise/#35b319b17226