March 13, 2019
Dive Brief:
- The American Hospital Association
and Federation of American Hospitals are stepping up opposition to a
public option, which would allow citizens to opt in to a government-run
health plan. They argue such a plan would cost hospitals $800 billion and
throw a kink in the employer-sponsored insurance market.
- A public option, an industry
report claims, would create only a "modest drop" in the
uninsured rate compared to the gains that could be made by expanding the
current coverage system, which FAH President Chip Kahn argued
"Americans are satisfied with." A January Kaiser Family
Foundation poll found 74% of Americans want something like
a public option, while 56% support the idea of Medicare for all.
- Hospital groups helped eliminate a
public option provision from the original Affordable Care Act, and
began ramping up lobbying effortsagainst
the Medicare for all idea toward the end of last year.
Dive Insight:
The
$774 billion reduction in payments AHA and FAH claim hospitals will face under
what they call a "Medicare-X Choice" proposal cover the period
between 2024 and 2033 and total a 10% reduction in hospital
payments.
Such
a proposal would also "stifle" hospitals' ability to keep up with
medical advances, invest in new delivery models and juggle rising drug costs,
the hospitals said. "This buy-in to a Medicare-like public option may
fit on a bumper sticker, but it is no solution for health care coverage,"
Kahn said in a statement.
Out
of the eight legislative proposals to expand insurance coverage introduced by
members of the 115th Congress in 2017, seven included a public option. The
eighth, a Medicare for all bill, would install a single-payer system. Medicare
for all, AHA president Tom Nickels said, would "impede" the
industry's goals.
"It
is not practical to disrupt coverage provided through employer-sponsored plans
that already cover more than 150 million Americans," Nickels said of the
public option.
Kelly
Coogam-Gehr of National Nurses United, which has been a very vocal proponent of
Medicare for all, shares the hospital groups' disdain of a public
option. Public option plans can be costly for families, increase premiums,
won't alleviate national health expenditures and don't solve the core problem
of administrative complexity, she said.
Government
would be forced to compete with private insurance prices. That's not ideal at
the moment, Coogam-Gehr added. "It allows private insurance to
cherry-pick the healthiest patients, while the sickest patients go into public
option," she said. "It will make it look like Medicare is a lot more
expensive than it actually is."
While
hospitals and systems oppose the idea, big doctor groups are in
favor, including the American Medical Association, the American College of
Physicians and the American Academy of Family Physicians.
Public
option, Medicare for All Who Want It, would be less disruptive and threatening
to many interests but would be less egalitarian, have higher administrative costs,
and still require higher taxes to pay for it and more cost controls that
threaten providers.
By
offering choice of keeping private insurance or a public plan, it will be less
threatening to those in the insurance and related fields and to employers and
employees who want to keep private insurance.
ACP
did not want to comment on the AHA/FAH report.
The
report itself was prepared by KNG Health, a consulting group founded by former
CMS economist Lane Koenig. Koenig was previously a scientist for UnitedHealth
subsidiary Lewin Group, a consulting firm known for its oft-cited 2009 study on
the ACA. That study also claimed that a public option would cause
employer-sponsored coverage rates to plummet by more than 100 million
people.
Many
also warned the ACA without the public option could erode employer based
insurance, though that hasn't come to pass.
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