Medicare for All Act of 2019

Yesterday, Sen. Bernie Sanders introduced the Medicare for All Act for 2019, along with 19 co-sponsors in the Senate.

This bill mostly follows the previous bill he introduced in 2017, yet it has one notable addition. The new bill is summarized as follows:

*  Eligibility: Covers everyone residing in the U.S.
*  Benefits: Covers medically-necessary services including primary and preventive care, mental health care, reproductive care (bans the Hyde Amendment), vision and dental care, and prescription drugs. This bill also provides home- and community-based long-term services and supports, which were not covered in the 2017 Medicare for All Act.
*  Patient Choice: Provides full choice of any participating doctor or hospital. Providers may not dual-practice within and outside the Medicare system.
*  Patient Costs: Provides first-dollar coverage without premiums, deductibles or co-pays for medical services, and prohibits balance billing. Co-pays for some brand-name prescription drugs.
*  Cost Controls: Prohibits duplicate coverage. Drug prices negotiated with manufacturers.
*  Timeline: Provides for a four-year transition. In year one, improves Medicare by adding dental, vision and hearing benefits and lowering out-of-pocket costs for Parts A & B; also lowers eligibility age to 55 and allows anyone to buy into the Medicare program. In year two, lowers eligibility to 45, and to 35 in year three.
According to the Physicians for a National Health Plan (PNHP), this bill can be improved by:
* Funding hospitals through global budgets, with separate funding for capital projects: A “global budget” is a lump sum paid to hospitals and similar institutions to cover operating expenses, eliminating wasteful per-patient billing. Global budgets could not be used for capital projects like expansion or modernization (which would be funded separately), advertising, profit, or bonuses. Global budgeting minimizes hospitals’ incentives to avoid (or seek out) particular patients or services, inflate volumes, or up-code. Funding capital projects separately, in turn, allows us to ensure that new hospitals and facilities are built where they are needed, not simply where profits are highest. They also allow us to control long term cost growth.
* Ending “value-based” payment systems and other pay-for-performance schemes: This bill continues current flawed Medicare payment methods, including alternative payment models (including Accountable Care Organizations) established under the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Studies show these payment programs fail to improve quality or reduce costs, while penalizing hospitals and doctors that care for the poorest and sickest patients.
* Establishing a national long-term care program: This bill includes home- and community-based long-term services and supports, a laudable improvement from the 2017 bill. However, institutional long-term care coverage for seniors and people with disabilities will continue to be covered under state-based Medicaid plans, complete with a maintenance of effort provision. PNHP recommends that Sen. Sanders include institutional long-term care in the national Medicare program, as it is in Rep. Pramila Jayapal’s single-payer bill, H.R. 1384.
* Banning investor-owned health facilities: For-profit health care facilities and agencies provide lower-quality care at higher costs than nonprofits, resulting in worse outcomes and higher costs compared to not-for-profit providers. Medicare for All should provide a path for the orderly conversion of investor-owned, for-profit health-care providers to not-for-profit status.
* Fully covering all medications, without co-payment: Sen. Sanders’ bill excludes cost-sharing for health care services. However, it does require small patient co-pays (up to $200 annually) on certain non-preventive prescription drugs. Research shows that co-pays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.
Any other legislation such as strengthening the ACA, or half-measures for Medicare such as
buy-ins or public options, or leaving private, employer-based insurance alone, will not solve the
problems we are having, which stem from the financing of health care, and not the providing of
health care.

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