Putting Every American in Charge of Their Health Care with Affordable Choice for All
In our country, the more than 27 million people who are uninsured are either paying too much for care or not getting the care they need because it’s too expensive.Key Facts about the Uninsured Population.” Kaiser Family Foundation. December 7, 2018. Uninsured individuals are less likely to access crucial preventive services—such as cancer screenings or cholesterol checksGarfield, Rachel, Kendal Orgera, and Anthony Damico. “The Uninsured and the ACA: A Primer - Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act.” Kaiser Family Foundation. January 25, 2019.—and more likely to forego care for chronic conditions, such as diabetes or heart disease. And 87 million people are underinsured, which means they’re also paying too much for care, in the form of high deductibles or out-of-pocket costs that make them more likely to struggle to pay for care or skip it altogether.Collins, Sarah R., Herman K. Bhupal, and Michelle M. Doty. “Health Insurance Coverage Eight Years After the ACA.” Commonwealth Fund. February 7, 2019. We must ensure that everyone has an affordable option for health coverage that guarantees access to care when they need it.
We must ensure that everyone has an affordable option for health coverage that guarantees access to care when they need it.
Through Pete’s Medicare for All Who Want It plan, everyone will be able to opt in to an affordable, comprehensive public alternative. This affordable public plan will incentivize private insurers to compete on price and bring down costs. If private insurers are not able to offer something dramatically better, this public plan will create a natural glide-path to Medicare for All. The choice of a public plan empowers people to make their own decisions regarding the type of health care that makes sense for them by leveling the playing field between patients and the health care system. It gives the American people a choice and trusts them to set the pace at which our country moves in a better direction on health care.
Pete’s coverage and affordability plan includes the following policy proposals:
The Medicare for All Who Want It public alternative will help America reach universal coverage by providing an affordable insurance option to the currently uninsured. The public alternative will provide the same essential health benefits as those currently available on the marketplaces and ensure that everyone has access to high-quality, comprehensive coverage.
The plan will automatically enroll individuals in affordable coverage if they are eligible for it, while those eligible for subsidized coverage will have a simple enrollment option. A backstop fund will reimburse health care providers for unpaid care to patients who are uninsured. Individuals who fall through the cracks will be retroactively enrolled in the public option.
Most commonly, unexpected bills arise when a patient receives care at an in-network hospital and, unbeknownst to them, is treated by an out-of-network physician.Lewis, David. “The changing landscape of out-of-network reimbursement.” Milliman White Paper. September 2018. This mismatch is a deliberate business strategy fueled by profit-driven firms in private equity.Kellett, Hunter, Alexander Spratt, and Mark Miller. “Surprise billing: choosing patients over profits.” Health Affairs. August 12, 2019. About one in five visits to the emergency room is likely to lead to a surprise bill.
Pete will require that bills related to in-network facilities be billed as in-network. His plan will also place limits on what out-of-network providers, including ambulances and air ambulance services, can charge.
Pete will make premium subsidies more generous for low-income people. Today, a family of three making $31,000 a year pays about $1,200 annually for “silver” coverage on the marketplace.Scott, Dylan. “House Democrats new plan to strengthen Obamacare, explained.” Vox. March 26, 2019. Under Pete’s plan, they will pay a maximum of roughly $600 a year for higher quality (i.e., gold-level) coverage.
This plan will also extend the subsidies to more middle-income people by capping premium payments for everyone. That means that the 60-year-old in Iowa making $50,000 and currently paying $12,000 annually in premiums will now pay no more than $4,250 annually for gold coverage. Pete will also lower out-of-pocket costs for consumers by increasing cost-sharing assistance.
One in four Medicare beneficiaries—15 million people—spend over 20 percent of their income on premiums and medical care.Schoen, Cathy, Karen Davis, and Amber Willinik. “Medicare beneficiaries' high out-of-pocket costs: costs burden by income and health status.” The Commonwealth Fund. May 12, 2017. Costs run much higher for many, including those with chronic disease and disability. The traditional Medicare program does not have a cap on out-of-pocket spending, putting seniors at risk of having medical or drug costs wipe out their savings. Pete believes that seniors in traditional Medicare deserve the same financial protection. He will improve affordability in Medicare by capping out-of-pocket costs, with lower caps for low-income seniors.
Non-profit hospitals do not pay federal taxes under the assumption that they benefit their communities. Many benefit their communities in a number of ways, such as by providing free care to uninsured patients and offering medical training.Hostetter, Martha and Sarah Klein. “In Focus: Hospitals Invest in Building Stronger, Healthier Communities.” Commonwealth Fund. September 23, 2016. However, some non-profit hospitals are doing little to benefit their community—sometimes even harming their own patients through aggressive billing and predatory collection practices.Beil, Laura. “As patients struggle with bills, hospital sues thousands.” The New York Times. September 3, 2019. Hancock, Jay and Elizabeth Lucas. “‘UVA has ruined us’: Health system sues thousands of patients, seizing patients and putting liens on home.” The Washington Post. September 9, 2019. Pete’s plan will strengthen community benefit requirements to ensure that hospitals are investing in the health of their patients and communities.
Health providers often charge private insurers exorbitant fees. As hospital prices for outpatient care increase at a rate four times faster than physician prices,Rosenthal, Elizabeth. “That beloved hospital? It’s driving up health costs.” The New York Times. September 1, 2019. hospital profits have risen to their highest levels in decades.Gee, Emily. “The High Price of Hospital Care.” Center for American Progress. June 26, 2019. As President, Pete will prohibit health care providers from pricing irresponsibly. This will also provide insurers with leverage to demand lower rates for in-network care.Chernew, Michael, et al. “The case for market-based price caps.” Health Affairs. September 3, 2019. As noted in our rural health plan, for these providers in underserved areas, Pete’s administration will increase Medicare reimbursement rates and encourage states to increase Medicaid reimbursement rates.
“Mental health parity” means that coverage and treatment for mental health and substance use disorder are provided on equal terms as treatment for physical conditions. Pete will enforce parity in several ways, including requiring health plans to annually report how they manage and meet parity. Health plans that violate this policy will face fines and statutory penalties. Those plans most often out of compliance will be publicly named.
Our health care system is the most costly in the world in part because it spends $496 billion annually on administrative costs—more than any other system globally.Gee, Emily and Topher Spiro. “Excess administrative costs burden the U.S. health care system.” Center for American Progress. April 8, 2019. To lower cost and improve quality, we must make our health care system more efficient. Pete’s plan will do this by harmonizing standards for transactions and holding insurance companies accountable for adopting them. It will simplify billing by creating a central clearinghouse for claims,Emanuel, Ezekiel. “Democrats are having the wrong health care debate.” The New York Times. August 2, 2019. establish an All-Payer Claims Database that supports health care quality initiatives,Calsyn, Maura. “Policy options to encourage all-payer claims databases.” Center for American Progress. April 20, 2018. and require integration of electronic records.
Health insurers, hospitals, pharmaceutical companies, and health care provider groups are all growing larger, but bigger has not been better for patients. Greater consolidation among providers and insurers results in higher prices for patients without improving quality. To ensure robust competition in health care markets and protect patients, Pete will increase funding for federal antitrust authorities to empower them to review more mergers and equip them to bring enforcement cases against activity that harms competition and hurts health care workers.
By making care more affordable and available to everyone, we will finally put Americans back in charge of their own health care decisions. If you’re with us, text HEALTH to 25859.
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