Ask the Advisor: April 2019

Ask the Advisor: April 2019

What is Medicare-For-All?

Q:  My husband and I keep hearing about “Medicare-for-all.”  Can you give us some information about what is being discussed, particularly how it would be financed?

A:  The new Congress is beginning to debate the next steps for expanding healthcare by extending Medicare coverage to more people.  A growing body of research has found that, even though our nation pays the highest healthcare costs of any industrialized nation in the world, our health outcomes are worse than those nations’.

So far, more than eight different Medicare expansion proposals have been put forward, and more are expected.  According to an analysis by the non-partisan Kaiser Family Foundation, the proposals fall into four general categories.  The categories include proposals that would:

  1. Create Medicare-for-All, a single national health insurance program for all U.S. residents;
  2. Create a new public plan option, based on Medicare that would be offered to individuals and some, or all employers, through the Affordable Care Act’s (ACA) healthcare marketplace;
  3. Create a Medicare buy-in option for older individuals (around 50 to 55 & up) who are not yet eligible for the current Medicare program; and
  4. Create a Medicaid (the low-income healthcare program) buy-in option that states can choose to offer to individuals through the ACA marketplace.

According to the Kaiser Family Foundation, many Americans like the idea of “Medicare-for-All.”  A Kaiser poll found, that 77% of the public including most Republicans (69%), favor allowing people between the ages of 50 to 64 to buy health insurance through Medicare.  Seventy-five percent of the public, including most Republicans (64%), favor allowing people who aren’t covered by their employer, to buy insurance through their state’s Medicaid program.

The poll, however, went on to probe public attitudes, after giving survey participants common arguments for and against a national Medicare-for-All plan.  The public’s attitudes shifted significantly depending on what people hear.  For example, those participating in the poll were more favorable to the proposal after hearing Medicare-for-All would guarantee health insurance as a right and would lower out-of-pocket costs but turned unfavorable when they learned the proposal would require most Americans to pay more in taxes or could lead to delays for people seeking care.

So far, lawmakers have not coalesced around any single approach, and more proposals are expected.  Democrats in the House will begin holding hearings on expanding Medicare this spring.  The Congressional Budget Office is working on an assessment that will help lawmakers understand the variables that need to be considered.

TSCL will be closely following this debate in the coming months.  What we do not want to see is a legislative initiative for an expansion of Medicare without a sound and fair plan for the financing of new benefits.  Most Medicare expansion proposals are expensive and would require major new sources of revenues.  Expanding Medicare may also mean that people would lose former healthcare coverage, while the new coverage under “Medicare for All” may cost some people, including middle-income households, far more than they paid before.

TSCL feels that it will take Members of Congress from both sides of the political aisle to change our nation’s health insurance system in a bipartisan way that extends Medicare to more people. It will be important to avoid the kind of political and legal challenges that have plagued the Affordable Care Act since it became law.

What you can do:  TSCL is conducting our annual senior survey to collect information about healthcare costs, and to learn more about the attitudes of older Americans on proposals to change Medicare.  Take the 2019 Senior Survey here.