Healthcare In 2020 And Beyond
What Are The Candidates Really Saying?
WHAT YOU CAN DO...
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By Alexander Kucherina
Plans for Candidates
Did you know that over 50 percent of Americans do not receive the proper preventative care and pre-screening that medical experts recommend? Additionally, 1 out of every 10 Americans lives without insurance? These are catastrophic problems that are somehow still not addressed with the modern-day United States healthcare system. Now that the 2020 Presidential race is up and running, an immense amount is at stake for Americans and their healthcare. The Democratic candidates, pushing and shoving their way to a party nomination, plan to enact policies that could drastically change the realm of healthcare coverage, accessibility, and costs for millions of Americans. Many of the Democratic proposals rally around a healthcare system known as “Medicare for All”, while the remaining candidates have introduced plans combining both private and universal coverage into a hybrid system. Yet, the national media tends to summarize candidates’ plans into headlining news, often failing to elaborate on how the plan would actually impact Americans on a day-to-day basis. This media shortcoming strips the public of knowing integral pieces of the proposals such as what benefits these plans would offer, the different types of healthcare providers included, insurance for non-generic drugs, etc.
The main goal of the Affordable Care Act (ACA), otherwise known as “Obamacare”, enacted in 2010 was to reduce the number of uninsured Americans without further decimating the federal budget1. Obamacare aimed to encourage Medicaid for lower class citizens not already eligible for coverage while simultaneously subsidizing private health insurance for the middle class. Democratic frontrunner Joe Biden aims to build off of the precedents of the Affordable Care Act he and former President Barack Obama crafted almost a decade ago. Biden wants to offer Americans a “new choice” through a public health insurance option. This ACA expansion would shift power into the peoples’ hands to choose whether or not they want to buy-in to the program. The question is, would this public option work?
If he bases this option off of the previous exchange system, he might not be able to pull it off. This exchange system failed when premiums continued to rise, and enrollees’ medical costs exceeded total premiums. Additionally, if the Affordable Care Act is to be expanded as Biden’s proposal suggests, many claim it should be managed at a national level instead of under state jurisdictions. Over 14 states were able to opt out of the Affordable Care Act’s Medicaid expansion proponent after a 2012 Supreme Court ruling granted them this right. These states turned down funds that could have significantly increased coverage rates at the expense of slightly raising sales taxes per state. If the Affordable Care Act is to be expanded, Biden must tailor it in a way that would unify the states and their individual interests. A personal recommendation would be to offer each state a “safety net” plan. This would be of three options: withdrawing from the expansion if results are not visible, require cost-sharing for enrollees, or simply using the expansion funds for other areas. This would at least make sure that the funding is going through to most states. Without something like a “safety net” many underprivileged communities may once again fall victim to coverage gaps and un-insurance problems.
The next plan that is currently turning heads in Washington is the Medicare for All Act proposed by Senator Bernie Sanders of Vermont. Sanders vows it will “provide comprehensive healthcare to every man, woman and child in our country without out-of-pocket expenses”. The bill will also stretch Medicare coverage to include dental, hearing and vision care. This will be pivotal, as these categories are not currently covered under our nation’s Medicare system that’s been relatively untouched since 1965. It also calls for expanded coverage to include and pay for long-term care paired with no copayments for healthcare visits.
Sanders has been very vocal towards his desire to provide extensive taxes on upper classes to not only fund his healthcare bill, but to shrink the gap of income inequality in America. It must be noted that the current Medicare plan often relies on enrollees signing up for a “Part C” option which works like a supplemental insurance plan. This is likely to be eliminated under Sanders’ plan which will reduce the cost of healthcare substantially for the enrollee. Medicare is currently financed by a “pay as you go” system, where current workers pay for older Americans entering retirement. The other parts of Medicare are financed by federal tax revenues, which cover 75% of Part B (physician, outpatient care) and 75% of Part D (drug prescriptions). According to a recent study, over 40% of Medicare is financed by taxpayers. If Medicare expands into a universal system as Sanders proposes, it will likely result in an increase of medical costs that could trickle into higher payroll taxes. People would indeed pay more taxes, but likely less for their healthcare. For an individual, cost sharing is more than likely to go down under this plan, with a decrease in deductibles and copayments. Additionally, with the likelihood of physicians being paid less and crackdowns on the “Fee for Service system”, patients will not be forced into paying out of pocket for supplemental procedural needs. Quality of care will go up for most individuals, and less unnecessary, pricey x-rays will be ordered.
Without this increase in taxes, components of the healthcare coverage would inevitably have to be cut. This includes public health programs, hospital spending, etc. Medicare for All seeks to eliminate the loopholes in the current healthcare system by insuring coverage to everyone. Sanders often refers to the European healthcare systems and how they are successful with their adoption of universal, single-payer coverage. He is undoubtedly right, as their healthcare spending is dramatically less, and the average individual has a multitude of affordable options in front of them when in need of medical care. On average, other wealthy countries spend about half as much per person on health than the United States spends2. It will be interesting to see how large biotech and pharmaceutical companies will respond to a Medicare for All policy. They will not be as willing to surrender their profits and allow the government to be the big single payer within the system.
Massachusetts Senator Elizabeth Warren has also been extremely vocal about Medicare for All. Although media and news outlets tend to describe the candidate’s “Medicare for All” policy as a replication of Senator Sanders’ proposal, Warren’s plan has distinctive features. One unique driving force of Warren’s plan is a proposed bill titled “The Affordable Drug Manufacturing Act”3. This bill places responsibility on the federal government to step in and manufacture generic drugs when prices have dramatically spiked or if there is a shortage of supply. This may prove to be pivotal in regulating the price of drugs like insulin, which is currently produced by just a few companies worldwide. Nevertheless, it gives any individual a chance for receiving their necessary prescription generic or non-generic drugs if it happens to be pulled off.
Another extremely unique component of Warren’s plan is a potential “Behavioral Health Coverage Transparency Act”, which would hold insurance companies accountable for providing adequate mental health benefits. This bill is extremely flexible and can be applied under nearly any payer system. Any insurance plan can be mandated to implement mental health coverage, which would shift the conversation of healthcare towards the individual and alleviate mental health problems that are not nearly discussed enough in current debates. Additionally, Warren’s proposed “Care Act” seeks to fight America’s opioid crisis through federal funding that would support access to medication-based treatment, public health centers, and preventative and rehabilitative care.
A lot of talk in recent months has been centered around where the funding for these acts and plans would exactly come from. Although Warren is still working on releasing an official bill outlining the budget, her proposals target highly specific and underrated elements of what healthcare means in the United States. Hitting these points would make vital differences in the day-to-day lives of individuals who are being stripped of necessary prescription drugs, mental health care, or proper rehabilitative aid.
Senator Kamala Harris has pledged her support of Medicare for All in the past. However, Senator Harris’ full-fledged healthcare proposal includes some noteworthy variations. For one, her bill would still include small private insurers playing a role within the Medicare for All system. Another distinction of her healthcare bill is the 10-year transition period needed to cover all Americans under this policy, while Senator Sanders’ calls for only a 4-year period. Many critics deem a 10-year plan too slow and not urgent enough in solving many of the country’s healthcare problems. Harris sticks to her claim that current Medicaid and public option enrollees will slowly transition into the Medicare for All plan she offers in order to keep the burden on American taxpayers low.
Harris ensures the government will regulate the private market that has been in the crosshairs of public scrutiny, but many analysts say this will be far more difficult than the Senator from California suggests. For instance, physicians are paid over 48% less by Medicaid than by the private insurers, on average4. This results in many providers not accepting new Medicaid or subsidized insurance plans. In 2013, only 6% of physicians accepted new Medicaid patients in Minnesota. These numbers may cause individuals currently on public options to have low belief in the plan if it takes over 10 years. On the other hand, Harris promises that at the end of the 10-year period certain beneficiaries like seniors will “see stronger Medicare benefits than they have now.” In reality, individuals may actually be forced to play succumb to the soaring prices of private insurers if they are not eligible or cannot successfully register for the public option of Medicare for All that Harris offers. Upregulating the big pharmaceutical and biotech companies would have to be essential in leveling out the playing field between them and the proposed public option.