by Jordan Roberts
Director of Government Affairs, John Locke Foundation
Last week, representatives of the U.S. House introduced competing bills on healthcare.
On the Democratic side, Rep. Pramila Jayapal introduced what she calls a “very different” Medicare-for-All bill than previous versions introduced by Senator Bernie Sanders. The bill would overhaul the U.S. healthcare system by implementing a single-payer model and eliminate the majority of private insurance.
What is different about this bill compared to Senator Sanders’ bill is that among other things, it would implement the disruptive changes within two years compared to four years. Also, the bill would provide more benefits such as long term care, no out-of-pocket spending on prescriptions, and provide assistance for those who lose their jobs as a result of Medicare for all. These additional elements of the bill will no doubt make the price tag higher than previous estimates.
Here is a small description of how the logistics of such a plan would work:
The Health and Human Services secretary would set a national health budget to cover operating costs, capital expenditures, and administrative costs. To assist workers affected by the overhaul, 1 percent of that budget for the first five years would support assistance like wage replacement or job training.
It would also change how doctors and hospitals are paid. Institutional providers like hospitals or skilled nursing facilities would be paid through a global budget, so that hospitals would receive a quarterly lump sum to cover items and services. Individual providers would be paid based on a national fee schedule set by the HHS secretary. The bill would bar providers from using those funds for activities like marketing, increasing their profits or political activity. Providers would submit applications for capital expenditures.
This bill would demolish any potential benefits that could arise from private enterprise in the healthcare industry. Do we want this much government control over the entire provision of American healthcare?
On the other side of the aisle, Republican Rep. Bruce Westerman introduced a bill that took elements from several different proposals introduced previously. This bill is based on the notion that the ACA is unlikely to be repealed and would instead seek to sure up the exchanges by increasing the amount of funding, as well as change the way the subsidies can be used in state exchanges. Here is a brief description of the bill:
Westerman’s plan would keep the Obamacare exchanges, through which people buy private health insurance. And it would provide for states to expand the exchanges so that low-income people currently on Medicaid who do not have a disability will also use the private market. That change would be achieved by letting states take Medicaid as a block grant and using that money to pay to subsidize people on the exchange…
…The bill would also reauthorize cost-sharing reduction subsidies Trump ended in 2017 that help pay for out-of-pocket medical expenses for low-income people and estate “copper plans” that have low premiums and higher deductibles. Both provisions were part of the stabilization efforts the Senate had worked on.
The reality is very few individuals in Congress can completely agree on where the healthcare system should go. Both Republican and Democratic caucuses are not in agreement on the path forward. However, while Republicans are in agreement that a single-payer system is not the answer, there is not the same cohesion for a Democratic position on the idea. As calls for a single-payer system grow louder, Democrats may have a harder time convincing more moderate members of their own party to go along with such a plan.