Medicare for All Act

Last updated

Medicare for All Act of 2021
Medicare for All Act of 2022
Great Seal of the United States (obverse).svg
Long titleTo establish an improved Medicare for All national health insurance program.
Announced inthe 117th United States Congress
Number of co-sponsors121
Legislative history

The Medicare for All Act (abbreviated M4A), also known as the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with 38 co-sponsors. [1] [2] In 2019, the original 16-year-old proposal was renumbered, and Pramila Jayapal (D-WA) introduced a broadly similar, but more detailed, bill, [3] HR 1384, in the 116th Congress. [4] As of November 3,2019, it had 116 co-sponsors still in the House at the time, or 49.8% of House Democrats. [5]

Contents

The act would establish a universal single-payer national health insurance system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for private health insurance and premiums, and re-casting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventive universal health care and the elimination of insurance company overhead and hospital billing costs. [6]

On September 13, 2017, Senator Bernie Sanders (I-VT) introduced a parallel bill in the United States Senate, with 16 co-sponsors. [7] [8] [9] The act would establish a universal single-payer health care system in the United States. [6]

Provisions

The laws proposed are not necessarily identical year-over-year.

John Conyers' bill

The summary of the National Health Care Act as proposed in the 111th Congress (2009–2010) includes the following elements, among others: [10]

  1. Expands the Medicare program to provide all individuals residing in the 50 states, Washington, D.C., Puerto Rico, and territories of the United States with tax-funded health care that includes all medically necessary care. That would include primary and preventive care, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
  2. Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate. On the whole, private insurance would be replaced with the new nationalized system for all basic, major care.
  3. Gives patients the freedom to choose from participating physicians and institutions, which, given the coverage of the new national system, would be any institution or clinic in the United States receiving any degree of public funding (the vast majority).
  4. Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows the private insurers to sell benefits not medically necessary, such as cosmetic surgery benefits.
  5. Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
  6. Establishes the USNHC Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% of income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions. Transfers and appropriates amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the State Children's Health Insurance Program. Taxes would be paid instead of insurance premiums, as the government (instead of private insurance companies) would be paying for the care under the single-payer health care.
  7. Establishes a program to assist individuals whose jobs are eliminated (such as within insurance companies) by the simplified single-payer administrative process.
  8. Requires creation of a confidential electronic patient record system.
  9. Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
  10. Provides for the eventual integration of the Indian Health Service into the Program and evaluation of the continued independence of Department of Veterans Affairs (VA) health programs.
  11. The bill covers treatments starting on the first day of the year that follows one year after the date of passage.
  12. Compensation continues for 15 years to owners of converting for-profit providers for reasonable financial losses.

Pramila Jayapal's bill

Pramila Jayapal's Medicare for All Act of 2019, introduced in the House is broadly similar but more detailed [3] than the original Conyers proposal, but the "parallel" proposal by Sanders has significant differences, including a "global budget" system for hospitals. [11] Both proposals contain expansive coverage including long-term care and dental care with no cost-sharing such as coinsurance, deductibles, or premiums, which as of 2019 is unprecedented in the world. [12]

Under the House version, funding for institutions such as hospitals would be negotiated with regional directors, while individual providers would be paid a fee-for-service. [13] Value-based pay for performance incentives would not be allowed. [13] HHS would have administrative authority to set various details. [13]

The Senate proposal sets out a four-year transition plan and the House proposal is two years. [14]

As of April 2019, the Senate proposal did not include details on how to completely pay for the plan, but Sanders had released a paper listing ideas. [15] [16]

Legislative history

As of 13 December 2022:

CongressShort titleBill number(s)Date introducedSponsor(s)# of cosponsorsLatest status
108th Congress Expanded and Improved Medicare for All Act of 2003 H.R. 676 February 12, 2003 John Conyers

(D-MI)

38Died in Committee
109th Congress Expanded and Improved Medicare for All Act of 2005 H.R. 676 February 8, 2005 John Conyers

(D-MI)

78Died in Committee
110th Congress United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) of 2007 H.R. 676 January 24, 2007 John Conyers

(D-MI)

93Died in Committee
111th Congress Expanded and Improved Medicare for All Act of 2009 H.R. 676 January 26, 2009 John Conyers

(D-MI)

87Died in Committee
112th Congress Expanded and Improved Medicare for All Act of 2011 H.R. 676 February 11, 2011 John Conyers

(D-MI)

77Died in Committee
113th Congress Expanded and Improved Medicare for All Act of 2013 H.R. 676 February 13, 2013 John Conyers

(D-MI)

63Died in Committee
114th Congress Expanded and Improved Medicare for All Act of 2015 H.R. 676 February 3, 2015 John Conyers

(D-MI)

62Died in Committee
115th Congress Expanded and Improved Medicare for All Act of 2017 H.R. 676 January 24, 2017 John Conyers

(D-MI)

124Died in Committee
S. 1804 September 13, 2017 Bernie Sanders

(I-VT)

16Died in Committee
116th Congress Medicare for All Act of 2019 H.R. 1384 February 27, 2019 Pramila Jayapal

(D-WA)

118Died in Committee
S. 1129 April 10, 2019 Bernie Sanders

(I-VT)

14Died in Committee
117th Congress Medicare for All Act of 2021 H.R. 1976 March 17, 2021 Pramila Jayapal

(D-WA)

122Died in Committee
Medicare for All Act of 2022 S. 4204 May 12, 2022 Bernie Sanders

(I-VT)

14Died in Committee
118th Congress Medicare for All Act of 2023 H.R. 3421 May 17, 2023 Pramila Jayapal

(D-WA)

113Referred to Committees of Jurisdiction
S.1655 May 17, 2023 Bernie Sanders

(I-VT)

14Referred to Committees of Jurisdiction

Analysis

An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year. [17] Others have estimated a long-term savings amounting to 40% of all national health expenditures due to the extended preventive healthcare and the elimination of insurance company overhead costs. [18]

A study estimated the 1999 costs of U.S. health care administration at nearly $300 billion, accounting for 30.1% of health care expenses, versus 16.7% in Canada. This study estimated the U.S. per-person administrative cost at $1,059. [19]

Charles Blahouse, who worked as George W. Bush's economic advisor and as a public trustee for medicare and social security, wrote a Mercatus Center study of the 2017 proposal [20] It claims that Sanders' M4A plan will increase federal spending by at least $32 trillion (this money is currently going to private healthcare) but that the savings on administrative and other costs could save $2 trillion in healthcare costs. However, Blahouse stresses that these savings rely on multiple generous assumptions and that the plan will likely cost significantly more.

A 2019 analysis was critical of Sanders' bill for allowing accountable care organizations and failing to include a provision to negotiate budgets with hospitals. [21]

According to a 2020 study in The Lancet, the Medicare for All Act was estimated to save 13% in national health-care expenditure (equivalent to more than US$450 billion annually), and save more than 68,500 lives every year. [22]

See also

Other countries

Related Research Articles

<span class="mw-page-title-main">Medicare (United States)</span> U.S. government health insurance for the old and disabled

Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.

<span class="mw-page-title-main">Congressional Progressive Caucus</span> Caucus within the Democratic congressional caucus in the United States Congress

The Congressional Progressive Caucus (CPC) is a congressional caucus affiliated with the Democratic Party in the United States Congress. The CPC represents the furthest left-leaning faction of the Democratic Party. It was founded in 1991 and has grown since then, becoming the largest Democratic caucus in the House of Representatives.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system.

The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

Health care prices in the United States of America describe market and non-market factors that determine pricing, along with possible causes as to why prices are higher than in other countries.

Physicians for a National Health Program (PNHP) is an advocacy organization of more than 20,000 American physicians, medical students, and health professionals that supports a universal, comprehensive single-payer national health insurance program. Since being co-founded in 1987 by physicians David Himmelstein and Steffie Woolhandler, PNHP has advocated for reform in the U.S. health care system.

The Healthy Americans Act(HAA), also known as the Wyden-Bennett Act, is a Senate bill that had proposed to improve health care in the United States, with changes that included the establishment of universal health care. It would transition away from employer-provided health insurance, to employer-subsidized insurance, having instead individuals choose their health care plan from state-approved private insurers. It sought to make the cost of health insurance more transparent to consumers, with the expectation being that this would increase market pressures to drive health insurance costs down. The proposal created a system that would be paid for by both public and private contributions. It would establish Healthy Americans Private Insurance Plans (HAPIs) and require those who do not already have health insurance coverage, and who do not oppose health insurance on religious grounds, to enroll themselves and their children in a HAPI. According to its sponsors, it would guarantee universal, affordable, comprehensive, portable, high-quality, private health coverage that is as good or better than Members of Congress have today; A 2008 preliminary analysis by the Congressional Budget Office concluded it would be "essentially" self-financing in the first year that it was fully implemented.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

The history of health care reform in the United States has spanned many decades with health care reform having been the subject of political debate since the early part of the 20th century. Recent reforms remain an active political issue. Alternative reform proposals were offered by both of the major candidates in the 2008, 2016, and 2020 presidential elections.

The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.

The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the United States. The public option is not the same as publicly funded health care, but was proposed as an alternative health insurance plan offered by the government. The public option was initially proposed for the Patient Protection and Affordable Care Act, but was removed after independent Connecticut senator Joe Lieberman threatened a filibuster.

There were a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.

<span class="mw-page-title-main">Affordable Care Act</span> U.S. federal statute also known as Obamacare

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.

Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.

All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. It can be used to increase the market power of payers versus providers, such as hospital systems, in order to control costs. All-payer characteristics are found in most developed economies with multi-payer healthcare systems, including France, Germany, Japan, and the Netherlands. The U.S. state of Maryland also uses such a model.

This article summarizes healthcare in California.

<span class="mw-page-title-main">Elijah Cummings Lower Drug Costs Now Act</span> Proposed legislation

The Elijah Cummings Lower Drug Costs Now Act is proposed legislation in the 117th United States Congress. The bill is designed to lower prescription drug costs in the United States. Notably, the law gives the federal government the power to negotiate prescription drug prices. The legislation takes the name of late Maryland Representative Elijah Cummings.

<span class="mw-page-title-main">Whole Washington</span> Healthcare advocacy organization

Whole Washington is a statewide universal healthcare advocacy organization in Washington state that advocates for universal single-payer healthcare for Washington and the United States of America. Whole Washington is a 501(c)(4) organization and has campaigns for statewide single payer healthcare in Washington via both the state legislature and statewide ballot initiative. It is also a supporter of single payer at the federal level through Medicare for All as introduced into the US Congress by Pramila Jayapal in the House of Representatives and Bernie Sanders in the Senate.

References

  1. ↑ H.R. 676
  2. ↑ "House Reps Introduce Medicare-for-All Bill" Becker's Hospital Review, Feb. 14, 2013
  3. 1 2 "Medicare for All bill loses its special number". Modern Healthcare. February 2, 2019. Retrieved June 17, 2019.
  4. ↑ "Dingell, Jayapal and more than 100 Co-Sponsors Introduce Medicare For All Act of 2019". U.S. Representative Debbie Dingell. February 27, 2019. Retrieved June 18, 2019.
  5. ↑ "H.R.1384 - Medicare for All Act of 2019". U.S. Congress. Retrieved November 3, 2019.
  6. 1 2 Krugman, Paul (June 13, 2005). "One Nation, Uninsured". The New York Times. Retrieved December 4, 2011.
  7. ↑ "Bernie Sanders to Sponsor Single-Payer Healthcare Bill". Newsweek. March 26, 2017.
  8. ↑ RoseAnn DeMoro [@RoseAnnDeMoro] (September 13, 2017). ".@BernieSanders shouts out the Democrats that did the right thing in supporting #MedicareForAll. #WednesdayWisdom" (Tweet). Retrieved September 13, 2017– via Twitter.
  9. ↑ "115th United States Congress". U.S. Congress. 2017–2018.
  10. ↑ "United States National Health Care Act – Summary". U.S. Congress. Retrieved December 4, 2011.
  11. ↑ Keith, Katie (2019). "Unpacking The House Medicare-For-All Bill". Health Affairs. doi:10.1377/forefront.20190302.150578.
  12. ↑ Wilensky, Gail R. (April 29, 2019). "Medicare for All". The Milbank Quarterly. 97 (2): 391–394. doi:10.1111/1468-0009.12389. PMC   6554505 . PMID   31033020.
  13. 1 2 3 Foley, Jonathan (2019). "Taking Medicare For All Seriously". Health Affairs. doi:10.1377/forefront.20190606.959973.
  14. ↑ Klein, Ezra (February 28, 2019). "Pramila Jayapal Thinks We Can Get to Medicare-for-all Fast". Archived from the original on February 28, 2019. Retrieved March 4, 2019.
  15. ↑ Kliff, Sarah (April 10, 2019). "Bernie Sanders's Medicare-for-all plan, explained". Vox. Retrieved June 18, 2019.
  16. ↑ "OPTIONS TO FINANCE MEDICARE FOR ALL".
  17. ↑ Physicians for a National Health Program (2008) "Single Payer System Cost?" Archived December 6, 2010, at the Wayback Machine
  18. ↑ Hogg, W.; Baskerville, N; Lemelin, J (2005). "Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis". BMC Health Services Research. 5 (1): 20. doi: 10.1186/1472-6963-5-20 . PMC   1079830 . PMID   15755330.
  19. ↑ "Research Report-Harvard & Canadian Institute for Health Information-Costs of Healthcare Administration in the U.S. and Canada 2003" (PDF). Retrieved December 4, 2011.
  20. ↑ Blahous, Charles (July 30, 2018). "The Costs of a National Single-Payer Healthcare System". Mercatus Research Paper. Rochester, NY: Mercatus Center. SSRN   3232864.
  21. ↑ scripthacker (April 23, 2019). "Rep Jayapal and Sen Sanders Have Introduced Medicare For All Bills: One Is a Lot Better Than the Other". the deductible. Retrieved June 17, 2019.
  22. ↑ Galvani, Alison P.; Parpia, Alyssa S.; Foster, Eric M.; Singer, Burton H.; Fitzpatrick, Meagan C. (February 15, 2020). "Improving the prognosis of health care in the USA". The Lancet. 395 (10223): 524–533. doi:10.1016/S0140-6736(19)33019-3. ISSN   0140-6736. PMC   8572548 . PMID   32061298. S2CID   211105345.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.