Healthcare Coverage for All

The critical issue with comprehensive health insurance for all at least from my perspective is the eventual goal.  Based on my experience and knowledge of the literature a Medicare For All model that allows a buy-in for those who need health care while keeping the current private health insurance options in place seems most viable.  With this model, the current successful Medicare model would be a phased-in by first reducing the age for eligibility to 50. The proposal is similar to a new proposal Medicare X. Lowering the entitlement should also offset some of the high-cost insurance programs for those not currently eligible for health subsidies. The percentage of the population between 50 and 65 have more health needs thus forcing the private insurance market to raise the premiums to cover their financial risks.  One of the Affordable Care Act “Achilles heel” particularly for individuals living in rural areas is the lack of any financial support for premiums for those not eligible for subsidies.  In addition to lowering the Medicare eligibility to 50, another viable option is to create a reinsurance pool.  The pool would cover a portion of the claims insurers face which means the overall premiums can be decreased because there are lower claims for the insurers.  The program Minnesota Health Insurance Program has worked well in Minnesota and in Alaska who has a similar plan.  While participation in having insurance with coverage currently required with Medicare such would be mandatory. Individuals could purchase private insurance plans if so desired.  There would be a tax penalty for those who do not have any insurance.  The health tax would provide a fund for health care providers to supplement bad debts.

The Medicaid expansion options would continue as would the Children Health Insurance Program.  The patient would still choose his/her provider as now done with Medicare.  The 20% co-payment would remain so a requirement for secondary privately funded insurance would be needed.  The Center for Medicare and Medicaid would have authority to negotiate pharmaceutical costs.  Current provisions such as Prospective Payment System, Medicare Hosptial Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Prospective Payment System, Valued Based Programs,  and Alternatives to Nursing Homes would be strengthened.  While participation would be mandatory individuals could purchase private insurance plans if so desired.  There would be a tax penalty for those who do not have any insurance.  The health tax would provide a fund for health care providers to supplement bad debts.

The outlook for any of these changes except the Minnesota option which is state funded is slim as long as there is a Republican control Senate and White House.  Thus, the 2020 elections will largely determine how the reality of healthcare for all will be manifested.