Proposals to expand access to public health insurance put forward by several high-profile Democrats all aim to increase access to affordable coverage, but specifics vary widely, according to a new paper by the American Academy of Actuaries' Health Practice Council.
The academy looked at four general proposals: a government-facilitated or administered plan in the Affordable Care Act exchanges, a Medicaid buy-in, a Medicare buy-in and a Medicare for all, or more, option.
Candidates like Sens. Kamala Harris, D-Calif., and Bernie Sanders, I-Vt., support a single-payer system. Sen. Amy Klobuchar, D-Minn., backs a more modest Medicaid buy-in proposal. Klobuchar said a larger Medicare for all proposal could be explored down the road, but Medicaid buy-in is something that can take shape now.
Democrats successfully batted away the repeal-and-replace movement by Republicans in 2017. Now back in control of the House, the party is pushing progressive ways to reshape America's healthcare system. Underlining the plans is the notion that the government needs to help improve access to health insurance and lower costs to Americans.
Academy Senior Health Fellow Cori Uccello, the lead author of the paper, said the health insurance expansion proposals have different implications for consumers, taxpayers, payers, employers and providers.
Medicare for all is the catch-all that presidential candidates are using, but the term means quite different approaches depending on the proposal. Huge differences exist between a plan that expands Medicaid or Medicare coverage and one that ends private health insurance.
A more modest proposal would cost less, but also limit who's covered. A new universal single-payer system would cover everyone, but comes at a much higher cost and larger impact on every part of healthcare, including on individuals, payers, providers and hospitals.
The report said design features are needed to evaluate each proposal properly. These specifics include eligibility, whether the plan would create a single-payer system with no private insurance or supplement private plans that work with private payers, who's eligible and cost-sharing requirements.
A recent proposal gained the signatures of more than 100 Democratic lawmakers. Rep. Pramila Jayapal, D-Wash., introduced a bill proposing a universal system.
Jayapal's proposal would provide a public health insurance system. The program wouldn't charge copays, premiums or deductibles. But the proposal doesn't offer specifics of how to pay for the plan and what it would mean for provider reimbursements.
Providers are already taking up arms against any expanded public health plan. Since Medicare and Medicaid tend to pay less than private payers, more government reimbursement would mean less money in hospitals' coffers.
And the proposals have little hope of garnering backing from Republicans.
Despite that opposition, a recent Kaiser Family Foundation study found that 56% of Americans said they back a Medicare for all plan and 42% opposed the idea. That said, support for Medicare for all dips once Americans are told it would require higher taxes and could mean the end of private insurance.